Adjustable selective maxillary expansion combined with maxillomandibular surgery: A case report.
BACKGROUND
Surgically assisted rapid maxillary expansion (SARME) is usually considered the gold standard for maxillary transverse expansion in adults. However, a second surgical procedure is needed in cases of associated sagittal or vertical discrepancies. We describe the use of two new innovative devices for the correction of discrepancies in all dimensions during a single surgical procedure, thus reducing treatment duration.


METHODS
We report the case of a 21-year-old female patient, referred to our department for skeletal Class III malocclusion associated with right-side laterognathism and transverse maxillary deficiency. The patient underwent one-stage surgery, using sliding osteosynthesis plates and an adjustable bone-borne distractor. Pre-surgical orthodontics consisted in leveling and aligning the mandibular arch; maxillary leveling was initiated 3 months before surgery. Postoperative palatal distraction combined with orthodontic finishing enabled complete correction of dental and bony discrepancies after 3 months.


CONCLUSIONS
In our experience, treatment of transverse, sagittal and vertical discrepancies has been possible in a single surgical procedure, using two innovative techniques: sliding osteosynthesis and an adjustable bone distractor. Two years post-surgery, the correction is stable in all dimensions.
Department of maxillofacial and plastic surgery, Robert-Ballanger Hospital, boulevard Robert-Ballanger, 93602 Aulnay-sous-Bois, France. Electronic address: patrickleyder@noos.fr.
Patrick
P
Leyder
Private practice, 2, rue Malleville, 95880 Enghien-Les-Bains, France.
Gérard
G
Altounian
Department of maxillofacial and plastic surgery, Robert-Ballanger Hospital, boulevard Robert-Ballanger, 93602 Aulnay-sous-Bois, France.
Jacques
J
Chardain
Department of maxillofacial and plastic surgery, Robert-Ballanger Hospital, boulevard Robert-Ballanger, 93602 Aulnay-sous-Bois, France.
Julien
J
Quilichini
D001860:Bone Plates; D004867:Equipment Design; D005146:Facial Asymmetry / Q000601:surgery / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008312:Malocclusion, Angle Class II / Q000601:surgery / Q000628:therapy*; D008437:Maxilla / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000295:instrumentation* / Q000379:methods; D019340:Osteotomy, Le Fort / Q000295:instrumentation / Q000379:methods*; D059229:Osteotomy, Sagittal Split Ramus / Q000379:methods; D010155:Palatal Expansion Technique / Q000295:instrumentation; D016896:Treatment Outcome; D055815:Young Adult
Distraction osteogenesis; Maxillary transverse deficiency; Orthognathic surgery; SARME