Mandibular midline distraction: A systematic review

Introduction: A systematic review of mandibular midline distraction (MMD) was carried out to assess effectiveness, treatment related difficulties, complications and biomechanical effects of this treatment modality objectively. Material & methods: Randomized controlled trials (RCT), controlled clinical trials (CCT) and case series concerning MMD with a sample size of >5 were searched electronically in Pubmed/Medline, Embase, Cochrane and CENTRAL up to September 6th 2010. Results: 85 unique articles were found of which 22 met our inclusion criteria. The study designs of the articles found were prospective (9), retrospective (9) or uncertain (2). One clinical trial and no randomized clinical trials were found. The methodological quality was considered low in most articles. Conclusion: Generally MMD is a safe and effective treatment modality to treat transverse mandibular discrepancies, however controversies still exist: choice of distractor, surgical setting, distraction rate, start of orthodontic treatment and relapse. In addition, little is known about patient experience and quality of life after treatment. Further prospective trials are necessary to address these controversies and questions. (C) 2011 European Association for Cranio-Maxillo-Facial Surgery.