Studio clinico osservazionale sul dolore e i disturbi correlati all’espansione rapida del palato in pazienti pediatrici con e senza labiopalatoschisi

Introduction and Objectives Rapid palatal expansion (RPE) is an orthodontic procedure aimed at correcting transverse discrepancies of the upper dental arch to improve both aesthetics and function. It is particularly recommended for growing patients, promoting harmonious skeletal development by widening the maxilla. Pain experience and adverse events may vary depending on craniofacial syndromes, expander type, and anchorage site. This study aimed to evaluate the intensity of pain and associated disturbances in pediatric patients with cleft lip and palate and non-syndromic patients treated with Haas or Hyrax expanders, and to analyze the influence of the anchorage site on pain perception. Materials and Methods A total of 152 patients were included: 47 with cleft lip and palate and 105 non-syndromic. Patients were divided according to expander type: 43 received a Haas expander (18 syndromic, 25 non-syndromic) and 109 a Hyrax expander (29 syndromic, 80 non-syndromic). Pain was monitored daily for up to 21 days, with focus on the first three weeks when data completeness was highest. Pain was assessed using the Wong-Baker scale, with daily scores averaged for each patient. Comparative analyses between groups employed the non-parametric Mann-Whitney U test. Treatment-related disturbances—including increased salivation, difficulty speaking, swallowing difficulties, and epistaxis—were analyzed using contingency tables and Fisher’s exact test. The effect of the expander’s anchorage site (deciduous teeth vs. first permanent molars) on pain perception was also investigated. Results In the Haas group, the presence of cleft lip and palate did not significantly affect mean pain (0.70 ±0.91 vs. 0.94 ±0.75; p = 0.2037). Daily pain was initially low (mean 1.9 in syndromic, 1.2 in non-syndromic patients) and rapidly stabilized at low levels. In the Hyrax group, non-syndromic patients reported significantly higher mean pain than syndromic patients (1.38 ±0.64 vs. 0.98 ±1.21; p = 0.0003), with high initial pain (mean 4.5) decreasing below 1 after 18 days. Syndromic patients treated with Hyrax reported lower initial pain (mean 2.6) and rapid reduction within the first week. Regarding anchorage, when placed on deciduous teeth, non-syndromic patients experienced higher pain than syndromic patients (1.61 ±0.72 vs. 0.82 ±1.05; p = 0.0020). Anchorage on first permanent molars showed no significant differences (p = 0.6823). Concerning disturbances, the Haas expander showed no significant differences between groups. For Hyrax, swallowing difficulties were more frequent in non-syndromic patients (51.25%) than in syndromic ones (6.90%; p = 0.0006). Other disturbances—such as increased salivation, difficulty speaking, and epistaxis—showed trends without statistical significance. Conclusions Pain perception and the frequency of disturbances during RPE are influenced by cleft lip and palate, expander type, and anchorage site. The Hyrax expander is associated with higher initial pain in non-syndromic patients and a higher frequency of swallowing difficulties, whereas the Haas expander generally results in lower pain, less influenced by syndromic conditions. Anchorage on deciduous teeth correlates with higher pain in non-syndromic patients, while permanent molar anchorage does not show significant differences. These findings highlight the importance of personalizing orthodontic management according to the patient’s clinical profile, optimizing expander selection, and considering the anchorage site to reduce pain and improve patient quality of life. Further studies with larger samples are recommended to confirm these results.