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Purpose:Lefort III distraction is an effective tool to address midface hypoplasia and obstructive sleep apnea in syndromic patients[1]. Conventional osteotomies require extensive dissection and devascularization of the segments. This may affect stability, growth and lead to increased morbidity. The authors report a minimally invasive approach with transconjunctival osteotomies and external rigid distractors to minimize morbidity , improve stability and airway patency in a syndromic population.
Materials and Methods:From 2004 to 2013, 12 syndromic patients with proven obstructive sleep apnea and failed conservative management underwent Lefort III osteotomies through extended transconjunctival and 1 cm vestibular incisions. Ages ranged from 3-15 yrs. Osteotomies were performed with the Sonopet Ultrasonic Aspirator (Stryker) and subsequent rigid external device (KLS-Martin) fixation. Distraction was performed at 2 mm a day and discontinued when airway was deemed improved by direct microlaryngoscopy. Linear bone movements were measured by weekly cephalographs.
Results:2-D cephalometrics were used to assess pre-operative and post-operative midface movement up to 2 years following surgery. The average pre and post-operative posterior airway space (PAS) increase in distance is 8.99+ 5.4 mm (43.5 %). The average pre and post-operative menton to hyoid (Me-Hy) increase in distance was 19.72 + 9.8 mm (47.9%). The average SNA angle increase is 13.4 + 7.5 degrees post-distraction. Average blood loss was 295mL. Comparative outcome data will be presented regarding operative cost, ICU and overall hospital stay, blood loss, transfusion rates, decannulation rates and peri-operative complications.
Conclusion: Drawbacks of LeFort III distraction relate to extensive degloving during hardware placement and osteotomy. We developed a transconjunctival approach to address these issues utilizing ultrasonic osteotomy and limited dissection. Early outcomes appear to be superior to open procedures with improved stability and decreased morbidity.
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