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Reduced Three-Dimensional Nasal Airway Volume in Treacher Collins Syndrome and Its Association with Craniofacial Morphology

Ma, Xiaoyang M.D.; Forte, Antonio Jorge M.D.; Berlin, Nicholas Lee M.P.H.; Alonso, Nivaldo M.D., Ph.D.; Persing, John A. M.D.; Steinbacher, Dereck Matthew M.D., D.M.D.

Plastic and Reconstructive Surgery: May 2015 - Volume 135 - Issue 5 - p 885e–894e
doi: 10.1097/PRS.0000000000001160
Pediatric/Craniofacial: Original Articles

Background: Airway insufficiency decreases quality of life and may be life threatening in patients with Treacher Collins syndrome. The authors calculated the three-dimensional nasal airway volume in patients with Treacher Collins syndrome to identify correlations between nasal airway volume and craniofacial morphology and provide guidance for surgical planning.

Methods: Thirty nonoperated patients with Treacher Collins syndrome were compared with 35 unaffected age- and gender-matched controls. Anatomic variables of the cranial base, the maxilla complex, and internal diameters of nasal airway were compared between patients and control subjects using three-dimensional craniometric analyses. In the Treacher Collins group, the relation of craniofacial morphology to nasal airway volume was assessed separately. Statistical analyses were performed using independent sample t tests and Pearson correlation coefficient analyses.

Results: Nasal airway volume was decreased 38.6 percent in patients with Treacher Collins syndrome relative to controls (p = 0.001). A positive correlation of maxillary position and nasal airway volume was shown in Treacher Collins patients (r = +0.463, p = 0.013). Maxillary, nasal bone, and orbitale width were also positively correlated with nasal airway volume (r = +0.582, p = 0.001; r = +0.408, p = 0.035; and r = +0.677, p < 0.001, respectively). Shortened internal diameters of the nasal airway all positively correlated with nasal airway volume.

Conclusions: Nasal airway volume is reduced in patients with Treacher Collins syndrome. Reduced projection of the maxilla and transverse maxillary deficiency are correlated with reduced nasal airway volume and are primarily responsible for obstruction of the nasal airway.


New Haven, Conn.; Beijing, China; and São Paulo, Brazil

From the Section of Plastic and Reconstructive Surgery at Yale University School of Medicine; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, and Department of Plastic Surgery, Peking Medical College; Yale University School of Public Health; and Department of Plastic and Reconstructive Surgery, University of São Paulo.

Received for publication August 13, 2014; accepted October 24, 2014.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

John A. Persing, M.D., 333 Cedar Street, Boardman Building, Third Floor, New Haven, Conn. 06520,

©2015American Society of Plastic Surgeons