Surgically assisted rapid maxillary expansion: a systematic review of complications

A systematic review of the literature on the complications of surgically assisted maxillary expansion (SARME) was performed. The search strategy was based on the PRISMA guidelines. The PubMed, SCOPUS, and Cochrane Library databases were searched. Data were extracted from the full texts after screening of the abstracts and titles. Human clinical studies encompassing 'maxillary expansion', 'palatal expansion', 'SARME', or 'SARPE' and that reported sufficient data for 'complication' were included. In vitro studies, case reports, meta-analyses, reviews, book chapters, animal studies, and studies with missing or insufficient data were excluded. The final selection included 12 articles for data extraction. A total of 851 patients underwent SARME, with 187 reported complications (21.97%). Epistaxis (2.47%) and postoperative pain (2.00%) were the most often reported minor complications, and asymmetric or inadequate expansion presented an occurrence rate of 4.47%. Minor complications were equally distributed between surgical (49.30%) and orthodontic complications (50.70%). The technique without pterygomaxillary disjunction increased the occurrence of minor complications (29.95% vs. 16.87%), and the expansion pattern with less than 0.5 mm/day increased the occurrence of orthodontic complications (30.93% vs. 1.83%), i.e. asymmetric expansion. In conclusion, SARME procedures mostly present minor complications. Although several types of complication are described in the literature, occurrence rates are low, and technical issues such as pterygomaxillary disjunction and the pattern of distraction can be predictors of the complication risk.