Mandibular Distractor Site Care

Important information:

Your child has had surgery to place mandibular distractors. These devices pass through the skin and muscle and attach to the jawbone. They help advance the jawbone and move soft tissues forward to keep the airway open.

Patient instructions: Daily care and cleaning

You will need to care for the distractor sites 3 to 4 times each day.

Before cleaning the sites, check for signs of infection, including:

• Redness or tenderness around the pins

• Pus (thick, creamy drainage) coming from any distractor site

• Fever of 101°F (38.3°C) or higher

• Bleeding from a distractor site that does not stop with pressure

If you see signs of infection:

• Monday through Friday, 8 am to 5 pm call 215-590-2208

• Evenings, weekends, and holidays call 215-590-1000 and ask for the plastic surgery resident  on call

• If you are asked to send photos, email them to [email protected] or send through your MyCHOP account.

Gather supplies:

• 2 clean disposable cups, such as small paper cups

• Tap water

• A mixture of half hydrogen peroxide and half tap water (only if there is crusting)

• Clean cotton swabs

• Mepilex® Lite (a thin, soft foam dressing; your case manager will help you order supplies) NOT required after discharge from hospital unless directed to use by the Plastic Surgery Team.

• Clean scissors (to cut the dressing) only to be used only for distractor care

• Paper tape, found in the first aid section of a drugstore

Cleaning steps for distractors without crusting

1. Fill one cup with tap water.

2. Remove the old dressing, if present, and throw it away.

3. Check the distractor sites for signs of infection.

4. Wet a cotton swab with tap water.

5. Gently clean around the distractors. Use a new swab when the old one gets dirty. Use a new swab for each distractor site.

6. If the distractor arms are in place:

• Cut a slit in the foam dressing so it fits under and around the distractor arms

• Place the foam dressing around the distractor

Cleaning steps for distractors with crusting

1. Fill one cup with tap water and the other with a mixture of half hydrogen peroxide and half tap water.

2. Remove the old dressing, if present.

3. Check the distractor sites for signs of infection.

4. Wet a cotton swab with the water and hydrogen peroxide mixture.

5. Gently clean around the distractors. Use a new swab when the old one gets dirty. Use a new swab for each distractor site.

6. Gently remove loosened crusts.

7. Wet a new cotton swab with tap water.

8. Gently rinse the distractor sites. Use a new swab when the old one gets dirty. Use a new swab for each distractor site.

9. If the distractor arms are in place:

• Cut a slit in the foam dressing so it fits under and around the distractor arms

• Place the foam dressing around the distractor

Contact your CHOP healthcare team with questions, concerns, or signs of infection above.

Division of Plastic, Reconstructive and Oral Surgery

Monday through Friday, 8 AM -5 PM 215-590-2208

Evenings, weekends, and holiday, call 215-590-1000 and ask to speak with the plastic surgery resident or fellow on call

Reviewed February 2025 by Nancy Folsom, RN