Rapid Maxilla Expansion Technique in Patients With Severe Hemophilia Type A: Treatment Protocol

Performing major surgical procedures on hemophilia patients is a challenge for dental surgeons. Hemophilia is a hereditary bleeding disorder linked to the X chromosome and can be classified as type A, characterized by changes in coagulation factor VIII, and type B, in factor IX. The objective of this study is to report the authors' experience in the treatment of hemophilia patients undergoing surgically assisted rapid maxillary expansion. Two adult patients diagnosed with maxillary atresia and severe Hemophilia A were treated with factor VIII replacement preoperatively, aiming for plasma levels of 100% and maintenance of replacement during the Hyrax device activation period at levels of approximately 40% to 50%. In the trans-operative period, fibrin sealant was applied to the osteotomy line and surgical wound. The cases were treated by the Oral and Maxillofacial Surgery and Traumatology service and by the Hematology and Hemotherapy service of a tertiary hospital. No complications were associated with the treatment period. Surgical treatment of maxillary atresia, conducted by a maxillofacial surgeon, and systemic clinical management performed by a hematologist in patients with severe Hemophilia A, proved to be effective and safe for the two cases reported.