Non-surgical management of a traumatic mid-palatal suture diastasis by novel use of an orthodontic appliance

Abstract

Sutures are formed during embryonic development at the sites of approximation of the membranous bones of the craniofacial skeleton. They afford major sites of bone expansion during postnatal craniofacial growth, and also influence facial fracture patterns through offering a path of least resistance to force. There are some studies that have shown that the mid-palatal suture (MPS) fuses at 11–13 years and 14–16 years in females and males, respectively. This means that during childhood, the suture is open; thus force applied to the palate at this time tends to split the bone in the midline between the two unfused palatal shelves. The understanding of this biological process allows orthodontists to correct transverse growth discrepancies of the maxilla. Various appliances, including the hyrax appliance, can be used to allow rapid maxillary expansion (RME) by expanding the suture. Paradoxically, the same appliance can be used to allow rapid maxillary contraction (RMC) by contracting the suture. This method of application using a hyrax appliance is rare. We present a case report where this method of application allowed closure of a traumatic mid-palatal suture diastasis, correction of a traumatic transverse discrepancy of the maxilla and avoided an invasive surgical intervention in a 15-year-old male. CPD/Clinical Relevance: This article highlights the importance of considering a patient's age and anatomical development when exploring treatment options. It is prudent to take advantage of this to enhance the natural biological healing process.