Midfacial advancement in patients affected by obstructive sleep apnea syndrome: polysomnographic and cephalometric evaluation

Objectives: We evaluated the correlation between the skeletal facial advancement through Le Fort III osteotomy and the modification of polysomnographic values in syndromic patients with sleep respiratory disorders affected by craniofacial synostosis. Methods: We selected a sample of 17 patients affected bymild to severe OSAS. All patients underwent a Le Fort III osteotomy. In five cases we used the “classical technique” and in 12 cases distraction osteogenesis. Sleep respiratory disorders were evaluated by pre-op and post-op polysomnography. All patients had pre-op and post-op cephalometric records. Results: The average midface advancement was 16mm (10–28mm)measured at A point. The average pre-op polysomnographic records were: ODI 28.6 (8–75), AHI 23.2 (8–50). The average post-op polysomnographic records were: ODI 3.88 (0.3–7), AHI 4.14 (0.2–3). In one tracheostomized patient we removed the tracheostomy and one patient with CPAP stopped the treatment. Conclusions: The respiratory disorders in syndromic patients with midfacial hypoplasia have different clinical manifestation: from snoring to acute respiratory distress requiring tracheostomy. Our study demonstrates an improvement of polysomnographic values in all patients, with a shift from severe to mild OSAS or even a complete resolution.