Feasibility and long-term stability of surgically assisted rapid maxillary expansion with lateral osteotomy

Abstract

Surgically assisted rapid maxillary expansion (SARME) has become a widely used and acceptable means to expand the maxilla in adolescents and adult patients. The method takes advantage of bone formation at the maxillary edges of the midline, while they are separated by an external force. The purpose of the present retrospective investigation was to evaluate the feasibility and long-term stability of maxillary expansion in patients in whom lateral pre-expansion osteotomy had been performed. The subjects were 20 patients (14 females, six males, mean age 30.6 years, range 16.2-44.2 years) whose malocclusions were treated solely or partly with SARME during 1988-1996. Two orthodontists carried out the post-orthodontic expansion treatment. The surgical technique followed a minimally invasive osteotomy on the lateral maxillary walls. Study models were obtained before surgery (T1), once expansion and the following orthodontic treatment were completed, before possible second-stage osteotomy (T2), and at long-term follow-up (T3). Using the study models, the width of the dental arch was measured with a digital sliding calliper. In addition, transverse occlusal relationships were examined at each time point. The results indicated that (1) SARME is possible when the minimally invasive operation technique is used, (2) long-term stability of maxillary expansion following the present technique compares favourably with the widening and stability achieved with other, more invasive, osteotomies. With age, several possible uncertainties are introduced to affect the course of SARME adversely. Therefore, more extensive osteotomies can be recommended in older patients.

Relevant Aspects in Surgical Expansion Osteotomies Used in the Management of Maxillary Atresia for Efficiency and Stability

“…To Antilla, et al [12] it is clear that there is no consensus regarding the minimal osteotomy required to facilitate maxillary expansion and that the question posed by Pogrel [10], namely "What is the minimum procedure required to produce consistent, stable maxillary expansion in adults?" could be answered in the following way: more extensive osteotomies could be indicated for older patients, taking into account that the surgical procedure should be in accordance with the type of expansion and the degree of expansion required [3,12].…”

“…could be answered in the following way: more extensive osteotomies could be indicated for older patients, taking into account that the surgical procedure should be in accordance with the type of expansion and the degree of expansion required [3,12].…”

“…Lehman, too, reported that Surgically Assisted Rapid Maxillary Expansion (SARME) could be carried out in adults when a minimally invasive surgical technique is used involving the lateral walls of the maxilla. In the procedure described there was no separation of maxilla and pterygoid plates and no invasion of the pterygo-maxillary junction [12].…”

Surgical treatment of maxillary transverse deficiency: retrospective study of 14 patients

“…When making treatment decisions, patient morbidity and the ability to achieve stable and predictable results with minimal disruption of routine activities should be the deciding factors in developing a treatment plan [3]. SARME has become a widely used and efficient means to expand the maxilla in skeletal mature patients [8]. However, the diverse osteotomies that have been proposed to facilitate the procedure highlight the fact that no consensus has been reached about the minimum osteotomy required to achieve maxillary expansion [8,9].…”

“…SARME has become a widely used and efficient means to expand the maxilla in skeletal mature patients [8]. However, the diverse osteotomies that have been proposed to facilitate the procedure highlight the fact that no consensus has been reached about the minimum osteotomy required to achieve maxillary expansion [8,9].…”