Complications of frontofacial advancement

Purpose The purpose of this study was to document the early and late complications associated with frontofacial distraction. Method A systematic review of the literature on complications in craniofacial surgery and a review of records of patients undergoing frontofacial distraction at Great Ormond Street Hospital for Children over a 10-year period were conducted. Results Complications arising from frontofacial advancement are common. Mortality rates varied between 0 and 4.5 %. There has been a general decline in reported mortality rates with time, and the most recent series report mortalities of less than 1 %. The incidence of significant blood loss (greater than one blood volume) in patients undergoing monobloc osteotomy varied between 5.3 and 9.1 %. CSF leaks following monobloc distraction are common (incidence, 2–20 %). Most of these leaks settle spontaneously. The incidence of frontal bone flap necrosis requiring debridement and a subsequent cranioplasty varied between 3 and 20 %. Conclusions The functional and aesthetic benefits of frontofacial distraction are well documented, but these advantages are associated with a significant complication rate. The potential benefits of frontofacial distraction need to be carefully weighed against the potential complications when deciding to recommend surgery.