Surgical procedures
Simultaneous advancement of the forehead-orbit region and the midface as one block – the most extensive craniofacial procedure.
Monobloc distraction is the most complex craniofacial procedure. It combines fronto-orbital advancement (FOA) and the Le Fort III osteotomy in a single procedure: frontal bone, orbital rim and the entire midface are separated from the skull base as one connected block (en bloc) and distracted forward together over weeks.
Monobloc is reserved for cases in which both regions — forehead/orbit and midface — must be treated at the same time:
Monobloc offers the best option to create a harmonious facial projection in one step. Downside: more demanding, more planning, higher blood loss and longer intensive care — only feasible at experienced centres.
In Apert syndrome the LF2ZR osteotomy (Le Fort II with zygomatic repositioning) is often preferred, advancing the central midface more than the classic LF3.
Virtual surgical planning (VSP) with 3D CT reconstruction is mandatory. Anaesthesiologically, demanding preparation is required (difficult airway, transfusion planning). Duration: approx. 6–8 hours; intensive care for several days. Distraction and retention phases as for Le Fort III distraction.
Overview · Le Fort III distraction · FOA · Apert · Crouzon
The forehead and midface are moved forward as a single unit. In certain syndromic forms the procedure can improve breathing and eye protection and is planned individually by the team.
The indication depends on diagnosis, findings and symptoms and is carefully reviewed at a specialist centre.