Stability of Surgically Assisted Rapid Palatal Expansion

The aim of this study was to evaluate the orthodontic retention of maxillary skeletal stability after surgically assisted rapid palatal expansion (SARPE). Ninety digitized plaster casts from 30 adult patients who underwent SARPE were assessed. Thirty patients were divided equally into two groups: the No Retention Group (n = 15) and the Retention Group (n = 15) with a Transpalatal Arch [TPA]). After the end of expansion, the expander appliance was stabilized and remained in place for 4 months. The additional retention period began in the Retention Group as soon as the expander was removed and replaced by a TPA. During the same period, the No Retention Group remained without retention. The casts were created pre-operatively, at 4 months and 10 months post-expansion. The models were digitized by means of a 3D Vivid 9i laser scanner. The palatal area and volume were assessed. Both variables increased after 4 months compared with pre-operative values ( p < .05). At 10 months, patients’ palatal areas and volumes were stable in both groups ( p > .05). In conclusion, no retention other than the expander appliance is needed after SARPE (ClinicalTrials.gov, NCT01770782).

[Necrotizing fasciitis after varicella]

Necrotizing fasciitis is a rare and severe infection characterised by extremely rapid progressive involvement of the superficial fascias and deep dermal layers of the skin, with resultant vasculitis and necrosis. The authors present three clinical cases of necrotizing fasciitis; all three patients previously had varicella rash, rapid progressive spreading erythema with severe pain and toxic shock syndrome. Two patients had positive cultures of b-haemolytic streptococcus. Early stage differential diagnosis with celulitis, aggressive antibiotic treatment and pediatric intensive care support are essential. However, the main therapy is early extensive surgical approach involving all indurate areas, down to and including the muscle fascia.