Monobloc and facial bipartition osteotomies: a step-by-step description of the surgical technique.

The surgical management of upper and midface deformities in the craniofacial dysostosis syndromes has evolved gradually. Staged surgical procedures performed at intervals to coincide with facial growth, visceral function, and psychosocial development represent the current approach. The lack of consensus on timing and techniques for the management of the complex upper and midface deformities reflects not only uncertainty about the results achieved with any one approach to treatment but also confusion about how to perform the intricate and technically sensitive procedures. The purpose of this article is to provide the surgeon with a step-by-step technical description of the monobloc and facial bipartition osteotomies as I routinely perform them. By understanding the details for their safe execution, craniofacial surgeons are able to maintain these reconstructive options as active components in their armamentarium.