Surgically Assisted Rapid Palatal Expansion

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SARPE or Quick Expansion of Surgical Enlargement Surgery is a technique in the orthodontic field used to extend the arch of the upper jaw. This technique is a combination of surgical and orthodontic processes. This procedure is primarily performed in adults whose palatal sutures have been fused and can not be expanded through other techniques.

Video Surgically Assisted Rapid Palatal Expansion

Histori

The orthodontic expansion was first described by Emersen Angell about 145 years ago. Kole in 1959 was the first to talk about corticotomy procedures in adults with maxillary constriction. Brown first described the surgical technique for SARPE in 1938. The first Steinhauser described a technique involving segmental left/right segregation of the maxilla along with graft placement in 1972.

Maps Surgically Assisted Rapid Palatal Expansion

Indication

• Skeletal Maturity or Adult Patient
• Combine Intermaxillary Fusion
• Transversal maxillary hypoplasia
• Bilateral posterior crosbite
• Failure to use other expansion tools
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Procedures

The procedure itself is part of two operating processes. Under the first operation, SARPE was performed to address changes in transverse dimensions in patients. This operation is then followed by Le Fort 1 in the second operation to address vertical and anterior-posterior changes. Between the two operations, the patient's mandibular arch is expanded with a fast maxillary expander placed in the upper jaw. For the first surgery, under general anesthesia, a patient first passes a Le Fort skull fracture without downfracture from the upper jaw. The oral surgeon also performs a midpalatal osteotomy to allow resting on the intermediate upper jaw. The surgeon, while performing LeFort 1 osteotomy, can separate the pterygoid plate during this procedure. This separation of the plate is referred to as Pterygomaxillary Disjunction (PMD). Some surgeons are cautious in their approach to separating the pterygoid process because of the risk of injury to the plexgoid plexus.

Sangsari et al. publishes a systematic review and meta-analysis in 2016 that studies the effects of PMD on SARPE results. Of the 3 studies included in their criteria, they concluded that the literature was inconclusive about the effects of PMD on SARPE results and that further controlled trials were required.

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Stability procedure

Chamberland and Profitt in 2011 published a paper in AJODO that looked at the long-term and short-term effects of the SARPE procedure. The SARPE procedure is performed by separating the pterygoid plate to achieve maxillary transverse expansion. The authors observed bone changes of about 3-4mm and these changes were stable. In a previous study published in 2008, the same authors state that about a third of the transverse gear expansion obtained with SARPE is lost, but skeletal expansion remains the same. They also suggest that post-surgical relapse with SARPE is similar to a change in the dimensions of the dental arch after a 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 a more recent study, a study conducted in 1997 by Northway et al. stated that the long-term buccogingival expansion was more acceptable in expanded adults with surgical enlargement than did orthopedic expanded. However, the decline of this study was the measurement of the teeth on the patient's dental model, and not the PA Cephalograms used in the study conducted by Profitt.

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Disadvantages

• Fulfillment of patients is required
• Second operation possible
• The period is not aesthetic after expansion with RME
• Implementation of postoperative palatal expander

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References

Source of the article : Wikipedia