title: Determining the osteotomy pattern in surgically assisted rapid maxillary expansion in a unilateral palatal cleft: a finite element model approach.
abstract: OBJECTIVE
  To evaluate the stress pattern in the craniofacial skeleton in a patient with unilateral cleft deformity of the secondary palate and alveolus in response to various techniques of surgically assisted rapid maxillary expansion (SARME).
  
  
  METHODS
  Three patient-specific composite skull models were developed for finite element model analysis. The details of the modeling procedure have been described in Part I of this series. The finite element analysis was performed on each model with a specified SARME technique in combination with RME using Abaqus (6.7).
  
  
  RESULTS
  The ideal form of surgery in SARME for patients with unilateral cleft deformity of the secondary palate and alveolus would be complete unilateral LeFort I with pterygoid dysjunction in combination with midpalatal split, followed by isolated midpalatal split and zygomatic buttress osteotomies.
  
  
  CONCLUSIONS
  A more invasive SARME technique can significantly reduce the resultant stresses. However, this benefit should be weighed against the risk of increasing complications associated with more extensive surgeries. When a more conservative surgical technique is selected, it would be preferable to perform a midpalatal split rather than zygomatic buttress osteotomies, as indicated by the stress-strain distribution and displacement pattern associated with different SARME techniques.
authors.affiliation: Craniofacial and Skeletal Diseases Branch, NIDCR/NIH, Bethesda, MD, USA.
authors.forename: Pawan
authors.initials: P
authors.lastname: Gautam
authors.forename: Linping
authors.initials: L
authors.lastname: Zhao
authors.forename: Pravin
authors.initials: P
authors.lastname: Patel
mesh_terms: D000293:Adolescent; D002972:Cleft Palate / Q000503:physiopathology / Q000601:surgery*; D003198:Computer Simulation; D003799:Dental Stress Analysis / Q000379:methods; D020342:Finite Element Analysis; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008437:Maxilla / Q000601:surgery; D056948:Orthognathic Surgical Procedures / Q000379:methods*; D019340:Osteotomy, Le Fort / Q000379:methods*; D010155:Palatal Expansion Technique; D021362:Palate, Hard / Q000601:surgery; D010347:Patient Care Planning; D013100:Sphenoid Bone / Q000601:surgery; D014057:Tomography, X-Ray Computed; D015050:Zygoma / Q000601:surgery