Functional outcomes in patients with facial dysostosis and severe upper airway obstruction |
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Authors: | P.P.J.M. van der Plas S. Yang M. Streppel B. Pullens S.L. Versnel M.J. Koudstaal E.B. Wolvius I.M.J. Mathijssen K.F.M. Joosten |
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Affiliation: | 1. Department of Oral and Maxillofacial Surgery, Sophia Children’s Hospital – Erasmus Medical Centre, Rotterdam, The Netherlands;2. Department of Plastic, Reconstructive and Hand Surgery, Sophia Children’s Hospital – Erasmus Medical Centre, Rotterdam, The Netherlands;3. Department of Otorhinolaryngology, Sophia Children’s Hospital – Erasmus Medical Centre, Rotterdam, The Netherlands;4. Department of Paediatric Intensive Care, Sophia Children’s Hospital – Erasmus Medical Centre, Rotterdam, The Netherlands |
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Abstract: | An increased risk of upper airway obstruction (UAO) is seen in up to 95% of patients with facial dysostosis. Secondary to respiratory problems are feeding difficulties and increased nutritional requirements. Little has been described regarding these outcomes in this patient population. Hence, a retrospective cohort study was performed to gather data on functional outcomes. Eighteen patients with facial dysostosis and severe UAO were included. The median follow-up time was 3.42 years. A tracheostomy tube was placed in 13 patients, of whom 10 subsequently underwent mandibular distraction. Three of the five patients without a tracheostomy underwent mandibular distraction as the primary surgical treatment; the remaining two patients were treated conservatively with oxygen supplementation. At presentation, 13 patients had feeding difficulties. Overall malnutrition was present in 16 patients during follow-up. At the end of follow-up, severe UAO was present in 12 patients, feeding difficulties in seven patients, and malnutrition in four patients, while two patients died. In conclusion, patients with facial dysostosis have a high prevalence of severe UAO, feeding difficulties, and malnutrition. Importantly, mandibular distraction has limited success in treating severe UAO in these patients. Close follow-up by a specialized craniofacial team is of paramount importance to manage the long-term consequences. |
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Keywords: | mandibulofacial dysostosis Treacher Collins syndrome tracheostomy distraction osteogenesis obstructive sleep apnoea nutritional status enteral nutrition |
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