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Surgically assisted rapid palatal expansion (SARPE)
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British Journal of Oral and Maxillofacial Surgery 49 (2011) 65–66
Technical note
Surgically assisted rapid palatal expansion (SARPE) R. Goddard ∗ , H. Witherow Maxillo-facial Department, St. George’s Hospital, Blackshaw Road, Tooting, London, UK Accepted 24 November 2009 Available online 18 February 2010
Keywords: Surgically assisted rapid palatal expansion (SARPE); Intermaxillary suture
SARPE is an effective and stable method of addressing severe maxillary transverse discrepancy in patients over the age of 15 years of age.1 A number of modifications of the surgical technique have been described, although most utilise a form of subtotal Le Fort I osteotomy with a midline palatal
Fig. 2. The split after the mucoperiosteal flap.
Fig. 1. The anterior palatal suture split by the rapid pal.
∗
Corresponding author. Tel.: +44 07877745167. E-mail address: [email protected] (R. Goddard).
cut between the maxillary central incisors.1 The midline cut has potential to damage the roots of these teeth, adjacent periosteum and compromise bone and soft tissue perfusion (Figs. 1–3).2 Pre-operative orthodontics aids separation of convergent incisor roots, helping to minimise risk of tooth damage. The intermaxillary and other circummaxillary sutures generally
0266-4356/$ – see front matter © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2009.11.013
66
R. Goddard, H. Witherow / British Journal of Oral and Maxillofacial Surgery 49 (2011) 65–66
large inter-individual variation in palatal suture closure. The anterior portion closes somewhat later as this process initially commences posteriorly.1 Pre-operative rapid maxillary expansion (RME) can therefore promote shelf separation. In our experience, activating the RME appliance by 0.5 mm twice a day for 1 week before SARPE opens the anterior palatal suture. This creates an anterior groove for placement of a fine osteotome in order to achieve “atraumatic” midline osteotomy. We have successfully used this technique in patients ranging from 15 to 27 years with no adverse sequelae. We routinely carried out a standard Fe Fort I osteotomy, ensuring pterygoid plate disjunction and midline maxillary separation with a fine osteotome. We also confirmed separation of the midline maxillary suture by single turn activation and de-activation of the expansion device intra-operatively, noting change in the gap between the two segments. We strongly recommend a 1 week period of pre-operative RME prior to SARPE. This negated the need for orthodontic root separation pre-operatively and decreases surgical morbidity.
Conflict of interest None. Fig. 3. The fine osteotome in the suture.
start to fuse after 15 years of age. Cases below this age are therefore amenable to conventional rapid maxillary expansion (RME). Above this age, without surgical separation, RME results in tipping of the molars with little expansion of the maxillary arch. It has been suggested that the intermaxillary suture anterior to the incisive canal never ossifies until very late in life.3 Consequently, SARPE can be performed in adults in their 20s and 30s, although at this age, there is
References 1. Anttila A, et al. Feasibility and long-term stability of SARME with lateral osteotomy. Eur J Orthod 2004;26:391–5. 2. Cureton and Cuenin. SARPE: orthodontic preparation for clinical success. AJ of Orthodontics and Dento-facial Orthopaedics July 1999;vol./is.116/1(46–59):0889–5406. 3. Stomberg C, Holm J. SARME in adults. A retrospective long-term followup study. J Craniomaxillofac Surg 1995;23(August (4)):222–7.
British Journal of Oral and Maxillofacial Surgery 49 (2011) 65–66
Technical note
Surgically assisted rapid palatal expansion (SARPE) R. Goddard ∗ , H. Witherow Maxillo-facial Department, St. George’s Hospital, Blackshaw Road, Tooting, London, UK Accepted 24 November 2009 Available online 18 February 2010
Keywords: Surgically assisted rapid palatal expansion (SARPE); Intermaxillary suture
SARPE is an effective and stable method of addressing severe maxillary transverse discrepancy in patients over the age of 15 years of age.1 A number of modifications of the surgical technique have been described, although most utilise a form of subtotal Le Fort I osteotomy with a midline palatal
Fig. 2. The split after the mucoperiosteal flap.
Fig. 1. The anterior palatal suture split by the rapid pal.
∗
Corresponding author. Tel.: +44 07877745167. E-mail address: [email protected] (R. Goddard).
cut between the maxillary central incisors.1 The midline cut has potential to damage the roots of these teeth, adjacent periosteum and compromise bone and soft tissue perfusion (Figs. 1–3).2 Pre-operative orthodontics aids separation of convergent incisor roots, helping to minimise risk of tooth damage. The intermaxillary and other circummaxillary sutures generally
0266-4356/$ – see front matter © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2009.11.013
66
R. Goddard, H. Witherow / British Journal of Oral and Maxillofacial Surgery 49 (2011) 65–66
large inter-individual variation in palatal suture closure. The anterior portion closes somewhat later as this process initially commences posteriorly.1 Pre-operative rapid maxillary expansion (RME) can therefore promote shelf separation. In our experience, activating the RME appliance by 0.5 mm twice a day for 1 week before SARPE opens the anterior palatal suture. This creates an anterior groove for placement of a fine osteotome in order to achieve “atraumatic” midline osteotomy. We have successfully used this technique in patients ranging from 15 to 27 years with no adverse sequelae. We routinely carried out a standard Fe Fort I osteotomy, ensuring pterygoid plate disjunction and midline maxillary separation with a fine osteotome. We also confirmed separation of the midline maxillary suture by single turn activation and de-activation of the expansion device intra-operatively, noting change in the gap between the two segments. We strongly recommend a 1 week period of pre-operative RME prior to SARPE. This negated the need for orthodontic root separation pre-operatively and decreases surgical morbidity.
Conflict of interest None. Fig. 3. The fine osteotome in the suture.
start to fuse after 15 years of age. Cases below this age are therefore amenable to conventional rapid maxillary expansion (RME). Above this age, without surgical separation, RME results in tipping of the molars with little expansion of the maxillary arch. It has been suggested that the intermaxillary suture anterior to the incisive canal never ossifies until very late in life.3 Consequently, SARPE can be performed in adults in their 20s and 30s, although at this age, there is
References 1. Anttila A, et al. Feasibility and long-term stability of SARME with lateral osteotomy. Eur J Orthod 2004;26:391–5. 2. Cureton and Cuenin. SARPE: orthodontic preparation for clinical success. AJ of Orthodontics and Dento-facial Orthopaedics July 1999;vol./is.116/1(46–59):0889–5406. 3. Stomberg C, Holm J. SARME in adults. A retrospective long-term followup study. J Craniomaxillofac Surg 1995;23(August (4)):222–7.