Monobloc Facial Advancement in the World of COVID-19 Testing: A New Potential Risk for Iatrogenic Injury

Abstract

Background: Monobloc advancement with distraction is a holistic approach to treat the sequelae of syndromic craniosynostosis. These osteotomies create a communication between the nasal cavity and anterior cranial fossa that must be surgically obliterated to limit the infectious risks. In light of mandatory COVID-19 testing protocols amidst the pandemic, we aim to identify the specific challenges in management and present our strategy to overcome them. Case presentation: We report 2 cases of syndromic craniosynostosis treated with monobloc distraction during the COVID-19 pandemic and highlight safety concerns and our approach to managing these patients by avoiding nasopharyngeal swabs that may potentially penetrate the cranial base and place the patient as risk for iatrogenic injury. Discussion/conclusion: In patients undergoing surgical procedures that create a cranial base defect, caution must be exercised when attempting to test for COVID-19 which may be a source of potential iatrogenic injury. We propose a new algorithm for COVID-19 screening/surveillance following frontofacial advancement. Patients must be screened via alternative testing methods or treated as potential asymptomatic carriers of COVID-19 until postoperative imaging demonstrates complete ossification of the cranial base.