Based on various genetic and developmental factors, your upper jawbone (maxilla) may develop abnormally. If your maxilla does not develop normally in the transverse plane (wide enough), subsequent functional issues can arise including insufficient tongue space, poor nasal breathing (both of which can lead to sleep-related breathing disorders), increased airway collapsability, impacted teeth and dental crowding.
What is Maxillary Transverse Deficiency?
Functional issues like chronic mouth-breathing can lead to a maxilla that does not develop wide enough, also known as a maxillary transverse deficiency. The maxilla is the largest facial bone and encompasses much more than what we see in the mouth. The maxillary body and its four processes form the bone that holds the upper teeth, the roof of the mouth (which impacts tongue space), and the floor and lateral walls of the nasal cavity (which impact nasal breathing). Some common complaints a patient with maxillary transverse discrepancy may experience include: open-mouth breathing, chronic nasal congestion, impacted teeth, crooked teeth, tiredness, lack of concentration, snoring, neck posture issues, difficulty chewing, TMJ problems, and headaches.
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What Are the Surgical Options?
Dr. Coppelson performs and has even developed some of the most exciting and new techniques to achieve maxillary expansion using minimally invasive techniques. Depending on your treatment plan and preferences, these procedures can sometimes even be performed safely in the office under local anesthesia or IV sedation. Also, depending on your case and preferences, Dr. Coppelson can even perform these procedures in the operating room setting for maximum patient comfort. Some of the techniques Dr. Coppelson performs include Surgically-assisted miniscrew-anchored rapid palatal expansion (SMARPE), Endoscopically-assisted surgical expansion (EASE), Distraction osteogenesis maxillary expansion (DOME), and Surgically-assisted rapid palatal expansion (SARPE).
What is Minimally-Invasive Maxillary Expansion?
Depending on your age, sex, morphological presentation, and specific preferences- Dr. Coppelson can customize the best treatment plan for you. As a fellowship-trained oral and maxillofacial surgeon who specializes in skeletal expansion, Dr. Coppelson is highly trained and very experienced in all of the state-of-the-art and minimally-invasive techniques that can correct maxillary transverse deficiency and the symptoms it causes. Therapy ranges from the use of an expander alone, to in-office surgical adjuncts, to even operating room based surgical procedures.
Cantarella D, Dominguez-Mompell R, Moschik C, et al. Midfacial changes in the coronal plane induced by microimplant-supported skeletal expander, studied with cone-beam computed tomography images. Am J Orthod Dentofacial Orthop. 2018;154(3):337-345.
What are SMARPE and EASE?
Prior to turning 15 years old, the two maxillary bones have yet to fuse and surgical adjuncts are rarely necessary. However, after these bones fuse a surgical procedure may be indicated to achieve the desired expansion. SMARPE and EASE are both minimally-invasive surgical techniques that help facilitate maxillary expansion in skeletally mature adults. In fact, with these techniques, you can often achieve true expansion of the entire maxilla and not just the alveolar process (the bone that houses the teeth.)
What are DOME and SARPE?
DOME and SARPE are both techniques that primarily expand the alveolar process of the maxilla. This is accomplished by performing a 2-piece LeFort I osteotomy (see the picture in the right column). Even though the entire maxilla is not expanded, these procedures still expand the nasal floor, the palate, and the volume of alveolar bone (the bone that houses the maxillary teeth). Therefore these patients still experience improvement in their ability to breathe through their nose, palatal tongue space, and volume of alveolar bone required to uncrowd teeth. The primary difference between DOME and SARPE is in the type of expander used. Post-surgical expansion with a SARPE will be achieved using a tooth-borne expander, while a bone-borne expander will be used in DOME.