Burcu GÜRSOYTRAK, Yazgı Ay ÜNÜVAR, Mehçure Nur ALBAYRAK

Evaluation of Complications Associated with Surgically Assisted Rapid Maxillary Expansion in Cases with or Without Pterygomaxillary Disjunction

Objective: Surgically assisted rapid maxillary expansion (SARME) is a widely used treatment method for the correction of transversal deficiencies of the maxilla. The gold standard treatment method among various surgical techniques has not been established. This retrospective study aimed to determine complications in SARME cases with and without pterygomaxillary disjunction and evaluate the differences between intraoperative and post-operative complications between the two groups. Materials and Methods: We enrolled 38 patients (25 females and 13 males) who underwent SARME under general anaesthesia at Aydın Adnan Menderes University Faculty of Dentistry between January 2015 and January 2020 in this study. These patients were divided into the following two groups: Patients with pterygomaxillary disjunction group and patients without pterygomaxillary disjunction group. The intraoperative and post-operative complications were evaluated for both the groups. Results: Technically, the pterygoid junction was broken in 17 of the 38 patients included in this study with SARME; however, it was intact in 21 patients. Intraoperative haemorrhage was observed in two patients in the group with pterygomaxillary disjunction and in one patient in the group without pterygomaxillary disjunction. Electrocauterisation was performed to control bleeding in both the groups. In the group with pterygomaxillary disjunction, post operative hematoma was observed following intraoperative haemorrhage in two patients, post-operative asymmetric expansion in two patients and post-operative unilateral transient paraesthesia in one patient. Conclusion: The most common complication was haemorrhage, which was more observed in the group with pterygomaxillary disjunction. However, asymmetric disjunction was also seen in the group with pterygomaxillary disjunction. Whereas, minor complications were observed in the group without pterygomaxillary disjunction. As a result, the surgical technique, where the pterygoid junction remained intact, has minimal risk for complications.

Pterygomaksiller Ayrılmanın Olduğu Ya Da Olmadığı Olgularda Cerrahi Destekli Hızlı Maksiller Genişletme ile İlişkili Komplikasyonların Değerlendirilmesi

Amaç: Cerrahi destekli maksiller genişletme, maksillanın transversal yön yetersizliklerinin düzeltilmesinde yaygın olarak kullanılan bir tedavi yöntemidir. Yapılan çalışmalarda bu tedavi yönteminde kullanılan farklı cerrahi tekniklerle ilgili bir altın standart bulunamamıştır. Bu retrospektif çalışmanın amacı pterygomaksiller ayrılmanın gerçekleştiği ve gerçekleşmediği cerrahi destekli hızlı üst çene genişletme olgularında görülen komplikasyonları belirlemek ve iki grup arasındaki intraoperatif ve post-operatif komplikasyon farkını değerlendirmektir. Gereç ve Yöntemler: Aydın Adnan Menderes Üniversitesi Diş Hekimliği Fakültesi'nde Ocak 2015-Ocak 2020 tarihleri arasında genel anestezi altında cerrahi destekli hızlı maksiller genişletme yapılmış tüm hastaların verileri retrospektif olarak taranmıştır. Dosyada verileri tam olan 38 adet hasta çalışmaya dahil edilmiştir. Bu hastalar pterygomaksiller ayrılma olan ve olmayan olarak iki gruba ayrılarak, bu iki grup için de intraoperatif ve post-operatif komplikasyonlar değerlendirilmiştir. Bulgular: Çalışmaya dahil edilen 38 hastanın (25 kadın,13 erkek) 17’sinde cerrahi destekli maksiller genişletmede teknik olarak pterygoid bağlantı kırılmış, 21’inde ise pterygoid bağlantı kırılmamıştı. Pterygoid ayrılan grupta 2 hastada, pterygoid ayrılmayan grupta ise 1 hastada intraoperatif hemoraji geliştiği görüldü. Her iki grupta da kanama kontrolü için elektrokoterizasyon kullanılmıştı. Pterygoid ayrılan grupta 2 hastada intraoperatif hemorajiyi takiben postoperatif hematom, 2 hastada post-operatif asimetrik ekspansiyon ve 1 hastada post-operatif tek taraflı geçici parestezi görüldü. Sonuç: En sık karşılaşılan komplikasyon hemorajiydi ve bu da pterygoid bağlantının ayrıldığı grupta daha sık gözlendi. Yine asimetrik ayrılma da pterygoid bağlantının ayrıldığı grupta görüldü. Pterygoid bağlantının ayrılmadığı grupta minör komplikasyonlar gözlendi. Sonuç olarak pterygoid bağlantının kırılmadığı cerrahi teknik komplikasyon açısından daha az risklidir.

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