Serene dental surgery with Apert syndrome patient

Apert Syndrome and Dental Care: Ensuring Patient Comfort and Safety

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Kai Mendoza in Health & Wellness December 2025 • 5 min read.

"Discover how deep sedation and local anesthetics provide a safe and comfortable experience for Apert syndrome patients undergoing oral surgery."


Apert syndrome (AS) is a rare genetic disorder characterized by craniosynostosis (premature fusion of skull bones), midface hypoplasia, and syndactyly (fusion of fingers and toes). This condition, affecting as few as 1 in 160,000 individuals, is caused by mutations in the FGFR2 gene, which plays a crucial role in bone and tissue development. The complex craniofacial malformations associated with AS can lead to significant challenges, particularly in managing the airway during medical and dental procedures.

Oral surgical procedures in patients with Apert syndrome require careful planning and execution due to potential airway difficulties and other complications. Traditional approaches to anesthesia may not always be suitable, making it essential to explore alternative methods that ensure patient comfort and safety. This article delves into a case study demonstrating the successful use of deep sedation combined with local anesthetic blocks in an outpatient setting, providing valuable insights for clinicians managing similar cases.

The case involves an 18-year-old African American female with Apert syndrome who presented for the extraction of non-salvageable teeth. Given her medical history, which included previous brain shunt placement and reported maxillary hypoplasia, the dental team opted for an anxiolytic anesthesia treatment plan. This approach aimed to minimize the risks associated with general anesthesia while ensuring the patient's comfort and cooperation throughout the procedure.

Deep Sedation with Local Anesthesia: A Balanced Approach

Serene dental surgery with Apert syndrome patient

The anesthetic protocol involved a combination of 25 µg fentanyl and 1 mg midazolam, titrated to achieve the desired level of sedation. Continuous monitoring by an anesthesiologist ensured that vital signs and airway patency were maintained throughout the procedure. Local anesthesia, using 2% lidocaine with 1:100,000 epinephrine and 4% articaine HCl with 1:100,000 epinephrine, was administered to ensure complete nerve blockage at the surgical site. The combination of these agents allowed for a shorter and more controlled anesthesia time, optimizing the safety of the patient.

Several key considerations influenced the choice of deep sedation over general anesthesia for this patient. The patient’s comfort was a primary concern, given the extent of the bony impaction and the need for sectioning the teeth. Deep sedation offered a way to minimize anxiety and discomfort while still allowing the patient to maintain some level of consciousness and cooperation. The availability of intravenous access was also crucial, enabling immediate intervention in case of an emergency, such as the need for intubation.

  • Patient Comfort: Deep sedation minimizes anxiety and discomfort.
  • Airway Management: Allows for better control and immediate intervention.
  • Synergistic Drug Effects: Fentanyl and midazolam reduce the required dosage of each drug.
Furthermore, the choice of medications was carefully considered to avoid potential complications. Ketamine, while a possible induction agent, was deemed unsuitable due to its hallucinogenic properties, which could adversely affect a patient with Apert syndrome. Additionally, ketamine's potential to increase intracranial pressure made it a less favorable option, given the patient's history of brain shunt placement. Fentanyl, chosen for its analgesic properties, and midazolam, used for its sleep-inducing, relaxing, and amnesic effects, provided a synergistic combination that minimized the required dosages of each drug.

A Safe and Effective Approach

In conclusion, the use of deep sedation combined with local anesthetic blocks presents a safe and effective treatment option for patients with Apert syndrome undergoing oral surgery. This approach ensures patient comfort, minimizes potential complications, and allows for efficient management of dental procedures in an outpatient setting. By carefully considering the patient's medical history, individual needs, and the synergistic effects of medications, clinicians can provide optimal care for individuals with Apert syndrome.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

Everything You Need To Know

1

What exactly is Apert syndrome?

Apert syndrome is a rare genetic disorder that is characterized by the premature fusion of skull bones, known as craniosynostosis, underdevelopment of the midface, or midface hypoplasia, and the fusion of fingers and toes, referred to as syndactyly. The condition is caused by mutations in the FGFR2 gene, which plays a vital role in the development of bone and tissue. The craniofacial malformations associated with Apert syndrome can cause significant challenges, particularly in managing the airway during medical and dental procedures.

2

Why is deep sedation a good option for people with Apert syndrome?

Deep sedation, when used with local anesthetic blocks, offers a balanced approach by minimizing anxiety and discomfort during oral surgery, while still allowing the patient to maintain some level of consciousness and cooperation. This is significant because it reduces the risks associated with general anesthesia, such as airway difficulties, which are particularly relevant for individuals with Apert syndrome who may have complex craniofacial malformations. Intravenous access is available allowing immediate intervention in case of an emergency.

3

What is the purpose of using local anesthetic blocks during dental procedures?

Local anesthetic blocks are used to ensure complete nerve blockage at the surgical site, preventing the patient from feeling pain during the procedure. Medications such as 2% lidocaine with 1:100,000 epinephrine and 4% articaine HCl with 1:100,000 epinephrine are commonly used. This is important because it reduces the need for higher doses of sedatives, minimizing potential side effects and ensuring a more comfortable experience for the patient.

4

How do medications like Fentanyl and Midazolam help during the sedation process?

Fentanyl is used for its analgesic properties, providing pain relief during the procedure. Midazolam is used for its sleep-inducing, relaxing, and amnesic effects, helping to reduce anxiety and ensure the patient remains calm. The combination of fentanyl and midazolam provides a synergistic effect, which means that the required dosages of each drug can be minimized, reducing the risk of potential complications. Other medications such as Ketamine are not used due to the side effects.

5

How does using deep sedation and local anesthetic blocks improve the overall experience of dental surgery?

The combination of deep sedation and local anesthetic blocks ensures patient comfort by minimizing anxiety and discomfort during oral surgery. It also allows for better airway management and immediate intervention if needed. By carefully considering the patient's medical history, individual needs, and the synergistic effects of medications, clinicians can provide optimal care for individuals with Apert syndrome undergoing dental procedures. The result is a safer and more effective treatment experience with reduced risks and improved outcomes.

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