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Airway Analysis in Apert Syndrome

Forte, Antonio J. M.D., Ph.D.; Lu, Xiaona M.D.; Hashim, Peter W. M.D.; Steinbacher, Derek M. M.D., D.M.D.; Alperovich, Michael M.D.; Persing, John A. M.D.; Alonso, Nivaldo M.D., Ph.D.

Plastic and Reconstructive Surgery: September 2019 - Volume 144 - Issue 3 - p 704-709
doi: 10.1097/PRS.0000000000005937
Pediatric/Craniofacial: Ideas and Innovations

Background: Apert syndrome is frequently combined with respiratory insufficiency, because of the midfacial deformity which, in turn, is influenced by the malformation of the skull base. Respiratory impairment resulting from Apert syndrome is caused by multilevel limitations in airway space. Therefore, this study evaluated the segmented nasopharyngeal and laryngopharyngeal anatomy to clarify subcranial anatomy in children with Apert syndrome and its relevance to clinical management.

Methods: Twenty-seven patients (Apert syndrome, n = 10; control, n = 17) were included. All of the computed tomographic scans were obtained from the patients preoperatively, and no patient had confounding disease comorbidity. Computed tomographic scans were analyzed using Surgicase CMF. Craniometric data relating to the midface, airway, and subcranial structures were collected. Statistical significance was determined using t test analysis.

Results: Although all of the nasal measurements were consistent with those of the controls, the nasion-to–posterior nasal spine, sphenethmoid-to–posterior nasal spine, sella-to–posterior nasal spine, and basion-to–posterior nasal spine distances were decreased 20 (p < 0.001), 23 (p = 0.001), 29 (p < 0.001), and 22 percent (p < 0.001), respectively. The distance between bilateral gonions and condylions was decreased 17 (p = 0.017) and 18 percent (p = 0.004), respectively. The pharyngeal airway volume was reduced by 40 percent (p = 0.01).

Conclusion: The airway compromise seen in patients with Apert syndrome is attributable more to the pharyngeal region than to the nasal cavity, with a gradually worsening trend from the anterior to the posterior airway, resulting in a significantly reduced volume in the hypopharynx.

Jacksonville, Fla.; Beijing, People’s Republic of China; New Haven, Conn.; and São Paulo, Brazil

From the Division of Plastic Surgery, Mayo Clinic; the Chinese Academy of Medical Sciences, Peking Union Medical College, Plastic Surgery Hospital; the Division of Plastic and Reconstructive Surgery, Yale School of Medicine; and the Department of Plastic Surgery, University of São Paulo.

Received for publication August 3, 2018; accepted February 6, 2019.

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

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John A. Persing, M.D., Section of Plastic and Reconstructive Surgery, Yale School of Medicine, 330 Cedar Street, 3rd Floor Boardman Building, New Haven, Conn. 06520,

Copyright © 2019 by the American Society of Plastic Surgeons