Midface Advancement Surgery and Its Effects on Upper Airway Function and Obstructive Sleep Apnea Status in Children With Syndromic Craniosynostosis: A Systematic Review

Background: Syndromic craniosynostosis (SC) is a craniofacial developmental disorder characterized by the premature fusion of one or more cranial sutures. This early fusion leads to irregular skull shapes and, in severe cases, to complications, including respiratory problems. SC was reported to be associated with more than 150 syndromes, among them Apert, Crouzon, and Pfeiffer are the most common. Individuals with SC often experience OSA and airway obstruction. Surgical interventions, including midface advancement, address the deformities of these complications. Objective: This study aims to present a comprehensive systematic review evaluating upper airway and OSA status in SC children, before and after midface advancement surgery. Methods: A modified Population, Intervention, Comparison, Outcome strategy was performed using a combination of electronic (PubMed, Medline, Cochrane, Embase) searches up to August 2025. The inclusion criteria were limited to the involving pediatric patients with SC undergoing midface advancement with preoperative and postoperative evaluation of airway and OSA status. Results: The initial search revealed 15 studies, of which 6 were included for analysis. The main results showed improvements in airway space after midface advancement with a reduction in the severity of OSA. Conclusions: Midface advancement has a significant effect in improving airway volume and OSA status in children with SC.