Comparison of Complication Rate Between LeFort III and Monobloc Advancement With or Without Distraction Osteogenesis

Background: LeFort III osteotomies or monobloc advancements, with or without distraction, can be used to treat mid-facial hypoplasia causing exorbitism and obstructive sleep apnea in syndromic patients. This report is a meta-analysis of the complication rates following LeFort III osteotomies or monobloc advancement with or without distraction. Methods: Triple database search was conducted to identify articles addressing mid-facial hypoplasia treated with LeFort III or monobloc in which complications were detailed. Complications were considered major if they required a second operation or were potentially life threatening. Statistical analysis was performed with Student t test. Results: Fifteen studies fit inclusion criteria. This yielded 363 total patients. In patients treated with a monobloc advancement, there was a statistically higher rate of major (P < 0.0001) and minor (P < 0.0001) complications, death (P = 0.02), cerebrospinal fluid (CSF) leaks (P < 0.0001), and meningitis/abscess (P < 0.0001) when distraction was used. In patients treated with a LeFort III, there was a statistically higher rate of reoperation when distraction was used (P = 0.001). In patients treated without distraction, there was a statistically higher rate of major (P < 0.0001) complications, death (P = 0.008), CSF leaks (P = 0.003), and reoperation (P < 0.0001) with a monobloc and a statistically higher rate of minor complications (P < 0.001) with a LeFort III. Conclusion: LeFort III proved to be a safer technique for the treatment of mid-facial hypoplasia. Although distraction was initially introduced to reduce complications, in this review, monobloc with distraction had the highest rate of major complications. There are multiple confounding factors that influence success of mid-face surgery and every patient must be evaluated and treated individually.