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. 2009 Nov 21;8(3):249–253. doi: 10.1007/s12663-009-0061-4

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

Cintia Mussi Milani Contar 1,✉, Paulo Roberto Muller 2, Ademir Roberto Brunetto 2, Maria Angela Naval Machado 2, Abrao Rappoport 3
PMCID: PMC3454243  PMID: 23139519

Abstract

Introduction

The diversity of the proposed techniques in the treatment of maxillary transverse deficiency in adults reflects the conflicting opinions about the primary area of resistance to maxillary expansion in the craniofacial skeleton. In order to evaluate the efficiency of the surgical expansion in which no osteotomies of the pterygomaxillary junction were made, we have carried out a retrospective study with 14 patients with maxillary transverse deficiency, who were treated from 2003 to 2006.

Material and methods

In the study, models were made prior to and after surgery, and the intercanine and intermolar distances and the improvement of the interocclusal relationships were analyzed. Breathing function and the complications that occurred during and after the surgeries were also analyzed.

Results

All expansions were carried out according to pre-surgical planning so that expansion completely corrected the crossbite, resulting in the desired final occlusion for all patients. Intraoperative complications were limited to one Hyrax appliance deformation. Two patients had minor postoperative complications that included wound dehiscence and pain. Improvements in nasal breathing were observed in all patients that complained of breathing problems prior to the surgery.

Conclusion

The satisfactory results obtained turns the surgical protocol described in this study recommended for the treatment of maxillary transverse deficiency in adults. Importantly, we found that pterygomaxillary osteotomy is not essential for maxillary expansion. The morbidity of the procedure was low with fairly minor complications, and surgically assisted rapid maxillary expansion was shown to improve nasal breathing.

