Safety and Operative Outcomes of the Use of Resorbable Distractors in Posterior Cranial Vault and Mandibular Distraction

Background: Distraction osteogenesis (DO) is a critical craniofacial technique used to address congenital and acquired skeletal deficiencies through gradual bone elongation. While metallic devices have been traditionally employed for both mandibular distraction (MD) and posterior cranial vault distraction (PCVD), resorbable distractors offer several advantages, including elimination of secondary hardware removal procedures and decreased risk of dural violation. This systematic review evaluates the safety, technical feasibility, and operative outcomes of resorbable distractors in PCVD and MD. Methods: A comprehensive literature search was conducted according to PRISMA guidelines across PubMed, Cochrane, EMBASE, and ClinicalTrials.gov through April 2024. Studies evaluating resorbable distractor systems in PCVD or MD were included. Data were extracted on operative characteristics, complications, clinical outcomes, and comparisons to metallic controls. Results: Thirteen studies encompassing 205 patients (5 PCVD, 8 MD) were included. Hybrid systems combining metallic distraction arms with resorbable fixation were common in PCVD, while most MD procedures employed fully resorbable distractors. In PCVD, latency periods ranged from 2 to 5 days, distraction periods from 23 to 48 days, and consolidation durations averaged 3 to 4 months. Mean distraction rate was ~1 mm/d. All patients achieved clinical improvement, with one study reporting a 15.8% intracranial volume increase. Complication rates were low, with only one patient requiring revision surgery. In MD, distraction periods ranged from 10 to 30 days with consolidation times of 4 to 7 weeks. Mean lengthening ranged from 7 to 25.4 mm. Across studies, 100% clinical success was reported in nearly all cohorts, except for 2 patients with persistent airway obstruction. Complications included infections, device displacement, and regression; however, the use of resorbable plates was associated with significantly reduced postoperative regression (5.1% versus 32.9% in controls). Device absorption time ranged from 6 to 12 months. Conclusions: Resorbable distractor systems in both PCVD and MD demonstrate excellent safety profiles and favorable functional and aesthetic outcomes. These systems offer meaningful operative advantages, including reduced surgical morbidity, fewer revisions, and avoidance of secondary procedures, making them a valuable alternative to metallic hardware in select pediatric craniofacial populations.