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Background: This study aims to assess the improvement of sleep apnea after sec-ondary Le Fort III facial advancement with distraction (LF3) in faciocraniosynostosis (FCS) pa-tients with sleep apnea who have previously undergone fronto-facial monobloc advancement (FFMBA) with distraction.

Methods: Patients having undergone secondary LF3 were selected from a cohort of FCS pa-tients with documented sleep apnea who had previously undergone fronto-facial monobloc advancement. Patient charts and polysomnographic records were reviewed. Apnea-hypopnea index (AHI) was recorded before and at least 6 months after secondary LF3. The primary out-come was normalization of AHI (less than 5/h was considered normal). Hierarchical multilevel analysis was performed to predict postoperative AHI evolution.

Results: Seventeen patients underwent a secondary LF3, 7.0 +/- 3.9 years after the primary FFMBA. The mean age was 9.6 +/- 3.9 years. A total of 15 patients (88%) normalized their AHI. Two of four patients were decannulated (50%). There was a statistically significant decrease in AHI (preoperative AHI 21.5/h vs. 3.9/h postoperatively, p = 0.003). Hierarchic multilevel mod-eling showed progressive AHI decrease postoperatively.

Conclusion: Secondary LF3 improves residual or relapsing sleep apnea in FCS patients who have previously had FFMBA.