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Does unilateral surgically assisted rapid maxillary expansion (SARME) lead to perinasal asymmetry?

Verursacht die unilaterale chirurgisch assistierte schnelle Gaumennahterweiterung (SARME) eine perinasale Asymmetrie?

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Abstract

Objective

True unilateral posterior crossbite (TUPC) requires unilateral expansion to prevent nonocclusion at the noncrossbite (NC) side. The recommended osteotomies for TUPC after sutural closure are anterior, lateral, and posterior osteotomies only on the crossbite (C) side and median osteotomy of the midpalatal suture, i.e., unilateral surgically assisted rapid maxillary expansion (SARME). The goal was to assess airway and perinasal soft tissue outcomes after SARME.

Methods

Data from 16 patients (8 males, 8 females; mean age 18.38 ± 1.45 years) were retrospectively assessed after unilateral SARME. The expansion (twice daily: 0.5 mm/day) and retention periods comprised 3 weeks and 6 months, respectively. Stereophotogrammetric images were used for soft tissue assessment; cone beam computed tomography (CBCT) was used to evaluate the anterior nasal airway. Statistical analyses were performed.

Results

Using linear measurements, soft tissue distances of the alar base and alare to midsagittal plane (MSP) were significantly increased on the C side. A significant decrease was observed for the distance from the lower nostril point to the MSP on the NC side compared to a significant increase on the C side. Comparing the C and NC sides, the changes were significantly higher on the C side for all parameters except the upper nostril point to the MSP distance. Cheek volume was significantly higher on the C side. Volume changes of the anterior nasal airway (ANA) were significantly increased on the C side, but volume changes between NC and C were not significantly different.

Conclusions

Unilateral SARME led to significant expansion of ANA on the C side, but did not lead to asymmetry in the nasal region or have adverse effects on the airway or perinasal soft tissues. Thus, this novel treatment method may be useful in the treatment of patients with TUPC.

Zusammenfassung

Zielsetzung

Ein echter unilateraler posteriorer Kreuzbiss (TUPC) erfordert eine unilaterale Erweiterung, um eine Nonokklusion auf der Nichtkreuzbisseite (NC) zu verhindern. Die empfohlenen Osteotomien für TUPC nach Nahtverknöcherung sind anteriore, laterale und posteriore Osteotomien nur auf der C(Kreuzbiss)-Seite und eine mediane Osteotomie der Mittelpalatinalnaht, d.h. eine unilaterale chirurgisch assistierte schnelle Oberkieferexpansion (SARME). Ziel war es, die Auswirkungen auf die Atemwege und das perinasale Weichgewebe nach SARME zu beurteilen.

Methoden

Die Daten von 16 Patienten (8 Männer, 8 Frauen; Durchschnittsalter 18,38 ± 1.45 Jahre) wurden nach unilateraler SARME retrospektiv ausgewertet. Die Expansions- (2-mal täglich, 0,5 mm/Tag) und Retentionszeiträume umfassten 3 Wochen bzw. 6 Monate. Stereophotogrammetrische Bilder wurden zur Beurteilung des Weichgewebes verwendet; zur Beurteilung des vorderen nasalen Atemwegs wurde die DVT (digitale Volumentomographie) eingesetzt. Es wurden statistische Analysen durchgeführt.

Ergebnisse

Unter Verwendung linearer Messungen waren die Weichteilabstände der Alarbasis und der Alare zur mittleren Sagittalebene (MSP) auf der C‑Seite signifikant erhöht. Für den Abstand vom unteren Nasenflügelpunkt zur MSP wurde eine signifikante Abnahme auf der NC-Seite im Vergleich zu einer signifikanten Zunahme auf der C‑Seite beobachtet. Beim Vergleich von C‑ und NC-Seite waren die Veränderungen auf der C‑Seite für alle Parameter signifikant höher, außer für den Abstand vom oberen Nasenflügelpunkt zur MSP. Das Wangenvolumen war auf der C‑Seite signifikant höher. Die Volumenänderungen des vorderen nasalen Atemwegs waren auf der C‑Seite signifikant erhöht. Die Volumenänderungen zwischen NC und C waren dagegen nicht signifikant unterschiedlich.

Schlussfolgerungen

Die unilaterale SARME führte zu einer signifikanten Vergrößerung der ANA auf der C‑Seite, nicht aber zu einer Asymmetrie im Nasenbereich und hatte auch keine nachteiligen Auswirkungen auf die Atemwege oder die perinasalen Weichteile. Diese neuartige Behandlungsmethode kann also bei der Behandlung von Patienten mit TUPC nützlich sein.

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Acknowledgements

We would like to thank Dr. Şirin Hatipoğlu, Dr. Faysal Uğurlu, and Dr. Tuna Akdoğan for the contribution to archive.

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Authors and Affiliations

  1. Faculty of Dentistry, Department of Orthodontics, İstanbul Medeniyet University, Fatih Mah., Eski Ankara Asfaltı Cad., No:28 Tuzla/Orhanlı, 34956, Istanbul, Turkey

    Gülden Karabiber DDS

  2. Faculty of Dentistry, Department of Orthodontics, Marmara University, Istanbul, Turkey

    Hanife Nuray Yılmaz DDS

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  1. Gülden Karabiber DDS
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Correspondence to Gülden Karabiber DDS.

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Conflict of interest

G. Karabiber and H.N. Yilmaz declare that they have no competing interests.

Ethical standards

This study consisted of 16 patients (8 males, 8 females; mean age: 18.38 ± 1.45 years) whose records were gathered from the archives of Marmara University, Faculty of Dentistry, Department of Orthodontics, [İstanbul], [Turkey]. This study was approved by the Ethical Committee of the Faculty of Dentistry, Marmara University (15.07.15-04). Written informed consent to participate and for publication was obtained from the patients in the study (or their parents in the case of children under 18).

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The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Oral presentation of some aspects of soft tissue evaluation presented at the XVth International Congress of the Turkish Orthodontic Society, October 1–5, 2016, Antalya, Turkey.

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Karabiber, G., Yılmaz, H.N. Does unilateral surgically assisted rapid maxillary expansion (SARME) lead to perinasal asymmetry?. J Orofac Orthop 84, 1–9 (2023). https://doi.org/10.1007/s00056-021-00333-y

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