Infection rate following mandibular distraction with internal and external devices in infants

Background

Internal and external devices may be utilized in mandibular distraction osteogenesis (MDO) for the correction of symptomatic micrognathia in infants and children.

Purpose

To compare the rate and severity of infection between internal and external MDO devices.

Study design, setting, sample

Retrospective cohort study utilizing an institutional database of patients who underwent MDO.

Independent variable

Use of internal versus external MDO hardware.

Main outcome variables

Rate of post-operative surgical site infections (minor and major).

Covariates

Patient age, device type, laterality, infection, and treatment were documented.

Analysis

Chi-Square and Fisher Exact Tests were used where appropriate for categorical variables and two-tailed T-tests were used for continuous variables. Significance was set at p < 0.05.

Results

Between 2010 and 2022, 36 infants (ages 7 days-12 months) underwent bilateral MDO. Thirteen cases utilized internal hardware (n = 26 surgical sites) and 23 cases utilized external hardware (n = 46 surgical sites). Fifteen patients developed post-operative infections (41.7 %), 11 of which were minor infections and 4 were major infections. Seven patients with internal devices (53.8 %) and 8 patients with external devices (34.8 %) developed an infection (p = 0.27). Minor infections occurred in 4 patients with internal hardware (30.8 %) and 7 patients with external hardware (30.4 %; p = 1.00). Major infections occurred in 3 patients with internal hardware (23.1 %) and 1 patient with external hardware (4.3 %; p = 0.25). There were 19 surgical site infections (26.4 %), 14 of which were minor infections and 5 of which were major infections. Ten internal devices (38.6 %) and 9 external devices (19.6 %) were complicated by infection (p = 0.08). Minor infections occurred in 6 internal devices (23.1 %) and 8 external devices (17.4 %; p = 0.56). Major infections occurred in 4 internal devices (15.4 %) and 1 external device (2.2 %; p = 0.05).

Conclusion

No significant difference was found in overall postoperative infection rate with internal and external MDO. A lower rate of major infection was observed in external devices.