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Updated: May 1, 2026
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Published on: November 14, 2018
Do Patient-Specific Distractors and Cutting Guides Reduce Operative Time in Infants Undergoing Mandibular Distraction
Jeffrey S Marschall1, Logan Sardzinksi2, Jeffrey Schootman2
1Assistant Professor, Department of Oral and Maxillofacial Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa.
Background:
Mandibular distraction osteogenesis (MDO) is a surgical treatment for upper airway obstruction in infants with micrognathia. Recent advances in computer aided design and manufacturing (CAD/CAM) have enabled the use of patient-specific cutting guides and distractors; however, limited data exist regarding the effect of patient specific hardware on MDO operative time.
Purpose:
The purpose of this study was to evaluate if the use of stock distractors with patient-specific cutting guides or patient-specific mandibular distractors with patient specific cutting guides was associated with decreased operative time compared to stock distractors alone for infants who underwent MDO.
Study Design, Setting, Sample:
A retrospective cohort study using consecutive cases was completed of infants treated with MDO at a single tertiary pediatric hospital between 2015 and 2026. Subjects older than 1 year of age or with incomplete data were excluded.
Predictor Variables:
Predictor variables included hardware used (group 1: stock distractors alone; group 2: stock distractors with patient specific cutting guides; group 3: patient specific distractors with patient specific cutting guides), age at first surgery (days), weight at first surgery (kg), sex, and presence of a syndromic diagnosis.
Outcome Variables:
The primary outcome variable was operative time (minutes).
Covariates:
Covariates included age, weight, sex, and syndromic diagnosis.
Analyses:
Descriptive statistics were calculated for all variables. Group comparisons were performed using Fisher's exact test or Kruskal-Wallis test. A linear regression model was constructed to identify independent predictors of operative time. Statistical significance was set at P< .05.
Results:
40 subjects were included in the analysis. Median age at surgery was 75 days (IQR, 30 to 133), and median operative time for the cohort was 198 minutes (IQR, 172 to 238). Stock distractors alone (group 1) were used in 15 (37.5%) cases, stock distractors with patient-specific cutting guides (group 2) in 15 (37.5%), and patient-specific distractors with patient-specific cutting guides (group 3) in 10 (25%). Median operative times were 232 minutes (IQR, 195 to 276), 184 minutes (IQR, 147 to 221), and 187 minutes (IQR, 171 to 228), respectively (P= .024). Linear regression demonstrated significantly reduced operative time with stock distractors with patient-specific cutting guides (β = -52 minutes; 95% CI, -86 to -18; P= .004) and with patient-specific distractors with cutting guides (β = -43 minutes; 95% CI, -81 to -4.7; P= .029).
Conclusion/Relevance:
Use of patient-specific cutting guides and distractors during MDO is associated with a clinically meaningful reduction in operative time. These findings support the routine incorporation of digital planning and patient-specific hardware use to improve operative efficiency in infants undergoing MDO.
