Complications of mandibular distraction osteogenesis Maria J. Troulis, DDS, MSc * , Leonard B. Kaban, DMD, MD Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine, 55 Fruit Street, Boston, MA 02114, USA Distraction osteogenesis (DO) has become an appealing alternative to traditional osteotomies and bone grafting for skeletal expansion. It is a less invasive surgical procedure, usually requires a shorter operating time than conventional procedures, and eliminates the need for a donor site [1,2]. Wide application of DO for correction of common dento- facial deformities is somewhat hampered by the cumbersome nature and complexity of distraction devices, cutaneous incisions and pin track scars (with external devices), lengthy treatment protocols, and lack of accurate three-dimensional control of the distraction vector. These issues are responsible, at least in part, for most complications that occur in DO cases. The complications that arise from DO should not be viewed as expected or acceptable side effects of the technique [3]. Ilizarov has pointed out that ‘‘there are no complications with the technique, there are only inexperienced surgeons causing problems for their patients’’ [4]. Cherkashin and Samchukov [4] have defined a complication of DO as ‘‘an unexpected deviation from the treatment plan that, without appropriate correction, will lead to worsening of the existing, development of a new, or recurrence of the initial pathologic process.’’ Such complications may occur as a result of inaccurate or inappropriate preoperative planning, incorrect placement of the osteotomy or the distraction device, mistakes or errors during the active distraction phase, and problems with the fixation. Preoperative (planning) phase Patient selection More than with most surgical procedures, DO depends highly on patient (and family) compliance. The use of an external device on the face may cause social problems for children, especially children in school, which may lead to poor compliance and a request or demand for early removal of the device. Prolonged treatment periods and the need for a blenderized diet and decreased physical activity may present problems for patients who fail to grasp these details preoperatively. The noncompliant or unprepared patient may turn the device in the wrong direction, fail to keep the wounds clean, activate the device too frequently or not frequently enough, and fail to comply with dietary, hygiene, and physical activity instructions. These compliance issues may lead to loosening or dismantling of the device (Fig. 1), premature union of the segments, malocclusion, wound dehiscence, inflammation, or frank infection. The surgeon must select patients who are willing and psychologically and physically capable of acti- vating the distraction device on a daily basis. The surgeon must be prepared to counsel and encourage the patient (and family) on a regular basis during the distraction phase. The decision to perform DO rep- 1042-3699/03/$ – see front matter D 2003, Elsevier Inc. All rights reserved. doi:10.1016/S1042-3699(02)00101-2 * Corresponding author. E-mail address: mtroulis@partners.org (M.J. Troulis). Oral Maxillofacial Surg Clin N Am 15 (2003) 251 – 264