In some patients, it is possible to advance the forehead and midface in one step, simultaneously improving the form and appearance of the forehead, eyes and midface. In these cases, the monobloc frontofacial advancement is performed instead of a combination of fronto-orbital and Le Fort III procedures. The preferred surgical approach is determined based on your child’s facial differences and where the midface and orbital elements lie.
Your child’s plastic surgeon and neurosurgeon will work together to perform this midface advancement procedure. Similar to a fronto-orbital advancement, a frontal craniotomy is performed, followed by an osteotomy of both the upper and lower eye sockets and midface, making a single bloc. An osteotomy is a surgical procedure in which a bone is cut to shorten, lengthen or change the alignment of the bone.
Although the monobloc procedure can be done as a single-stage procedure in which the face is then moved forward and fixated with screws, plates and bone grafts, it is more often done using distraction, as in the standard LeFort III procedures.
The advantage of using distraction is a greater degree of correction over time. As in all of the midface advancement procedures, secondary surgery of the forehead and midface may be required at a later age as your child grows and develops.