Complications with Facial Advancement

Certain procedures for facial advancement may carry greater risk than others. While many believe that separating the cranial base by monobloc advancement leads to a higher complication rate, no comparative series between the Le Fort III and monobloc advancements has ever been reported. We reviewed our series of these different techniques. Over a 15-year period, 29 patients underwent 30 surgical procedures, with either a midfacial or frontofacial advancement. The average age of patients at the time of surgery was 12 years, with a range from 3 to 26 years. There were 20 Le Fort III and 10 monobloc advancements. Follow-up averaged 4 years, with a range from 10 weeks to 13 years. There were no deaths in this series. The infectious complications differed significantly between the two groups, with all major infections occurring in the monobloc group. The noninfectious complications (2 major and 20 minor) were proportionately distributed between the Le Fort III and monobloc groups. Aesthetic results of the midface, judged by the percentage of revisions necessary, were found to be the same between the two procedures. Aesthetic results were noted to correlate strongly with age at the time of surgery, with the older patients being judged as having a better aesthetic result and most of the younger patients requiring a repeat of the facial advancement. We conclude that while we were unable to determine any definitive aesthetic advantage of one procedure over the other in our series, there was a significantly higher infection rate with the monobloc advancement. On the basis of these results, we recommend a staging of the forehead and midfacial advancements.