Minimally invasive surgically assisted rapid palatal expansion with limited approach under sedation: a report of 283 consecutive cases.
OBJECTIVE
An adequate transverse maxillary dimension is one of the critical aspects of a functional and stable occlusion. Surgically assisted rapid palatal expansion consists of a surgical liberation of the sites of resistance combined using orthopedic forces. Most technical descriptions advocate the use of general anesthesia with hospital admission.


METHODS
Between March 2000 and July 2008, surgery was performed on 283 consecutive cases with transverse skeletal maxillary hypoplasia. The incision ran horizontally to reach the level of the laterals. Osteotomies of lateral walls and pterygoid disjunction were performed in all cases. A V-Y closure was performed in 2 layers. Patients were discharged after recovery from sedation.


RESULTS
One hundred seventy-two of the 283 patients were male. Mean age was 18.3 years. Mean surgical time from incision to last suture was 19 minutes. Expanders were Hyrax in 221 cases and Haas in 61, and a bone-borne expander was used in 1 case. At the 1-year follow-up visit, mean expansion was 8.0 at the canines and 8.9 at the mesiovestibular cuspid of the first molar. General anesthesia has been classically advocated for these procedures, the argument being that pterygomaxillary disjunction was too traumatic to be performed under sedation. The surgical technique used sought to attain a balance between maximum mobilization of the maxilla with a complete liberation of all the buttresses and minimum morbidity to avoid further complications.


CONCLUSIONS
The new technique that we report seeks to combine both aspects and allows for rapid intervention with local anesthesia plus sedation and a minimal approach with a total liberation of the maxillary resistances (piriform aperture pillars, zygomatic buttresses, midpalatal suture, and pterygoid junctions). The minimal approach and incision used in the technique guarantee vascular support to the maxilla via the vestibular corridors.
Hernandez-Alfaro
Federico
F
Instituto de Cirugia Maxilofacial, Centro Medico Teknon, Oral and Maxillofacial Surgery, Universidad Internacional de Catalunya, Barcelona, Spain. 36984jmb@comb.es
Mareque Bueno
Javier
J
Diaz
Artur
A
Pagés
Carles Martí
CM
D000293:Adolescent; D000328:Adult; D000766:Anesthesia, Dental / Q000379:methods*; D000772:Anesthesia, Local / Q000379:methods; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D002355:Carticaine; D016292:Procedural Sedation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008437:Maxilla / Q000601:surgery*; D008874:Midazolam; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009967:Orthodontic Appliances; D010027:Osteotomy / Q000379:methods; D010155:Palatal Expansion Technique; D010880:Piperidines; D000077208:Remifentanil; D016896:Treatment Outcome; D055815:Young Adult
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D010880:Piperidines; D002355:Carticaine; D000077208:Remifentanil; D008874:Midazolam