The monobloc frontofacial advancement (FFA) has remained a controversial procedure over time due to the potential for complications such as frontal bone loss and CSF leaks. Reports following the introduction of distraction osteogenesis (DOG) indicated that DOG significantly lowered the complication rate. DOG has since been widely adopted for monoblocs. For the past 45 years, the senior author has employed various approaches for facial advancement, including monobloc FFA and Le Fort III advancement, tailoring treatment to presenting dysmorphology. Erin M. Wolfe @erin__wolfe and her co-authors evaluated the outcomes following facial advancement procedures (with and without the use of DOG) for the treatment of FGFR2 syndromic craniosynostosis, with the intent to evaluate long-term outcomes and the safety profile of each procedure. She and her co-authors found that there was no difference in the complication rate between patients who underwent monobloc FFA and patients who underwent Le Fort III advancements. DOG was used more often in patients who underwent monobloc FFA compared to Le Fort III advancement, but had a lower complication rate. Although monobloc FFA carries with it substantial risks, with careful consideration of airway control, the anterior cranial base dura, and the retro-frontal dead space, the procedure is recommended for carefully selected patients.
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