Nasal soft tissue changes after two different approaches for surgically assisted rapid maxillary expansion

Area of Science:

• Orthodontics
• Craniofacial Surgery
• Plastic Surgery

Background:

• Surgically assisted rapid maxillary expansion (SARME) is a common procedure for correcting maxillary hypoplasia.
• Different surgical techniques exist, potentially impacting soft tissue changes.

Purpose of the Study:

• To compare nasal soft tissue alterations following SARME using two distinct surgical approaches.
• To evaluate the necessity of anterior nasal spine (ANS) exposure during SARME.

Main Methods:

• Thirty-two patients underwent SARME, divided into two groups based on surgical technique: standard Le Fort I with ANS exposure (Group A) and standard Le Fort I without ANS exposure (Group B).
• Three-dimensional facial imaging was used to measure philtrum, nasal, subnasal, and columella width at baseline, post-distraction, and 6 months postoperatively.
• Maxillary expansion was comparable between groups (approx. 7.4 mm).

Main Results:

• Both surgical approaches resulted in increased nasal and subnasal dimensions.
• Group A (with ANS exposure) showed significantly smaller changes in columella width compared to Group B.
• No significant difference in overall maxillary expansion was observed between the groups.

Conclusions:

• Intraoperative release of soft tissues around the ANS during SARME may not be required if adequate columella width is maintained.
• The choice of surgical approach can influence specific soft tissue changes, particularly columella width.
• Further large-scale randomized trials are needed to confirm these findings.