[Glassman palatine expansion. Experiences with mono- and bimaxillary dysgnathia operations]

The median palatine suture has long been regarded as having the greatest resistance to dilatation of the maxilla. In 1984 Glassman [3] presented a conservative-surgical method of division of the palatineal suture in which only the lateral and anterior support of the maxilla is debilitated surgically. An orthodontic apparatus cemented in place preoperatively is already used intraoperatively for dilatation of the maxilla. In the period from 1991 to 1997, 16 patients with a leptomaxilla and various dysnathic findings have been operated on at our clinic by the method described by Glassman. Sometimes the maxilla was dilated intraoperatively using the apparatus cemented in place by the method of Derichsweiler and dilatation was continued post-operatively until the described result was achieved. After successful dilatation of the maxilla and a stabilizing phase, a mono- or bimaxillary operation was performed. The use of this method led to the desired result in 15 patients. Dilatation of the maxilla was objectivized by determining the pre- and postoperative width of the anterior and posterior dental arch using models and X-ray of the occlusal overlay of the maxilla. In one patient who was operated on at the age of 38 years, a fracture of the alveolar process of the maxilla occurred unilaterally due to the completed ossification of the median palatine suture. The method of surgically aided dilatation of the maxilla at the level of Le Fort I plane is suitable for patients up to the age of 30. In older patients, the median palatine suture should be transsected as well.