Surgically Assisted Rapid Palatal Expansion

SARPE or Surgically Assisted Rapid Palatal Expansion is a technique in the field of orthodontics which is used to expand the maxillary arch. This technique is a combination of both surgical and orthodontic processes. This procedure is primarily done in adults whose palatal sutures have fused and cannot be expanded via other techniques.

History

Orthodontic expansion was first described by Emersen Angell about 145 years ago. Kole in 1959 was the first person to speak about about the procedure of corticotomy in adults with maxillary constriction.[1]

Indications

Procedure

The procedure itself is part of two surgery process. Under the first surgery, SARPE is performed to address the transverse dimension changes in a patient. This surgery is then followed by Le Fort 1 in a second surgery to address the vertical and the anterior-posterior changes. Between the two surgeries, a patient's constricted maxillary arch is expanded with the rapid maxillary expander device placed in the maxilla. For the first surgery, under general anesthesia, a patient first goes through Le Fort fracture of skull without the downfracture of maxilla. The oral surgeon also performs the midpalatal osteotomy to allow the break in the inter-maxillary suture. The surgeon, while performing the LeFort 1 osteotomy, may separate the pterygoid plates during this procedure. This separation of the plates is termed as Pterygomaxillary disjunction (PMD). Some of the surgeons are cautious in their approach to separate the pterygoid processes due to a risk of injury to pterygoid plexus.

Sangsari et al. published a systematic review and a meta-analysis in 2016 which studied the effects of PMD on the outcome of SARPE. From the 3 studies that were included in their criteria, they concluded that the literature is inconclusive regarding the effect of PMD on the outcomes of SARPE and that further controlled trials are needed.[2]

Stability of procedure

Chamberland and Profitt in 2011 published a paper in AJODO which looked at long-term and short-term effects of SARPE procedure. The procedure of SARPE was done with pterygoid plate separation to achieve the transverse expansion of the maxilla. The authors observed skeletal changes of about 3-4mm and these changes were stable.[3] In an earlier study published in 2008,[4] the same authors stated that about one-third of the transverse dental expansion obtained with SARPE is lost, however the skeletal expansion remains the same. They also stated that post-surgical relapse with SARPE was similar to the changes in dental arch dimensions after non-surgical rapid palatal expansion, and also quite similar to dental arch changes after segmental maxillary osteotomy for expansion. Therefore, the stability of the procedure is not superior to other known expansion techniques.

Contrary to the newer studies, a study performed in 1997 by Northway et al. stated that the long-term buccogingival expansion was more acceptable in adults expanded with surgical augmentation than in those expanded orthopedically.[5] However, a setback of this study was that the measurements were dental on dental models of patients, and not PA Cephalograms that were used in the study done by Profitt.

Disadvantages

References

  1. ↑ Koudstaal, M. J.; Poort, L. J.; van der Wal, K. G. H.; Wolvius, E. B.; Prahl-Andersen, B.; Schulten, A. J. M. (2005-10-01). "Surgically assisted rapid maxillary expansion (SARME): a review of the literature". International Journal of Oral and Maxillofacial Surgery. 34 (7): 709–714. doi:10.1016/j.ijom.2005.04.025.
  2. ↑ "Surgically Assisted Rapid Palatomaxillary Expansion With or Without Pterygomaxillary Disjunction: A Systematic Review and Meta-Analysis". www.sciencedirect.com. Retrieved 2016-11-12.
  3. ↑ Chamberland, Sylvain; Proffit, William R. (2016-11-14). "Short-term and long-term stability of surgically assisted rapid palatal expansion revisited". American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics. 139 (6): 815–822.e1. doi:10.1016/j.ajodo.2010.04.032. ISSN 0889-5406. PMC 4044726Freely accessible. PMID 21640889.
  4. ↑ Chamberland, Sylvain; Proffit, William R. (2016-11-14). "A CLOSER LOOK AT STABILITY OF SURGICALLY-ASSISTED RAPID PALATAL EXPANSION". Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons. 66 (9): 1895–1900. doi:10.1016/j.joms.2008.04.020. ISSN 0278-2391. PMC 2556547Freely accessible. PMID 18718397.
  5. ↑ Northway, W. M.; Meade, J. B. (1997-01-01). "Surgically assisted rapid maxillary expansion: a comparison of technique, response, and stability". The Angle Orthodontist. 67 (4): 309–320. doi:10.1043/0003-3219(1997)0672.3.CO;2. ISSN 0003-3219. PMID 9267580.
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