Craniofacial Surgery
Systematic Review Paper
Complications of mandibular distraction osteogenesis for congenital deformities: a systematic review of the literature and proposal of a new classification for complications

https://doi.org/10.1016/j.ijom.2014.07.009Get rights and content

Abstract

A systematic review of English and non-English language articles on the complications of mandibular distraction osteogenesis (MDO) for patients with congenital deformities was performed, in accordance with the PRISMA statement. Search terms expressing distraction osteogenesis were used in ‘AND’ combination with search terms comprising ‘mandible’ and terms for complication, failure, and morbidity. A search using PubMed (National Library of Medicine, NCBI), EMBASE, and the Cochrane Central Register of Controlled Trials yielded 644 articles published between 1966 and mid October 2013. Clinical articles that reported complications related to MDO were included. Finally 81 articles on MDO in congenital deformities were eligible and were screened in detail. Complications including minor infection (6.0%), device-related problems (7.3%), skeletal open bite (2.4%), hypertrophic scar formation (2.1%), facial nerve palsy (1.8%), neurosensory disturbances of the inferior alveolar nerve (1.9%), and (fibrous) non-union (0.7%) were seen. A new index for more detailed classification of complications in MDO is proposed based on six categories that indicate the impact of the complication and its further treatment or final results. The proposed complication index may be a useful tool to classify complications related to MDO.

Section snippets

Literature search

A comprehensive systematic review of the literature was performed in the bibliographic databases PubMed (National Library of Medicine, NCBI), EMBASE, and the Cochrane Central Register of Controlled Trials from inception to 15 October 2013; the review was performed in accordance with the PRISMA statement.11 Search terms included controlled terms from medical subject headings (MeSH) in PubMed and Emtree in EMBASE, as well as free text terms. We used free text terms only in the Cochrane register.

Results

The study included 81 publications reviewing a total of 1258 patients. The majority of the group consisted of paediatric patients. The eligible articles displayed a broad spectrum of congenital deformities. Hemifacial microsomia patients accounted for the majority of this group (HFM, n = 717, 57.0%). Detailed information on the remaining congenital deformities is shown in Table 3.

Mandibular lengthening was carried out in 99.8% (n = 1255) of the cases. The MDO was performed bilaterally in 665

Discussion

Mandibular distraction osteogenesis (MDO) is a relatively new technique that has had a major impact on the correction of various craniofacial deformities.2 The number of publications on this subject continues to increase. Nevertheless, evidence is essential and is required for further validation of this broad spectrum of treatments. Our initial PubMed search yielded approximately 5500 articles using the terms ‘mandibular’ and ‘distraction osteogenesis’. With the addition of the search terms

Funding

None.

Competing interests

None declared.

Ethical approval

Not required.

Patient consent

Not required.

References (92)

  • C.K. Kolstad et al.

    Mandibular distraction osteogenesis: at what age to proceed

    Int J Pediatr Otorhinolaryngol

    (2011)
  • S.J. Lin et al.

    Distraction osteogenesis in the pediatric population

    Otolaryngol Head Neck Surg

    (2007)
  • M. Miloro

    Mandibular distraction osteogenesis for pediatric airway management

    J Oral Maxillofac Surg

    (2010)
  • B.I. Pluijmers et al.

    Custom-made intraoral mandibular distraction as treatment for neonatal airway obstruction

    Int J Oral Maxillofac Surg

    (2012)
  • A. Rachmiel et al.

    Intraoral distraction osteogenesis of the mandible in hemifacial microsomia

    J Oral Maxillofac Surg

    (2001)
  • A.A. Sadakah et al.

    Bilateral intra-oral distraction osteogenesis for the management of severe congenital mandibular hypoplasia in early childhood

    J Craniomaxillofac Surg

    (2009)
  • A. Sigler et al.

    Carotid artery injury during mandibular distraction

    Br J Oral Maxillofac Surg

    (2008)
  • R.J. Tibesar et al.

    Distraction osteogenesis of the mandible for airway obstruction in children: long-term results

    Otolaryngol Head Neck Surg

    (2010)
  • R.C. Robinson et al.

    Distraction osteogenesis in the craniofacial skeleton

    Otolaryngol Clin N Am

    (2005)
  • L.B. Kaban et al.

