What is the most common complication of surgically-assisted rapid palatal expansion (SARPE)?

Most Common Complication of Surgically-Assisted Rapid Palatal Expansion (SARPE)

The most common complication of surgically-assisted rapid palatal expansion (SARPE) is transient neurosensitive deficit, specifically hypoesthesia of the lower lip, which does not typically affect patients' quality of life. 1

Prevalence of Complications in SARPE

SARPE is generally considered a procedure with minimal patient morbidity, but it is not without risks. Studies have shown various complication rates:

• Overall complication rates vary by appliance type, with tooth-borne appliances having a 17.2% complication rate, bone-borne appliances 66.7%, and orthodontic mini-implant-borne appliances 15.4% 2
• In a large retrospective study of 120 patients, 41 patients (34.2%) developed at least one complication 3
• In another study of 55 patients, 28 patients (50.9%) presented with one or more complications 4

Neurosensitive Complications

• Transient anesthesia of the cheek and chin area occurs in virtually all patients immediately after surgery 1
• Residual neurosensitive deficit (hypoesthesia of the lower lip) is the most common persistent complication 1
• Injury to the infraorbital nerve was observed in 16 out of 55 patients (29.1%) in one study 4

Other Common Complications

Skeletal/Expansion-Related Complications

• Asymmetric and/or inadequate expansion was found in 13.3% of patients in one large cohort study, making it the most frequent surgical complication in that population 3
• Relapse is common, with studies showing varying rates:
  • Tooth-borne appliances: 1.44 mm (7.18%) relapse at the premolar level 2, 5
  • Bone-borne appliances: 0.76 mm relapse 2
  • Orthodontic mini-implant-borne appliances: 0.27 mm relapse 2

Dental and Periodontal Complications

• Gingival recession was reported in 8.3% of patients in one study, making it the most common dental complication 3
• Dental complications including damage to teeth were seen in 5 out of 55 patients (9.1%) in another study 4
• Buccal attachment loss (0.6 ± 0.5 mm) has been observed, particularly in female subjects 6
• Severe periodontal complications are rare but can be catastrophic - two patients in one study developed severe periodontal bone defects resulting in loss of central incisors 3

Other Significant Complications

• Postoperative hemorrhage was observed in 6 out of 55 patients (10.9%) 4
• Severe postoperative pain requiring additional management was reported in 4 out of 55 patients (7.3%) 4
• Perforation of the palate has been reported 1
• Maxillary pseudarthrosis can occur 1
• Malocclusion and dysgnathia due to mandibular deficiencies have been documented 1

Risk Factors and Prevention

• Eccentric interdental osteotomies can cause separation of bone from the root surface of central incisors, predisposing to periodontal defects 3
• Postoperative osteotomy site infections increase the risk of periodontal complications 3
• Careful patient selection and planning are essential to minimize complications 4

Clinical Implications

• Despite the occurrence of complications, most are mild and transient 4
• Prolonged hospital stay was necessary in 6 out of 55 patients (10.9%) in one study 4
• Additional surgery was required in only 2 out of 55 cases (3.6%) 4
• Most patients tolerate the neurosensitive changes well, with minimal impact on quality of life 1

In summary, while SARPE is generally considered safe, clinicians should be aware of the range of potential complications, with neurosensitive deficits being the most common persistent issue that patients may experience.