DOI: 10.1097/prs.0000000000011317 ISSN: 0032-1052

A European multicenter outcome study on the different perioperative airway management policies following midface surgery in syndromic craniosynostosis: a proposal for a Standard Operating Procedure.

Iris E. Cuperus, Irene M.J. Mathijssen, Marie-Lise C. van Veelen, Anouar Bouzariouh, Ingrid Stubelius, Lars Kölby, Christopher Lundborg, Sumit Das, David Johnson, Steven A. Wall, Dawid F. Larysz, Krzysztof Dowgierd, Małgorzata Koszowska, Matthias Schulz, Alexander Gratopp, Ulrich-Wilhelm Thomale, Víctor Zafra Vallejo, Marta Redondo Alamillos, Rubén Ferreras Vega, Michela Apolito, Estelle Vergnaud, Giovanna Paternoster, Roman H. Khonsari,
  • Surgery


Perioperative airway management following midface advancements in children with Apert and Crouzon/Pfeiffer syndrome can be challenging, and protocols often differ. This study examined airway management following midface advancements and postoperative respiratory complications.


A multicenter, retrospective cohort study was performed to obtain information about the timing of extubation, perioperative airway management, and respiratory complications after monobloc / le Fort III procedures.


Ultimately, 275 patients (129 monobloc and 146 Le Fort III) were included; 62 received immediate extubation and 162 delayed extubation; 42 had long-term tracheostomies and nine perioperative short-term tracheostomies. Short-term tracheostomies were in most centers reserved for selected cases. Patients with delayed extubation remained intubated for three days (IQR 2 – 5). The rate of no or only oxygen support after extubation was comparable between patients with immediate and delayed extubation, 58/62 (94%) and 137/162 (85%) patients, respectively. However, patients with immediate extubation developed less postoperative pneumonia than those with delayed, 0/62 (0%) versus 24/161 (15%) (P = 0.001), respectively. Immediate extubation also appeared safe in moderate/severe OSA since 19/20 (95%) required either no or only oxygen support after extubation. The odds of developing intubation-related complications increased by 21% with every extra day of intubation.


Immediate extubation following midface advancements was found to be a safe option, as it was not associated with respiratory insufficiency but did lead to fewer complications. Immediate extubation should be considered routine management in patients with no/mild OSA and should be the aim in moderate/severe OSA after careful assessment.

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