Clinical outcomes of transpalatal distraction for transverse maxillaryhypoplasia: a retrospective study

Abstract

Aim of study The aim of this clinical retrospective study is to evaluate the clinical outcomes of patients with transverse maxillary hypoplasia who underwent surgical assisted maxillary expansion (SARME) using a bone borne distractor in 2 different surgical centers.

Patients and Methods This is a clinical retrospective cross‐sectional study of adult patients diagnosed with maxillary transverse hypoplasia and having had transpalatal distraction by SARME done in two surgical centers (Oral and Maxillofacial Surgery, The University of Hong Kong, Hong Kong and The Baruch Padeh Medical Center, Poriya, Israel) from January 2004 to December 2011. A total of 37 patients were identified. The mean age was 27.1. Each patient underwent a standard Le Fort I osteotomy with midline split with no mobilization under general anesthesia. A bone‐borne palatal distractor was fitted on the hard palate. The distractor was activated at a rate of 0.6mm per day following 5 ‐ 7 days of latency until the amount of expansion was reached according to plan. Occlusal radiographs and lateral cephalographs were obtained at pre‐expansion phase and regular postoperative intervals during the activation and consolidation period. Among the 37 patients, only 15 patients could be contacted by phone, mail or e‐mail and has agreed to participate in the cross‐sectional analysis. Clinical examination was performed and included the following: tooth vitality, tooth mobility, periodontal status and occlusion. Questionnaire was also given to patients to grade their experiences toward the treatment outcome.

Results The mean transverse expansion achieved was 9.58mm. The TPD was removed from the patients in the ranged of 2 months to the longest 8 months (mean: 5.2 months). The distraction gap was gradually ossified by bone and then the teeth were aligned into the space achieving stable dental occlusion. No intra‐operative complications were recorded. Post‐operatively, 2 patients had to be re‐operated due to failure to activate the distractor. Others post‐operative complications encountered were pain, fixation screw loosening, insufficient distractor length, infection, asymmetric expansion and tooth migration into the distraction gap. These complications were well managed accordingly. Majority of the patients were satisfied with the treatment and will recommend it to others.

Conclusions Correction of maxillary transverse hypoplasia using a transpalatal distractor can reliably achieve large bony expansion of the maxillary arch with few postoperative complications.