Perioperative outcomes and management in midface advancement surgery: a multicentre observational descriptive study from the paediatric Craniofacial Collaborative Group.

This multicentre observational descriptive study looked at 4 year data from the Paediatric Craniofacial Surgery Perioperative Registry in 72 cases of children undergoing midface advancement involving distractor application. Data reviewed included patient demographics, perioperative management, complications, fluid and transfusion volumes and length of stay. There are 2 main procedures performed for midface hypoplasia: the Lefort III and Monobloc procedure. The main difference is the Monobloc procedure mobilizes the midface, brow and forehead as a single unit that requires creating a communication between intracranial and nasal cavities whereas Lefort III is completely extracranial. Given that midface advancement is a relatively infrequent surgical procedure, the authors sought to compare perioperative variables namely surgical times, transfusion requirements, and length of ICU and hospital stay. The cases were pooled from 11 institutions ; 49 children undergoing Lefort III and 23 undergoing Monobloc procedures. Monobloc patients were younger, weighed less and were more likely to have tracheostomies and elevated intracranial pressure. They also had greater transfusion requirements (higher volumes in ml/kg) and a longer median hospital and ICU stay. Perioperative complications were also higher in the Monobloc group.
Whilst this is well presented data which was cross validated and rectified before submission to the registry, the information presented is limited to practice in North America. There may be inaccurate or missing data, and as this is observational data, cause and effect relationships cannot be established. There is useful information about perioperative complications of each procedure, and strategies used to manage blood loss such as antifibrinolytic therapy, but other useful measures such as preoperative optimization of the patient is not mentioned. Furthermore there is no mention of institutional differences in surgical management.
Take Home Message
The generalisability of this descriptive study is limited. A larger multicentre review of worldwide practice or comparison with similar registries around the world may provide more detailed information on outcomes for these procedures.
Reviewed by: Dr Balvindar Kaur