Feasibility and long-term stability of surgically assisted rapid maxillary expansion with lateral osteotomy

Surgically assisted rapid maxillary expansion (SARME) has become a widely used and acceptable means to expand the maxilla in adolescents and adult patients. The method takes advantage of bone formation at the maxillary edges of the midline, while they are separated by an external force. The purpose of the present retrospective investigation was to evaluate the feasibility and long-term stability of maxillary expansion in patients in whom lateral pre-expansion osteotomy had been performed. The subjects were 20 patients (14 females, six males, mean age 30.6 years, range 16.2-44.2 years) whose malocclusions were treated solely or partly with SARME during 1988-1996. Two orthodontists carried out the post-orthodontic expansion treatment. The surgical technique followed a minimally invasive osteotomy on the lateral maxillary walls. Study models were obtained before surgery (T1), once expansion and the following orthodontic treatment were completed, before possible second-stage osteotomy (T2), and at long-term follow-up (T3). Using the study models, the width of the dental arch was measured with a digital sliding calliper. In addition, transverse occlusal relationships were examined at each time point. The results indicated that (1) SARME is possible when the minimally invasive operation technique is used, (2) long-term stability of maxillary expansion following the present technique compares favourably with the widening and stability achieved with other, more invasive, osteotomies. With age, several possible uncertainties are introduced to affect the course of SARME adversely. Therefore, more extensive osteotomies can be recommended in older patients.