Craniomaxillofacial deformities/cosmetic surgery
Complications Following Surgically Assisted Rapid Palatal Expansion: A Retrospective Cohort Study

https://doi.org/10.1016/j.joms.2011.09.050Get rights and content

Purpose

To examine the prevalence of complications and characterize the associated clinical findings in patients undergoing surgically assisted rapid palatal expansion (SARPE).

Materials and Methods

A retrospective evaluation was conducted of all patients who underwent SARPE from January 2004 through December 2008 at Kaiser Permanente Oakland Medical Center. Medical records were abstracted, and demographic factors and relevant comorbidities were identified. Clinical features of patients with complications (surgical and/or dental) after SARPE were characterized.

Results

One hundred thirty-one patients comprised the study sample and 11 patients were excluded. Of the remaining 120 patients (median age, 29.5 yrs; interquartile range, 22.0 to 39.0 yrs), 51.7% were women, 41 developed at least 1 complication, 33 had surgical complications, 18 had dental and/or periodontal problems, and 10 developed both surgical and dental or periodontal problems. Asymmetric and/or inadequate expansion was the most frequent surgical complication, found in 13.3% of the study cohort, and gingival recession (8.3%) was the most common dental complication. Two patients developed catastrophic periodontal bone defects resulting in loss of the central incisors; these patients had eccentric interdental osteotomies that caused separation of the bone from the root surface of the central incisors followed by postoperative osteotomy site infections.

Conclusions

Overall, the present findings suggest that, although major complications after SARPE were rare, asymmetric or inadequate expansion and dental and/or periodontal problems primarily involving the central incisors accounted for most complications. Future prospective and long-term follow-up studies are needed to identify individual risk factors that may predispose patients to adverse outcomes after SARPE.

Section snippets

Study Design and Sample

The investigators designed and implemented a retrospective review of all patients who underwent SARPE at Kaiser Permanente Oakland Medical Center (Oakland, CA) from January 2004 through December 2008. This study was approved by the Kaiser Foundation Research Institute's institutional review board.

Subjects eligible for study inclusion were consecutive patients who underwent SARPE by 1 of 6 surgeons at the Kaiser Permanente Oakland Medical Center, with or without resident assistance, who had at

Results

One hundred thirty-one patients who underwent SARPE during the study period were identified and 11 were excluded. The study cohort consisted of 120 patients with a median age of 29.5 years (interquartile range, 22.0 to 39.0 yrs) and slightly more than half (51.7%) were women. The median follow-up was 5.6 months (interquartile range, 1.0 to 19.25 mo; Table 1). Relevant comorbidities included diabetes (n = 2), the human immunodeficiency virus (n = 1), and current smoking (n = 13). The vast

Discussion

Of 120 patients who underwent SARPE, 41 developed complications. Overall, most complications were minor and resolved with local measures; however, 15% (n = 18) required additional unanticipated treatment. Asymmetric or inadequate expansion, the most frequent surgical complication, was found in 13.3% (16/120) of the study cohort. Dental and/or periodontal problems, including central incisor discoloration, gingival recession, and periodontal bone loss, occurred in 15% of the cohort. Two patients

Acknowledgments

The authors thank Dr Kenneth Wong for his assistance in manuscript preparation and Fareeza Khurshed, MSc, and Dr David William Chambers, BA, EdM, PhD, MBA, Professor of Dental Practice at Arthur A. Dugoni University of the Pacific School of Dentistry, for statistical analysis.

References (26)

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Received from the Division of Maxillofacial Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA.

This study was funded by a grant from Stryker Craniomaxillofacial, Kalamazoo, MI.

Conflict of Interest Disclosures: None of the authors reported any disclosures.

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