Surgically Assisted Rapid Palatal Expansion in Patients With Cleft and Craniofacial Diagnoses

ObjectiveTo evaluate the indications, techniques, outcomes, and complications associated with surgically assisted rapid palatal expansion (SARPE) in patients with cleft and craniofacial diagnoses.DesignRetrospective chart review.SettingSingle tertiary care craniofacial center.Patients and ParticipantsAll patients undergoing SARPE between 2008 and 2024 were reviewed. Of the 65 patients identified, 23 (35.4%) had cleft or craniofacial conditions.InterventionsSARPE was performed in all patients. Expansion was achieved using custom-fabricated appliances.Main Outcome MeasuresIndications for SARPE, amount of palatal expansion, complications, and need for future orthognathic surgery, including segmental Le Fort I osteotomies.ResultsOf 65 SARPE patients, 23 (35.4%) had cleft or craniofacial conditions. The mean age was 17.2 ± 3.2 years. Indications included closed mid-palatal suture (n = 14, 60.9%) and failed expansion (n = 7, 30.4%). Expansion averaged 7.0 ± 1.7 mm over 14.7  ± 6.3 days. Sagittal maxillary osteotomies were performed with Piezotome in 19 (82.6%) patients and were most commonly midline (n = 12, 52.5%) and unilateral parasagittal (n = 9, 39.1%). Complications were minimal (4.3% each for root injury, fistula, and debonding). Seventeen patients (73.9%) proceeded to orthognathic surgery, with only 2 (18.2%) requiring segmental Le Fort I osteotomies.ConclusionsSARPE is a safe and effective treatment for transverse maxillary deficiency in cleft and craniofacial patients, offering reliable expansion with minimal morbidity. Its successful application in this complex population may reduce the need for segmental Le Fort I osteotomies during future orthognathic procedures. These findings support broader adoption of SARPE in craniofacial care, with potential to streamline surgical management and improve long-term outcomes.