Are There Morphophysiological Airway Alterations in Syndromic Craniosynostosis? A 3D Computed Tomography and CFD Analysis

Abstract

Objectives

Characterize the upper airways (UAW) in individuals with syndromic craniosynostosis (SCS) using computed tomography scans and correlate with the airflow dynamics and craniofacial pattern.

Design

Observational, cross-sectional study.

Setting

Tertiary craniofacial center.

Individuals

Twenty-nine individuals were included, divided in 2 groups: CON (n = 19; 21.2 ± 3.7 y), individuals with no craniofacial anomalies and no UAW morphological alterations, and SCS (n = 10; 22.1 ± 5.1 y) individuals with SCS prior to maxillomandibular surgery.

Interventions

Volume (V, cm³) and minimal cross-sectional area (mCSA, mm²) was calculated (Mimics, Belgium). Computational fluid dynamics (ANSYS, EUA) was performed and flow (F, L/min), pressure (P, Pa), and resistance (R, Pa/[L/min]) were calculated. Cephalometric analysis (SNA[^o]), ANB[^o], Ba-S-N[^o]) was also assessed (Dolphin Imaging, USA).

Main Outcome

The morphophysiology of the UAW in SCS individuals was severely impaired compared with the CON group.

Results

The SCS group exhibited significant volumetric reduction in the total UAW (−29%), nasal cavity (−21%), and pharynx (−37%) compared with the CON group. The mCSA was 57% smaller in the SCS group. CFD simulations demonstrated decreased flow (−9%), increased pressure (136%), and resistance (156%) in the SCS group. UAW resistance presented a strong positive correlation with mCSA (CON: r = 0.77 / SCS: r = 0.88). Cephalometric findings revealed significant differences between CON and SCS, with the SCS group exhibiting values outside the normal range.

Conclusion

The UAW of individuals with SCS was anatomically and functionally impaired, suggesting a significant risk for obstructive sleep apnea.