Distraction Osteogenesis in Craniofacial Reconstruction: Clinical Applications, Device Selection, Outcomes and Future Perspectives of Internal and External Distractors - A Narrative Review

Abstract

AbstractDistraction osteogenesis (DO) has emerged as a transformative technique in oral and maxillofacial surgery, enabling simultaneous bone and soft tissue expansion through gradual mechanical traction. Since its adaptation from the Ilizarov principle to craniofacial surgery, DO has become an established treatment modality for congenital, developmental, post-traumatic, and acquired craniofacial deformities. The success of distraction osteogenesis is largely influenced by appropriate device selection, with internal (intraoral) and external (extraoral) distractors representing the two principal approaches. Internal distractors provide superior aesthetics, improved patient compliance, and lower infection rates, whereas external distractors offer enhanced three dimensional vector control and greater flexibility in managing severe skeletal deficiencies. This narrative review evaluates the biological principles, clinical applications, advantages, limitations, complications, and outcomes associated with internal andexternal distraction devices. Current evidence suggests that both modalities are effective in achieving skeletal advancement and functional rehabilitation. Internal distractors are generally preferred in mild to moderate deformities owing to their comfort and aesthetic benefits, whereas external distractors remain indispensable for complex craniofacial deformities requiring extensive skeletal movement and vector modifi-cation. Recent technological advances including computer assisted surgical planning, patient specific distractors, hybrid distraction systems, and three dimensional printing are expected to further refine treatment outcomes. Individualized treatment planning remains the corner-stone of successful distraction osteogenesis.