Association Between Ventriculoperitoneal Shunting and Postoperative Infection Following Frontofacial Monobloc Advancement.

BACKGROUND

Frontofacial monobloc advancement (FFMBA) carries a well-recognized risk of postoperative infection owing to the communication created between the nasal cavity and the anterior cranial base. Risk factors specific to this procedure have not been systematically characterized. This exploratory study aimed to examine preoperative factors associated with infection following FFMBA.

METHODS

We retrospectively reviewed 26 consecutive patients who underwent FFMBA at a single craniofacial center between 2015 and 2025. Six prespecified candidate variables were examined in univariable analyses: sex, operative time, intraoperative blood loss, tracheotomy, ventriculoperitoneal (VP) shunt, and institution of first cranial vault surgery. Categorical variables were compared using Fisher's exact test and continuous variables using the Mann-Whitney U test.

RESULTS

Postoperative infection occurred in 6 of 26 patients (23.1%). Time to infection ranged from 1 day to 4 years, with 5 cases within 1 month and 1 late case at 4 years in a VP-shunted patient, consistent with shunt-associated peritonitis. VP shunt status was the only variable showing a statistically significant association with postoperative infection (OR 45.00, 95% CI 3.35-604.02; P = 0.002): 5 of 7 VP-shunted patients (71.4%) developed infection compared with one of 19 non-shunted patients (5.3%). All 7 VP-shunted patients had received their VP shunt at another institution before referral. No other candidate variable reached nominal statistical significance.

CONCLUSIONS

In this exploratory series, VP shunt status was the only variable showing a statistically significant association with postoperative infection following FFMBA. The estimate was highly imprecise, and the finding should be regarded as hypothesis-generating. The proposed mechanism-persistent extradural dead space related to impaired brain expansion after advancement-remains speculative and requires prospective evaluation. Because all shunts had been placed elsewhere before referral, residual confounding related to referral patterns and treatment sequencing cannot be excluded. These findings support multidisciplinary planning and long-term surveillance in VP-shunted patients undergoing FFMBA.