Keywords: Crossbite, Maxilla, Osteotomy

Full Text

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References

  • 1.Berretin-Felix G., Yamashita R.P., Filho H.N., et al. Short- and long-term effect of surgically assisted maxillary expansion on nasal airway size. J Craniofac Surg. 2006;17(6):1045–1049. doi: 10.1097/01.scs.0000234987.84615.0c. [DOI] [PubMed] [Google Scholar]
  • 2.Betts N.J., Vanarsdall R.L., Barber H.D., et al. Diagnosis and treatment of transverse maxillary deficiency. Int J Adult Orthodon Orthognath Surg. 1995;10(2):75–96. [PubMed] [Google Scholar]
  • 3.Vandersea B.A., Ruvo A.T., Frost D.E. Maxillary transverse deficiency — surgical alternatives to management. Oral Maxillofac Surg Clin North Am. 2007;19(3):351–368. doi: 10.1016/j.coms.2007.04.007. [DOI] [PubMed] [Google Scholar]
  • 4.Kennedy J.W., 3rd, Bell W.H., Kimbrough O.L., James W.B. Osteotomy as an adjunct to rapid maxillary expansion. Am J Orthod. 1976;70(2):123–137. doi: 10.1016/S0002-9416(76)90313-4. [DOI] [PubMed] [Google Scholar]
  • 5.Pinto P.X., Mommaerts M.Y., Wreakes G., Jacobs W.V. Immediate postexpansion changes following the use of the transpalatal distractor. J Oral Maxillofac Surg. 2001;59(9):994–1000. doi: 10.1053/joms.2001.25823. [DOI] [PubMed] [Google Scholar]
  • 6.Bays R.A., Greco J.M. Surgically assisted rapid palatal expansion: an outpatient technique with long-term stability. J Oral Maxillofac Surg. 1992;50(2):110–113. doi: 10.1016/0278-2391(92)90352-Z. [DOI] [PubMed] [Google Scholar]
  • 7.Will L.A. Transverse maxillary deformities: diagnosis and treatment. Selected Readings in Oral and Maxillofacial Surgery. 1995;5:1–28. [Google Scholar]
  • 8.Anttila A., Finne K., Nisula K.K., et al. Feasibility and long-term stability of surgically assisted rapid maxillary expansion with lateral osteotomy. Eur J Orthod. 2004;26(4):391–395. doi: 10.1093/ejo/26.4.391. [DOI] [PubMed] [Google Scholar]
  • 9.Goldenberg D.C., Alonso N., Goldenberg F.C., et al. Using computed tomography to evaluate maxillary changes after surgically assisted rapid palatal expansion. J Craniofac Surg. 2007;18(2):302–311. doi: 10.1097/scs.0b013e3180336012. [DOI] [PubMed] [Google Scholar]
  • 10.Ilizarov G.A. Clinical application of the tension-stress effect for limb lengthening. Clin Orthop Relat Res. 1990;250:8–26. [PubMed] [Google Scholar]
  • 11.Handelman C.S., Wang L., BeGole E.A., et al. Nonsurgical rapid maxillary expansion in adults: report on 47 cases using the Haas expander. Angle Orthod. 2000;70(2):129–144. doi: 10.1043/0003-3219(2000)070<0129:NRMEIA>2.0.CO;2. [DOI] [PubMed] [Google Scholar]
  • 12.Glassman A.S., Nahigian S.J., Medway J.M., et al. Conservative surgical orthodontic adult palatal expansion: sixteen cases. Am J Orthod. 1984;86(3):207–213. doi: 10.1016/0002-9416(84)90372-5. [DOI] [PubMed] [Google Scholar]
  • 13.Lehman J.A., Jr, Haas A.J., Haas D.G. Surgical orthodontic correction of transverse maxillary deficiency: a simplified approach. Plast Reconstr Surg. 1984;73(1):62–68. doi: 10.1097/00006534-198401000-00013. [DOI] [PubMed] [Google Scholar]
  • 14.Shetty V., Caridad J.M., Caputo A.A., et al. Biomechanical rationale for surgical-orthodontic expansion of the adult maxilla. J Oral Maxillofac Surg. 1994;52(7):742–749. doi: 10.1016/0278-2391(94)90492-8. [DOI] [PubMed] [Google Scholar]
  • 15.Byloff F.K., Mossaz C.F. Skeletal and dental changes following surgically assisted rapid palatal expansion. Eur J Orthod. 2004;26(4):403–409. doi: 10.1093/ejo/26.4.403. [DOI] [PubMed] [Google Scholar]
  • 16.Marin C., Gil J.N., Lima S.M., Jr Surgically assisted palatine expansion in adult patients: evaluation of a conservative technique. J Oral Maxillofac Surg. 2009;67(6):1274–1279. doi: 10.1016/j.joms.2006.09.034. [DOI] [PubMed] [Google Scholar]
  • 17.Han U.A., Kim Y., Park J.U. Three-dimensional finite element analysis of stress distribution and displacement of the maxilla following surgically assisted rapid maxillary expansion. J Craniomaxillofac Surg. 2009;37(3):145–154. doi: 10.1016/j.jcms.2008.10.002. [DOI] [PubMed] [Google Scholar]
  • 18.Wertz R.A. Changes in nasal airflow incident to rapid maxillary expansion. Angle Orthod. 1968;38(1):1–11. doi: 10.1043/0003-3219(1968)038<0001:CINAIT>2.0.CO;2. [DOI] [PubMed] [Google Scholar]
  • 19.Wriedt S., Kunkel M., Zentner A., et al. Surgically assisted rapid palatal expansion: an acoustic rhinometric, morphometric and sonographic investigation. J Orofac Orthop. 2001;62(2):107–115. doi: 10.1007/PL00001921. [DOI] [PubMed] [Google Scholar]
  • 20.Ramires T., Maia R.A., Barone J.R. Nasal cavity changes and the respiratory standard after maxillary expansion. Braz J Otorhinolaryngol. 2008;74(5):763–769. doi: 10.1016/S1808-8694(15)31388-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Ribeiro Júnior P.D., Gonçalves E.S., Souza P.C.U., Nary Filho H., Luz J.G.C. Clinical evaluation of surgically assisted maxillary expansion (SAME) Rev Dent Press Ortod Ortop Facial. 2006;11:44–59. [Google Scholar]
  • 22.Mehra P., Cottrell D.A., Caiazzo A., Lincoln R. Life-threatening, delayed epistaxis after surgically assisted rapid palatal expansion: a case report. J Oral Maxillofac Surg. 1999;57(2):201–204. doi: 10.1016/S0278-2391(99)90241-0. [DOI] [PubMed] [Google Scholar]
  • 23.Lanigan D.T., Mintz S.M. Complications of surgically assisted rapid palatal expansion: review of the literature and report of a case. J Oral Maxillofac Surg. 2002;60(1):104–110. doi: 10.1053/joms.2002.29087. [DOI] [PubMed] [Google Scholar]
  • 24.Chuah C., Mehra P. Bilateral lingual anesthesia following surgically assisted rapid palatal expansion: report of a case. J Oral Maxillofac Surg. 2005;63(3):416–418. doi: 10.1016/j.joms.2004.03.021. [DOI] [PubMed] [Google Scholar]

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