Postoperative Upper Airway Volume Measurements Among Children With Craniofacial Abnormalities

Introduction: Craniofacial anomalies constitute one-third of all congenital defects. In most cases, patients are diagnosed through a focused physical examination. Radiological studies with three-dimensional reconstruction are used for surgical planning. This study measured post-operative airway volumes among patients with craniofacial abnormalities and compared them to normative values.

Methods: Retrospective imaging analysis of children with craniofacial abnormalities treated at NYU Langone Health from 01/2013 to 02/2021. Upper airway volumes post-craniofacial surgery were measured using 3D processing software (Dolphin 3D, version 11.95, Chatsworth, CA). These values were compared with published normative values.

Results: Twenty-one subjects were identified and compared to normative values. The oropharyngeal volumes were on average, 43.7% smaller than the normative values (p < 0.001), and the total upper airway volumes were 31.6% smaller than the normative values (p=0.003). No significant differences were observed in the nasopharyngeal or hypopharyngeal volumes of the study cohort as compared to the normative data. Similarly, among children ages 12-17 years, the mean oropharyngeal volumes were 47.6% smaller than normal (p < 0.001), and the mean total upper airway volumes were 34.6% smaller than normal (p < 0.001). Among children ages 7-11 years, the mean oropharyngeal volumes were 35.1% smaller than normal (p=0.049), but no difference in mean total upper airway volume was observed.

Conclusions: In children with craniofacial anomalies, post-operative airway volumes remain lower than normative values. However, even a small increase in airway volume can yield a substantial increase in flow rate. 3D airway evaluations are a valuable tool for surgical planning and analysis and can help with optimizing airway dynamics.