Airway volume changes after orthognathic surgery in patients with down syndrome: a diagnostic-therapeutic algorithm

Abstract

Background: Down syndrome (DS) patients tend to suffer severe dentofacial and skeletal deformities leading to severe occlusal, speech and respiratory problems. The increase in life expectancy of these subjects opens new horizons for improvement of their oral, dental and facial functions, among others. However, no surgical treatment protocol is described elsewhere in the literature. Then, the present study proposes a protocol for the surgical management of orodental and facial deformities in DS patients based on a series of three cases and a review of the literature. Methods: The protocol contemplates dentofacial deformity diagnostic work-up, obstructive sleep apnoea diagnosis and follow-up, pre-admission medical and anaesthetic evaluation, treatment plan, and perioperative management. Results: All patients presented with midface retrusion due to underlying severe maxillary hypoplasia and dental crowding. A mean maxillary advancement of 4.53 mm and a mean maxillary descent of 3.6 mm were obtained. A mean pharyngeal airway volume gain of 10,954.33 mm3 (50%) was recorded at the one-month follow-up visit. Non-relevant skeletal and airway relapses were noted. Stable occlusion was achieved in all cases after postoperative orthodontic treatment, with proper chewing function, and the parents referred decreased snoring. Conclusion: In selected DS patients with specific dysmorphic orofacial features, orthognathic surgery constitutes the first line treatment to improve the occlusion disorders and associated feeding, respiratory and sleep-disorder problems. Therefore, the use of this algorithm represents the first line surgical treatment for DS patients with dentofacial deformities and allows the clinician to tailor the surgical treatment to each patient’s needs.