Introduction: Following a fronto-orbital or monobloc advancement in infancy, further mid-facial deficiency is usually corrected by a Le Fort III advancement (now often with distraction techniques: external and internal). The approach to final skeletal correction of the adolescent patient with a syndromic craniosynostosis or a related anomaly receives less attention with respect to providing the best function and aesthetics.

Objective, patient and methods: Fifteen patients with significant craniofacial anomalies who had completed growth and treatment undergone the usual treatment sequence in the Melbourne Craniofacial Unit were identified. The management of the mid-face and associated structures during adolescence and post-puberty was recorded to identify the timing and type of intervention.

Results: A range of different procedures and timing was recorded but in general, severe mid-facial deficiency was managed by an interim mid-facial advancement, followed by definitive orthodontic treatment and a final orthognathic procedure. Rhinoplasty and fronto-orbital contouring was performed in 6 patients to complete treatment.

Conclusion: Due to the variability of mid-facial deficiency in this group of patients, a definitive protocol is difficult to develop. However, in severe cases post-puberty, advancement of the mid-face to normalize the orbital contours and minimize the gross Class III malocclusion is recommended. This can then be followed by orthodontic treatment and maxillo-mandibular surgery post-growth. Subsequently, nasal and frontal cranioplasty procedures to fine-tune aesthetics and function were required in some cases. In less severe cases, mid-facial advancement may be delayed for a one-stage correction post-growth. Cases will be presented to illustrate these pathways of treatment.

Conflict of interest: None declared.