title: Does the Rate of Distraction or Type of Distractor Affect the Outcome of Mandibular Distraction in Children With Micrognathia?
abstract: OBJECTIVE
  A variety of surgical protocols are available in the literature for performing mandibular distraction. This study aims to determine the ideal rate of distraction and compare outcomes between internal and external distractors in children and infants with upper airway obstruction due to micrognathia.
  
  
  METHODS
  A systematic review was performed. The databases searched included PubMed, Embase, Scopus, Web of Knowledge, and gray-literature sources. The intervention was bilateral mandibular distraction for upper airway obstruction in children with clinical evidence of micrognathia or Pierre Robin sequence. The variables for comparison included distraction rates of 1 mm/d and 2 mm/d and external versus internal distractors. The outcome was successful completion of distraction. Complications also were recorded and compared. The data were analyzed by cross tabulation to calculate odds ratios.
  
  
  RESULTS
  Overall, 43 studies were included in the surgical outcomes analysis. The overall success rate of distraction was 95.4%. There was no statistically significant difference in success rate with distraction at 1 mm/d or 2 mm/d (P = .18). Distraction at 1 mm/d was associated with a higher rate of technical failures. External distractors had a higher failure rate than internal distractors (P = .012). Internal distractors had a lower rate of significant scarring (P = .006) and had a lower incidence of technical failures (P = .039).
  
  
  CONCLUSIONS
  In children younger than 12 months, distraction at a rate of 2 mm/d is safe and appears to have a similar success rate to distraction at 1 mm/d. Internal distractors have a higher success rate than external distractors and should be used when possible.
authors.affiliation: Registrar, Oral and Maxillofacial Surgery Unit, Royal Melbourne Hospital, Melbourne, Victoria, Australia; and Masters Candidate, Joanna Briggs Institute, School of Translational Science, University of Adelaide, Adelaide, South Australia, Australia. Electronic address: Omar.breik@gmail.com.
authors.forename: Omar
authors.initials: O
authors.lastname: Breik
authors.affiliation: Research Fellow/Supervisor, Joanna Briggs Institute, School of Translational Science, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Tivey
authors.affiliation: Supervisor, Joanna Briggs Institute, School of Translational Science, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Kandiah
authors.initials: K
authors.lastname: Umapathysivam
authors.affiliation: Professor and Consultant Craniofacial Surgeon, Australian Craniofacial Unit, Women's and Children's Hospital, Adelaide, South Australia, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Anderson
mesh_terms: D002648:Child; D002675:Child, Preschool; D019465:Craniofacial Abnormalities / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008844:Micrognathism / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000295:instrumentation / Q000379:methods*