Analysis of errors and complications of mandibular distraction osteogenesis in children and adolescents: a report of three clinical cases

Background. Mandibular distraction osteogenesis (DO) is widely applied in the treatment of children and adolescents with mandibular underdevelopment and facial asymmetry. Despite its effectiveness, the technique is associated with complications that may significantly affect both functional and aesthetic outcomes. Objective. To present and analyze complications observed in three adolescent patients undergoing mandibular distraction osteogenesis and to compare these findings with current literature. Material and methods. Three adolescent patients (aged 14—17 years) with post-traumatic mandibular underdevelopment were treated with intraoral curved distractors (Conmet, Russia). General anesthesia was maintained with sevoflurane at standard pediatric concentrations. Radiological follow-up was performed using low-dose protocols in accordance with the ALARA principle. Results. Three types of complications were identified: (1) deviation of the distraction vector requiring reinstallation of the distractor; (2) high positioning of the distractor with a predominantly vertical vector, resulting in incomplete correction of asymmetry and the need for staged treatment; (3) loosening of distractor activation units in the early postoperative period, corrected by repeated fixation. In all cases, corrective measures allowed the distraction course to be completed with satisfactory clinical outcomes. Conclusion. Complications of mandibular distraction osteogenesis in adolescents may result from vector misalignment, improper device positioning, or technical malfunctions. Prevention requires thorough 3D preoperative planning, the use of surgical guides, and strict control of fixation and activation protocols. Early detection and timely correction of complications are key to minimizing adverse outcomes and improving treatment predictability.