Syndromic craniosynostosis is a complex pathology involving the craniofacial skeleton. Sporadic mutations occurring in the synchondrosis of the cranial base are the most common etiology for this condition. A midface that undergoes synostosis to such a pathological cranial base fails to advance along the physiological growth vector. The resulting midface retrusion causes severe airway compromise, (Obstructive Sleep Apnea - OSA)(Lo and Chen, 1999; Sculerati et al., 1998), ocular complications (Exophthalmos, subluxation of the globe) (Havlik and Bartlett, 1995), and malocclusion as primary effects, not to mention psychological distress and poor quality of life amongst these children (Mccarthy et al., 1992). Surgical Midface Advancement (SMA) is achieved through craniofacial disjunction at the level of Lefort III or as a monobloc including fronto-orbital components. (Mccarthy et al., 1992; Stevan, 2008).

It was Sir Harrold Gillies and co-workers (Gillies and Harrison, 1950) who proposed “high midfacial advancement” but advised against the technique, considering morbidity and higher rates of complications associated with the same in pediatric age group. Tessier (1971) and later McCarthy and co-workers (carthy et al., 1984) popularized the same with technical modifications and hypothesized that advancement surgery not only helps relieve the complications of midface retrusion but also unlocks the stenosed skeleton from the Anterior Cranial Base (ACB), paving the way for unhindered physiological growth. While some authors concur with Tessier about the surgery facilitating growth (EpkerBN, 1976; Munro, 1978; Kaban et al., 1984;carthy et al., 1984 ; Shyete2010), few others published contrasting findings and proposed that surgical intervention and the ensuing fibrosis led to stunting of further growth of the midface commensurate with the age of the individual (Freihofer, 1977; Kreiborg,1986; Mccarthy et al., 1992; Fearon, 2005; Meazzini et al., 2012; Patel, 2015). Over the past four decades, both osteotomy/advancement and distraction advancement have been widely used in the management of midface retrusion. However, the impact of the surgery on the growth of the midface is questionable and may be variable based on the time and type of intervention. There is no definitive consensus in the current literature on the aforesaid warranting the current systematic review.