    Clinical application of curvilinear distraction osteogenesis for correction of mandibular deformities

    J Oral Maxillofac Surg

    (2009)
  • J.G. McCarthy et al.

    Lengthening the human mandible by gradual distraction

    Plast Reconstr Surg

    (1992)
  • M.M. Mofid et al.

    Craniofacial distraction osteogenesis: a review of 3278 cases

    Plast Reconstr Surg

    (2001)
  • K. Nagy et al.

    No evidence for long-term effectiveness of early osteodistraction in hemifacial microsomia

    Plast Reconstr Surg

    (2009)
  • S. Zim

    Treatment of upper airway obstruction in infants with micrognathia using mandibular distraction osteogenesis

    Facial Plast Surg

    (2007)
  • D.L. Master et al.

    Complications of mandibular distraction osteogenesis

    J Craniofac Surg

    (2010)
  • D. Paley

    Problems, obstacles, and complications of limb lengthening by the Ilizarov technique

    Clin Orthop Relat Res

    (1990)
  • P.R. Shetye et al.

    Documentation of the incidents associated with mandibular distraction: introduction of a new stratification system

    Plast Reconstr Surg

    (2009)
  • E.H. Davidson et al.

    The evolution of mandibular distraction: device selection

    Plast Reconstr Surg

    (2010)
  • A. Liberati et al.

    The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration

    Ann Intern Med

    (2009)
  • F.D. Burstein

    Resorbable distraction of the mandible: technical evolution and clinical experience

    J Craniofac Surg

    (2008)
  • A. Margulis et al.

    Distraction osteogenesis of the mandible with an internal bioresorbable device

    J Craniofac Surg

    (2003)
  • C. Breugem et al.

    Bioresorbable distraction device for the treatment of airway problems for infants with Robin sequence

    Clin Oral Investig

    (2012)
  • J. Corcoran et al.

    Distraction osteogenesis of costochondral neomandibles: a clinical experience

    Plast Reconstr Surg

    (1997)
  • E.J. Stelnicki et al.

    Distraction osteogenesis of costochondral bone grafts in the mandible

    Plast Reconstr Surg

    (2002)
  • D.J. Thomas et al.

    Fibrous ankylosis after distraction osteogenesis of a costochondral neomandible in a patient with grade III hemifacial microsomia

    J Craniofac Surg

    (2001)
  • D.C. Wan et al.

    Distraction osteogenesis of costocartilaginous rib grafts and treatment algorithm for severely hypoplastic mandibles

    Plast Reconstr Surg

    (2011)
  • B.L. Eppley

    Distraction lengthening of the mandibular costochondral graft: a precautionary note

    J Craniofac Surg

    (2000)
  • D. Labbe et al.

    Mandibular reconstruction of gunshot wounds by progressive bone distraction. Report of five cases

    Ann Chir Plast Esthet

    (1998)
  • C. Mahatumarat et al.

    Mandibular distraction osteogenesis in unilateral craniofacial microsomia: preliminary report

    J Med Assoc Thai

    (2001)
  • F. Ortiz Monasterio et al.

    Simultaneous mandibular and maxillary distraction in hemifacial microsomia in adults: avoiding occlusal disasters

    Plast Reconstr Surg

    (1997)
  • F. Ortiz Monasterio et al.

    Maxillo-mandibular simultaneous distraction

    Cir Plast Ibero-Latinoam

    (2002)
  • D.A. Preciado et al.

    Mandibular distraction to relieve airway obstruction in children with cerebral palsy

    Arch Otolaryngol Head Neck Surg

    (2004)
  • S.T. Rhee et al.

    Pediatric mandibular distraction osteogenesis: the present and the future

    J Craniofac Surg

    (2003)
  • K. Satoh et al.

    Maxillo-mandibular distraction osteogenesis for hemifacial microsomia in children

    Ann Plast Surg

    (2002)
  • S.A. Schendel et al.

    Mandibular distraction osteogenesis by sagittal split osteotomy and intraoral curvilinear distraction

    J Craniofac Surg

    (2004)
  • W. Shen et al.

    Mandibular distraction osteogenesis to relieve Pierre Robin severe airway obstruction in neonates: indication and operation

    J Craniofac Surg

    (2009)

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