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This study focused mainly on the safety and unexpected incidents of mandibular distraction osteogenesis in treating patients with hemifacial microsomia.Records of 71 patients with hemifacial microsomia treated by mandibular distraction osteogenesis from February of 2010 to March of 2015 were examined in this retrospective study. The modified mandibular osteotomy was conducted under the assistance of three-dimensional reconstruction, computer-aided design, and rapid prototyping technique. Distraction was conducted 4 to 7 days postoperatively at a frequency of 1 mm/day; moreover, the distractor was kept in place for 4 to 13 months after the first operation before it was removed. The scope of distraction ranged from 20 to 40 mm. All incidents encountered during and after the mandibular distraction process were documented in the medical records of patients. The patients were followed up for an average of 34.4 months after the second-stage operation.The overall rate of incidents was 36.6 percent. Of them, minor incidents, which could be resolved with or without noninvasive therapy, were observed in 18.3 percent of all procedures in this series. Meanwhile, the rate of moderate incidents necessitating invasive therapy was reported to be 12.7 percent, whereas that of major incidents that could not be resolved with invasive therapy was 5.6 percent.Mandibular distraction osteogenesis is a widely used procedure for treating patients with hemifacial microsomia. It is extremely important to be fully aware of a variety of incidents occurring during and after the surgical procedure to minimize the frequency of occurrence of such incidents.Therapeutic, IV.