Massive Middle Cerebral Artery Infarction After Surgically Assisted Rapid Palatal Expansion: A Case Report

Displacement and stress distribution of the craniomaxillofacial complex under different surgical conditions: a three-dimensional finite element analysis of fracture mechanics

Objective

To provide a simplified treatment strategy for patients with maxillary transverse deficiency. We investigated and compared the fracture mechanics and stress distribution of a midline palatal suture under dynamic loads during surgically-assisted rapid palatal expansion.

Methods

Based on the cone-beam computed tomography (CBCT) data of a 21-year-old female volunteer, a three-dimensional model of the cranio-maxillofacial complex (including the palatal suture) was constructed. A finite element analysis model was constructed based on meshwork. After the yield strength of the palatal suture was set, an increasing expansion force (0–500 N) was applied within 140 ms to calculate the time–load curve, which mimicked nonsurgical bone expansion (model A). The same method was used to evaluate the fracture process, time and stress distribution of the palatal suture in maxillary lateral osteotomy-assisted (model B) and LeFort osteomy I (LFIO)-assisted expansion of the maxillary arch (model C).

Results

Compared with model A, the palatal suture of model B and model C showed a faster stress accumulation rate and shorter fracture time, and the fracture time of model B and model C was almost identical. Compared with model A, we discovered that model B and model C showed greater lateral extension of the maxilla, and the difference was reflected mainly in the lower part of the maxilla, and there was no difference between model B and model C in lateral extension of the maxilla.

Conclusions

Compared with arch expansion using nonsurgical assistance (model A), arch expansion using maxillary lateral wall-osteotomy (model B) or LFIO had a faster rate of stress accumulation, shorter time of fracture of the palatal suture and increased lateral displacement of the maxilla. Compared with arch expansion using LFIO (model C), arch expansion using lateral osteotomy (model B) had a similar duration of palatal suture rupture and lateral maxillary extension. In view of the trauma and serious complications associated with LFIO, maxillary lateral wall-osteotomy could be considered a substitute for LFIO.

A comparison of tooth-borne and bone-anchored expansion devices in SARME

PURPOSE

Major adult maxillary transverse discrepancies are usually treated with surgically assisted rapid maxillary expansion (SARME), utilizing a combination of surgical and orthodontic techniques. Unfortunately, a consensus has not been reached on topics ranging from the best surgical technique that should be performed to the ideal expander type that should be installed. The present study sought to evaluate the efficiency and stability of the maxillary expansion achieved with two types of expanders following the same SARME procedure without pterygomaxillary disjunction (PMD).

METHODS

Twenty-four patients with a maxillary transverse deficiency were enrolled in the study. All patients underwent the same SARME, and 12 received a bone-anchored (KLS Martin®) and 12 were installed with a tooth-borne (Hyrax®) expander. Dental impressions were collected both preoperatively and 1 year postoperatively. These casts were scanned and the distances between specific interdental and intergingival points were measured and analyzed. Statistical analyses were performed to assess the effects expander type had on the efficiency of the maxillary expansion and long-term stability.

RESULTS

Expansion in the anterior maxillary and premolar regions was found to be similar in both groups. In contrast, the tooth-borne device resulted in a significantly greater expansion in the molar region.

CONCLUSION

The SARME technique without PMD is highly effective at treating adults with maxillary transverse deficiencies, and the type of expander selected depends on the location of the larger maxillary constriction region of each patient.

Three-Dimensional Evaluation of the Effects of Kinesio Taping on Postoperative Swelling and Pain after Surgically Assisted Rapid Palatal Expansion

Objectives

The purpose of the present study was to evaluate the effects of kinesio taping on pain and swelling after surgically assisted rapid palatal expansion.

Material and Methods

A total of 21 (12 male and 9 female) patients with transverse maxillary deficiency were enrolled in the study. Kinesio taping (KT) was applied unilaterally in each patient, whereby sides of the face with KT application were included into the (a) KT group and the other sides were included into the (b) non-KT group. Changes in facial volume were evaluated on digital images using the 3dMD Face System. Pain scores were assessed at postoperative days 1, 2, 3, 4, 5, 6, and 7 using the visual analog scale (VAS). Two-way repeated measures analysis of variance and Mann Whitney U test were used for statistical analyses.

Results

Swelling was significantly lower in the KT group compared to the non-KT group from T0 to T1 (36.42 [SD 19.71] mm³ vs. 183.84 [SD 49.33] mm³) and was significantly greater in the non-KT group compared to the KT group from T0 to T2 (70.88 [SD 15.73] mm³ vs. 21.46 [SD 13.39] mm³) (P < 0.001 for both). The VAS scores were significantly lower in the KT group compared to the non-KT group at all time points (P < 0.05).

Conclusions

The application of kinesio taping after maxillofacial surgery reduced the pain and swelling in the postoperative period. Kinesio taping can be used as an alternative to other methods that are used for the reduction of postoperative complaints.