J Oral Maxillofac Surg 2019 Mar 26. Epub 2019 Mar 26.
Associate Professor, Dutch Craniofacial Center, Department of Oral and Maxillofacial Surgery, Erasmus University Hospital, Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands; Craniofacial Unit, Great Ormond Street Hospital, London, UK; Craniofacial Center, Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA.
Purpose: Obstructive sleep apnea (OSA) is a common problem in patients with craniofacial microsomia (CFM); however, the exact pathophysiology in patients with CFM remains unclear. The first aim of this study was to evaluate upper airway volume and morphology in patients with CFM. The second aim was to identify risk factors for the presence of OSA.
Materials And Methods: A cross-sectional study was set up and 3 study groups were identified: 1) CFM with OSA, 2) CFM without OSA, and 3) control. Computed tomographic (CT) scans of the head and neck were included and used to create 3-dimensional models. The age-matched control group consisted of patients evaluated for traumatic head injury or epilepsy. Volumetric and morphologic parameters were measured. The results of patients with CFM were compared among the 3 study groups. Descriptive statistics were computed using the Pearson χ test for categorical variables and nonparametric tests for continuous variables. A multiple variable regression model was used to identify risk factors for OSA.
Results: In total, 79 patients with CFM were included, of which 25 patients were diagnosed with OSA. A total of 145 CT scans could be analyzed. In addition, a control population of 88 patients was identified. Oropharynx volume, mean cross-sectional area (CSA), minimal CSA, and minimal retropalatal area were found to be markedly smaller in patients with CFM compared with the control population. In contrast, in patients with CFM and OSA, minimal retroglossal area, sphericity, and uniformity markedly differed from those in patients without OSA. Sphericity was identified as the main predicting variable of OSA in patients with CFM.
Conclusions: The upper airway of patients with CFM is markedly smaller and puts them at risk for developing OSA. Patients with CFM diagnosed with OSA have a markedly smaller CSA behind the base of the tongue and a difference in sphericity.