Analysis of the Learning Curve for a Surgeon Newly Trained in Frontofacial Monobloc Advancement

Background: Frontofacial monobloc advancement (FFMBA) is among the most complex craniofacial surgeries performed; however, the learning curve for this procedure has not been previously documented. In this study, we retrospectively investigated the learning process of a newly trained surgeon performing FFMBA. Methods: Twenty patients who underwent FFMBA between 2015 and 2024 were included in this study. All surgeries were performed by the same craniofacial surgeon and pediatric neurosurgeons. Operative time, blood loss, and complications were retrospectively analyzed using the Wilcoxon matched-pairs signed-rank test, with statistical significance set at P <0.01. Results: The study included 14 patients with Crouzon syndrome, 5 with Pfeiffer syndrome, and 1 with Beare–Stevenson syndrome (mean age: 10.6±12.7 y; range: 3–62 y). Operative time ranged from 218 to 510 minutes (mean: 321.9±83.5 min), and blood loss ranged from 350 to 2822 mL (mean: 944.1±621.3 mL), gradually decreasing over time. The patients were categorized into two groups based on their history of frontal surgery. Operative time and blood loss were significantly higher in patients with previous surgeries ( P <0.01). Complications, including meningitis, distractor prolapse, frontal bone resorption, and recurrent nerve palsy, occurred only in the previously treated group. Conclusions: The learning curve for FFMBA is influenced by the patient’s surgical history, particularly previous frontal surgeries. Careful case selection and collaboration within a multidisciplinary craniofacial team are essential for safely and effectively implementing this complex procedure.