Transverse effects after surgically assisted rapid maxillary expansion in the midpalatal suture using computed tomography

Patricia P Loddi, Max D Pereira, Angela B Wolosker, Claudia T Hino, Tessie M Kreniski, Lydia M Ferreira
Journal of Craniofacial Surgery 2008, 19 (2): 433-8
Surgically assisted rapid maxillary expansion is the treatment of choice for correcting maxillary transverse deficiency in adults. Traditionally, the appliance for expansion is tooth-borne and tissue-tooth-borne devices (Hyrax and Haas). Although a number clinical and radiographic studies have evaluated the surgically assisted rapid maxillary expansion, only limited information is available to study the transverse movement of the midpalatal suture with computed tomography. Forty adult patients of both sexes, ranging in age from 18 to 38 years, with bilateral transverse maxillary deficiency were operated on. Twenty patients had Hyrax expander, and 20 had Haas expander. Under general anesthesia, subtotal Le Fort I osteotomy was performed including pterygomaxillary dysjunction. The width of the midpalatal suture opening was measured at the anterior edge of the midpalatal suture and at the junction of the midpalatal suture and palatal bones, using computed tomography in axial acquisition, obtained in the preoperative period and immediately after the end of expansion. A digital caliper was used to measure Haas and Hyrax distance on the central jackscrew preoperatively and postoperatively. The proportion between the midpalatal suture expansion and the amount of expansion on the jackscrew was evaluated. The mean of midpalatal suture opening and screw opening for Haas group was 5.19 and 8.78 mm, and for the Hyrax group, 5.85 and 8.51 mm, respectively. Both groups showed parallel-shaped separation of the midpalatal opening with no significant difference in the anterior and posterior portion. Midpalatal/jackscrews opening proportion was greater in the Hyrax group (69,2%) than in the Haas group (60%).

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