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Posterior Maxillary Surgery: Its Place in the Treatment of Dentofacial Deformities
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
Greg J Knepil, Graham R Oliver
In modern practice, and referenced in this article, transverse discrepancies in the presence of a significant vertical or antero-posterior discrepancy can often be corrected in the pre-surgical orthodontic phase, allowing for appropriate arch coordination at the time of surgery. In cases where there is transverse coordination issue beyond the limits of orthodontics alone, then surgical expansion is indicated.11,12 As reported in the article, this can be carried out as a segmental procedure; however, surgically assisted rapid maxillary/palatal expansion (SARME/SARPE) has become the mainstay for surgical maxillary expansion.13,14 This may well be due to its basis and familiarity to a subtotal Le Fort I osteotomy; however, there is no agreed ideal surgical approach with variations based on release of the mid-palatal suture, pterygoid disjunction, length of corticotomy cuts, and type of distractor.15 The evidence appears to suggest that a more invasive approach results in more predictable expansion with fewer complications.15 Stability of any expansion-based procedure remains a key concern reported both in the article and in modern techniques.16
Patient-specific pre-operative simulation of the surgically assisted rapid maxillary expansion using finite element method and Latin hypercube sampling: workflow and first clinical results
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
L. Bonitz, A. Volf, S. Hassfeld, A. Pugachev, B. Ludwig, S. Chhatwani, A. Bicsák
The surgically assisted rapid maxillary expansion (SARME) was first described by E. C. Angell in 1860 (Angell 1860). Today, SARME and surgically assisted rapid palatal expansion (SARPE) are common, combined orthodontic and surgical procedures used to correct maxillary transverse deficiency in skeletally mature patients (de Gijt et al. 2017). The procedure consists of two steps. First, the maxilla is weakened by a bilateral osteotomy in the Le-Fort-I plane and pterygomaxillary suture and an opening in the mid-palatal suture is made (midline split). The extent of osteotomy depends on the patient’s age, bone quality, and anatomical conditions including the dental root position and neural structures (Koudstaal et al. 2005; Han et al. 2009; Rana et al. 2013). The state-of-the-art technique involves weakening the maxilla equally on both sides based on the experience of the surgeon. In this way, the extent of osteotomy can vary widely (Al-Ouf et al. 2010; Nada et al. 2012; Seeberger et al. 2015). In the second step, the maxilla is expanded using a distraction device, which is mounted on the palatine bone or the bicuspids of both the maxillary segments (Sander et al. 2006; Adolphs et al. 2014; Ulusoy and Dogan 2018).