Two Decades of Mandibular Distraction Osteogenesis: How Age Influences Surgical Outcomes

BACKGROUND: Mandibular distraction osteogenesis (MDO) is an effective treatment for life-threatening upper airway obstruction in pediatric patients with micrognathia. However, recent data on how age at the time of distraction affects complication rates is limited. This study seeks to fill this gap by evaluating age-related risks associated with MDO and offering updated insights into complication rates based on patient age at the time of surgery. METHODS: A retrospective review on patients who underwent MDO between 2004 and 2023 at a tertiary institution was conducted. Patients with less than 6 months of follow-up were excluded from the analysis. The study population was divided into three equal groups by age at surgery: less than 3 weeks old, 3–14 weeks old, and greater than 14 weeks old at time of MDO. Primary outcomes assessed were 30-day postoperative infection rates, major complications (defined as those requiring rehospitalization or reoperation), and minor complications (defined as self-resolving or medically managed issues that did not require hospitalization or general anesthesia). Statistical analyses were performed using Fisher's exact test, Pearson's chi-squared test, and the Mann-Whitney U test. RESULTS: A total of 133 patients met the inclusion criteria, with a median age of 5.6 weeks at the time of surgery and a median follow-up of 6.1 years. Preoperative tracheostomy was only observed in the oldest cohort (9.3%, p=0.16). There were no significant differences across cohorts in the presence of craniofacial syndromes, total distraction distance, distraction rate, or activation duration. Postoperative outcomes revealed no significant differences in major complications or 30-day infection rates. However, minor complication rates were highest in the youngest cohort at 53.5%, followed by 39.5% in the 3–14 weeks cohort, and 20.9% in the oldest cohort (p=0.008). Specifically, wound dehiscence that did not require surgical intervention was most prevalent in the youngest cohort (20.9%), this was significantly higher than the 2.3% rate in the 3–14 weeks cohort and the 4.7% in the oldest cohort (p=0.005). No significant differences were observed in need for postoperative tracheostomy or oxygen requirements across cohorts. CONCLUSION: Age does not significantly affect major complications following MDO, however, younger patients may be at a higher risk for minor complications, such as wound dehiscence. Overall, MDO remains a safe and effective procedure for patients of all ages, though attention to wound care and nutrition is especially critical for those who undergo surgery before three weeks of age.