Prostaglandin-E2 Mediated Inflammatory Response and Vas-Reported Pain During Rapid Maxillary Expansion in Patients with and Without Cleft: Prospective Cohort Study

Abstract

Objective

To compare subjective pain perception and local inflammatory response during rapid maxillary expansion (RME) in patients with and without cleft defects.

Design

Prospective cohort study.

Setting

Institutional clinical setting.

Participants

Sixteen patients were equally allocated to cleft and non-cleft groups (mean age: 9.5 ± 1.9 and 10.5 ± 1.2 years, respectively).

Interventions

All patients underwent tooth-borne rapid maxillary expansion using a standardised activation protocol of two turns per day (0.5 mm/day).

Main Outcomes Measures

Local inflammatory response was assessed by measuring prostaglandin E2 (PGE2) levels, while subjective pain was evaluated using a visual analogue scale (VAS). Measurements were recorded at baseline (T0), 1 day after the first activation (T1), at 7 days (T2), 14 days (T3), and 5 days after the final activation (T4).

Results

PGE2 peaked at T1 in both groups (cleft = 91.91 ± 48.52 pg/ml, non-cleft = 95.20 ± 53.98 pg/ml), then declined through T4. The values were higher in the non-cleft group, but not significant. VAS scores were significantly higher in the non-cleft group compared to the cleft group at T1 (4.50 ± 0.76 and 3.25 ± 1.67, respectively; p = 0.021), with no significant differences at T2 and T3. By T4, pain levels were minimal in both groups. Pearson correlation demonstrated a weak association between PGE2 levels and VAS scores.

Conclusions

Patients without cleft experienced higher subjective pain only after initial RME activation, while local inflammatory responses were comparable between groups throughout treatment.

Clinical Trial Registration

The Clinical Trials Registry- India (CTRI/2024/06/068906).