Understanding Age-Related Risks in Pediatric Mandibular Distraction Osteogenesis: Insights From 2 Decades of Patient Data

Objective Mandibular distraction osteogenesis (MDO) is a well-established intervention for severe upper airway obstruction in children with micrognathia. However, whether patient age influences postoperative complication risk remains debated. This study evaluates age-related differences in complications following pediatric MDO over a 20-year period. Design Retrospective cohort study. Setting Single tertiary pediatric referral center. Patients, Participants Patients who underwent MDO between January 2004 and January 2024 were identified. Patients with less than 6 months of follow-up were excluded. Patients were stratified into 3 age groups: neonate (≤30 days), early infant (31 days-5 months), and infant (≥5 months). Intervention MDO. Main Outcome Measure(s) 30-day postoperative infections, major complications requiring operative intervention, and minor complications requiring conservative management. Results A total of 133 patients met the inclusion criteria. Median age at surgery was 5.6 weeks, with a median follow-up of 6.1 years. Rates of major complications ( P = .63) and 30-day infections ( P = .18) did not differ significantly across age groups. Neonates, therefore, did not demonstrate higher rates of reoperation or rehospitalization. Minor complications, however, were significantly more frequent in neonates (54.2%) compared with early infants (28.6%) and infants (16.0%) ( P = .014). Conclusion MDO demonstrates a comparable safety profile across pediatric age groups in terms of major complications. Although neonates experience higher rates of minor complications, the complication profile must be weighed against the enduring risks of prolonged hypoxemia during the critical period of neurodevelopment. These findings support the use of early MDO when clinically indicated.