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Asymmetric Maxillary Expansion Introduced by Surgically Assisted Rapid Palatal Expansion: A Systematic Review
Jia-Hong Lin1, Chenshuang Li2, Hilary Wong3
1Orthodontic Resident, Department of Orthodontics, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA.
Summary
Asymmetric expansion after surgically assisted rapid palatal expansion (SARPE) occurs in 7.52% of patients, often requiring corrective surgery. Surgical technique variations significantly influence this complication, highlighting the need for careful surgical planning in SARPE procedures.
Area of Science:
- Orthodontics and Maxillofacial Surgery
- Dental Research
- Skeletal Expansion Techniques
Background:
- Asymmetric expansion is a frequent complication of surgically assisted rapid palatal expansion (SARPE).
- This unevenness between the left and right sides necessitates secondary corrective surgery.
- Previous research has not extensively explored the prevalence and causes of this specific complication.
Purpose of the Study:
- To systematically review and analyze the prevalence of asymmetric transverse dimension expansion following SARPE.
- To identify potential surgical causes contributing to asymmetric expansion after SARPE.
- To provide guidance for clinical practice based on the findings.
Main Methods:
- A systematic search of electronic databases and manual citation searching was conducted up to March 11, 2022.
- Included studies were original human research reporting asymmetric expansion rates after two-piece SARPE.
- Quality assessment and data analysis followed the 2020 Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines.
Main Results:
- 13 articles were included, with 8 showing high risk of bias and 5 medium risk.
- The overall prevalence of asymmetric expansion was 7.52%, with 12.90% of affected patients needing a second surgery.
- Pterygomaxillary fissure release increased asymmetry (11.02% vs 5.08%), while lateral nasal wall osteotomy and nasal septum release decreased it (4.26% vs 14.77% and 5.22% vs 17.15%, respectively).
Conclusions:
- Asymmetric dentoskeletal expansion is a common SARPE complication, often linked to surgical cut variations.
- Current literature on SARPE asymmetry suffers from a high risk of bias.
- Further research is essential to comprehensively understand the etiological factors of asymmetric expansion.
