The Process of a Monobloc Procedure
Once the patient is asleep, many monitoring devices will be placed to ensure safety throughout the operation. Blood transfusion is very common during this procedure.
An opening is made on the top of the scalp from one side of the ear to the other. This opening may take the form of a wavy line to help hide the scar within the hair. If you have a scar on your scalp from a previous craniofacial surgery, this scar may be used. Sometimes, openings around the eyelids and inside of the mouth are required. A pediatric neurosurgeon and craniofacial surgeon will work together to perform the surgery in a safe manner.
During the procedure, the forehead bone will be separated from the skull first. Following this part of the surgery, the upper 2/3rds of the facial bone will be carefully separated from the rest of the skull. This will include the brow, the front of the eye sockets, the nose, the cheekbones and the upper jaw in one piece. Your surgeons will take extra care to maintain safety, limit blood loss and protect the eyes and brain. Once the face and forehead bones are separated, segments of bone will be placed in the spaces between the separated bones. These segments of bone will be taken from the hip and these bone pieces will fill the space between the bones and prevent the separated forehead and facial bones from moving back to its original position. After these segments of hip bone, called grafts, are put into place, a membrane from the inside of the scalp is used to seal a space at the inside of the skull. This will help prevent infections after surgery. After this membrane is secured into place, metal plates and screws are used to secure the bones onto position. Sometimes wires are used to secure the teeth together. This is sometimes done to help keep the facial bones in place. A small drainage tube is commonly placed under the scalp skin and exits by the ear and into a collection bulb.
Post-Op & Recovery
The Monobloc surgery will produce dramatic swelling around the face and eyes. Fluid may drain from the scalp incision, mouth or eyes. Most of this fluid will stop draining after a couple of days. The eyes will swell shut over the course of one to two days. Due to the swelling, eating can become a challenge at first. If the teeth are wired together there will be greater difficultly when attempting to eat. Speaking will also require some adjustment due to the facial swelling or if the teeth are wired shut. The swelling should peak after 2-3 days and will slowly resolve over several weeks. Bruising around the eyes can also develop and this will resolve over the course of approximately 2 weeks.
Most of the discomfort experienced after the surgery will be from the hip rather than the face. Medicine will be prescribed to help with the discomfort. It may take several weeks for the pain in the hip to completely resolve. Cool compresses to the face and sleeping with the face raised above the heart will also help decrease the swelling. Lip moisturizer is recommended to prevent drying of the lips. It is very important to listen to the surgeon’s directions regarding the types of foods one can eat following the surgery and when it is safe to eat them. Eating appropriate foods will help with the healing, but eating hard foods too early can damage the surgery.
As the weeks pass, the swelling of the face and eyes will gradually subside and the changes to the face can be better appreciated. The cheekbones will look bigger and the eyes will sink back into the face. The teeth of the upper jaw will be in a better position and the nose will look longer.