Introduction:
Children with craniofacial syndromes are known to have a high prevalence of sleep disordered breathing (SDB) often of multifactorial aetiology, which can be severe and often requires multi-disciplinary management. Mid-face advancement with distraction can correct both aesthetic form and respiratory function. We assessed outcomes for all patients underwent mid-face distraction at the Auckland Craniofacial Unit.
Methods:
Restrospective audit was performed for surgical and respiratory outcomes of patients in our unit who had mid-face distraction (either Le Fort III or monobloc frontofacial advancement). Respiratory statuses in term of underlying sleep disordered breathing and the need for respiratory supports were compared pre-operatively and post-operatively.
Results:
Twenty-three patients had mid-face advancement with osteotomy and distraction using a rigid external distraction frame. Twenty patients had Le Fort III osteotomy and three had monobloc frontofacial osteotomy. Median age was 10 years at operation. Mean surgical time was 230 minutes, with an average inpatient stay of 19 days. Average latency period was 3 days, with duration of active distraction averaged slightly over 2 weeks, while average consolidation period was 50 days. Nine patients had minor post-operative complications but no one had failed to complete the distraction process. Around half of these patients had further aesthetic procedure post-operatively. Subgroup cohort analysis of respiratory outcomes had suggested improvement of SDB status in about half of our patients. Two patients had no post-operative improvement, requiring ongoing respiratory support.
Conclusion:
Mid-face advancement with distraction can result in improvement of respiratory status, as well as improving the obvious aesthetic appearance for patients with craniofacial dysostosis. While complete resolution of SDB could not be achieved in all, distraction enabled some to discontinue respiratory support. The incomplete data and variable input from multidisciplinary services supports consideration to a formalized multidisciplinary management approach.