Using Computed Tomography to Evaluate Maxillary Changes After Surgically Assisted Rapid Palatal Expansion

Abstract

Surgically assisted rapid palatal expansion (SARPE) is the procedure of choice for treating transverse maxillary deficiency in adult patients. The use of computed tomography (CT) as a method of evaluating the efficiency of this procedure has not been yet reported. Consequently, few landmarks for use in evaluating maxillary expansion have been defined. The goals of the present study were to define parameters to assess skeletal changes after SARPE and to use CT to evaluate those parameters. From June of 2004 to May of 2005, 15 patients underwent SARPE (a modified Le Fort I maxillary osteotomy without pterygomaxillary separation, together with a sagittal palatal osteotomy) according to a defined protocol. To determine the pattern of transversal expansion, linear and angular measurements of the anterior, intermediate, and posterior portions of the maxilla were evaluated in axial and coronal views. The cross-sectional area of the maxilla was calculated to obtain general information about maxillary expansion. The reliability of the method was confirmed. Significant overall expansion was observed. However, different patterns of expansion were seen in the three regions analyzed. In the anterior and intermediate portions of the maxilla, the increase in maxillary width was greater than that observed in the posterior portion. The transverse expansion of the maxilla achieved through SARPE without pterygoid plate separation was less than uniform. The accurate evaluation of the postoperative changes was heavily dependent upon images acquired through CT.

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

“…The improvement in nasal breathing of the twelve patients that complained of breathing problems prior to the surgery is in agreement with the data obtained in other studies [9,18,19]. Subjective evaluation of nasal breathing was also performed by Ribeiro Júnior et al [20] who revealed that 60% of his patients that underwent SARME reported improved nasal breathing.…”

“…The present study indicates that it is possible to achieve the desired expansion without the pterygomaxillary osteotomies. The technique used was found to be favorable comparared to the widening and stability achieved in other reports in wich less invasive osteotomies were used [9,12,13,16].…”

“…When pterygomaxillary and/or lateral nasal osteotomy and nasal mucoperiosteal dissection are not performed, the risk of an intra-or postoperative hemorrhage is very low [3,6,9]. In our study, none of the patients experienced hemorrhaging.…”

“…Some authors [9,12,13,16] favor SARME without pterygomaxillary osteotomies, while others [2,15] believe that pterygomaxillary osteotomies are essential in order to achieve a complete expansion in adults. Due to these clinical inconsistencies, experimental studies like those of Kennedy et al [4], Shetty et al [14] and Han et al [17] have been conducted.…”

“…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].…”