[Transverse maxillary deficiency: interest in the management of chronic nasal obstruction]

To describe the surgical orthodontic technique of correcting transverse maxillary deficiency associated with nasal obstruction and malocclusion.

The surgical-orthodontic correction of transverse maxillary deficiency consists in an incomplete Le Fort I procedure, without down-fracture, associated with a sagittal palatal osteotomy. This procedure is called SARE (Surgically Assisted Rapid Expansion). A pre-fabricated orthodontic appliance is cemented to premolars and molars prior to the surgical procedure. The patient activates the appliance allowing a 1 mm widening a day up to 10 mm. A stabilisation phase is mandatory to avoid early relapse of the correction. This phase involves ossification of the midline osteotomy site.

A 22 year old female consulted for a chronic nasal obstruction. Previous treatments, medical and surgical (septoplasty) did not improve her symptoms. She presented with a typical transverse maxillary hypoplasia. She underwent a surgery with the technique described above. Nasal patency improvement was noted on the first post-operative day. This was confirmed by comparing pre and post-operative rhinomanometry. An orthodontic treatment followed for several months to stabilize the result.

Main advantages of this surgical intervention are to correct both the dental malocclusion and the nasal obstruction by widening the nasal floor and the maxillary arch. Post-operative period is mostly uneventful. It can take up to six months to achieve a good result that is why a strong collaboration has to exist between the surgeon, the orthodontist and the patient.