Surgically-assisted rapid palatal expansion for management of transverse maxillary deficiency

An adequate transverse maxillary dimension is a critical component of a stable and functional occlusion.’ Orthopedic rapid palatal expansion in skeletally immature patients is the procedure of choice to correct this condition in that age group. However, as skeletal maturity approaches, bony interdigitation increases as the sutures fuse.2,3 This leads to difficulty separating the maxillas with orthopedic forces alone and bending of the alveolus, dental tipping and minimal maxillary expansion. The result is relapse despite overcorrection, periodontal defects, and malocclusion.4 A variety of surgical procedures including surgically-assisted rapid palatal expansion (SARPE) and segmental LeFort I osteotomies have been advocated in the treatment of transverse maxillary deficiency in skeletally mature patients. The decision to choose one surgical procedure over another has led to some controversy in the literature. The reasoning behind advocating SARPE will be discussed in this article. The isolated transverse maxillary deficiency can be treated either orthodontically or surgically with rapid palatal expansion. However, the long-term stability of the expansion is directly related to the skeletal maturity of the suture lines.5 Krebs6 showed that as sutures mature the majority of orthopedic rapid palatal expansion occurs by dental tipping and alveolar bone bending rather than by skeletal movement. Relapse, with an open bite deformity, may result when fixation is removed.