https://doi.org/10.1177/2732501620949195 FACE 2020, Vol. 1(1) 70–73 © The Author(s) 2020 DOI: 10.1177/2732501620949195 journals.sagepub.com/home/fac Article A combination of cranial vault and midfacial growth distur- bances exist with many craniofacial syndromes. Different mutations in the fibroblast growth factor receptor-2 gene may lead to Crouzon or Apert or Pfeiffer syndromes, which display restriction of the skull base, turribrachycephaly and cranial vault restriction. This restriction may lead to elevated ICP, which has negative consequences on long-term cogni- tive, psychological and other functional outcomes. Midfacial hypoplasia results in reduced orbital volume, exorbitism, corneal exposure, and loss of vision. 1 The midface hypopla- sia similarly produces functional problems that often need to be addressed. Narrowing of the nasopharynx and class III malocclusion produces sleep apnea, which affects respiration and overall well-being. 2 Malocclusion affects mastication and produces an aesthetic deformity. Monobloc advancement separates the anterior portions of the skull base, orbits, maxilla and dental arch, which remain in continuity, and are advanced anteriorly. The procedure can be effective in improving exorbitism, airway constriction, and overall aesthetic appearance (Figure 1). The procedure is not without significant complications, including bleeding, CSF leak, wound/pin site infection, meningitis, bone loss, and death. A mortality range of 0% to 4.5% has been reported, with current rates less than 1%. 2 Evaluation by all members of the multidisciplinary team permits complete assessment of the patient and improves preoperative planning. A pre-mission genetics evaluation will confirm the diagnosis, evaluate for associated medical problems, and identify other risks. A pre-mission ophthalmo- logic exam will identify papilledema secondary to elevated intracranial pressure and increase the urgency for surgery. Regarding preoperative imaging, which may or may not be difficult to obtain, computerized tomography (CT) is the gold standard. Many international centers have this capabil- ity and are able to reformat the images in 3-dimensions. A thorough review of the images at the time of patient screen- ing should identify prior attempts to address the underlying synostosis, as well as hydrocephalus, persistent ICP eleva- tion, posterior pharyngeal space narrowing and possibly a Chiari malformation. A lateral cephalogram may assist with advancement planning if distraction is considered. Magnetic resonance imaging is not necessary unless a brain abnormal- ity requires evaluation. In the mission setting, non-operative interventions may be required before the team arrives to manage the patient surgi- cally. Patching, moisturizing eye drops and tarsorraphy can protect the cornea against orbital exposure. The benefit from tarsorraphy may be self-limited and ultimately ineffective due to tissue stretch and dehiscence. Continuous positive air- way pressure (CPAP) or supplemental oxygen may be required for mild airway obstruction, while tracheostomy is indicated in more severe instances. At the time of the screening, team members need to evalu- ate the indications for surgery, all noted above. Patients with 949195FAC XX X 10.1177/2732501620949195FACE: Journal of the American Society of Maxillofacial SurgeonsTaub et al research-article 20202020 1 Icahn School of Medicine at Mount Sinai, New York, NY, USA 2 Komedyplast Surgical Charity, Chicago, IL, USA Corresponding Author: Peter J. Taub, Surgery, Pediatrics, Dentistry, and Neurosurgery, Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Box 1259, New York, NY 10029, USA. Email: peterjtaub@gmail.com Success With Monobloc Advancement in Mission Surgery Peter J. Taub 1 , Anand Kumar 2 , Alex Lin 2 , Chris Bonfield 2 , Cheryl Gooden 2 , Franklyn Cladis 2 , and Jeffrey Weinzweig 2 Abstract Syndromic hypoplasia of the orbit and midface results in noticeable dysmorphology. Correction involves advancement of the orbito-facial complex either directly or by distraction osteogenesis. The surgery is challenging no matter where it is performed, however, the challenges are amplified on a surgical mission. Komedyplast Surgical Charity (Chicago, IL) has been performing complex craniofacial procedures, including midfacial advancement at the Monobloc level, for 13 years with safety and success. As such, key points need specific attention to avoid complications in a remote location, where staff and resources may be less than adequately equipped to handle them. Keywords monobloc, maxillary hypoplasia, distraction