title: Complications of frontofacial advancement.
abstract: OBJECTIVE
  The purpose of this study was to document the early and late complications associated with frontofacial distraction.
  
  
  METHODS
  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.
authors.affiliation: Craniofacial Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1 3JH, UK. david.dunaway@gosh.nhs.uk
authors.forename: David J
authors.initials: DJ
authors.lastname: Dunaway
authors.forename: Johnathan A
authors.initials: JA
authors.lastname: Britto
authors.forename: Christopher
authors.initials: C
authors.lastname: Abela
authors.forename: Robert D
authors.initials: RD
authors.lastname: Evans
authors.forename: N U Owase
authors.initials: NU
authors.lastname: Jeelani
mesh_terms: D003394:Craniofacial Dysostosis / Q000601:surgery; D005147:Facial Bones / Q000601:surgery*; D005624:Frontal Bone / Q000601:surgery*; D006801:Humans; D019857:Osteogenesis, Distraction / Q000009:adverse effects*; D011183:Postoperative Complications / Q000503:physiopathology*; D019651:Plastic Surgery Procedures / Q000009:adverse effects*