Surgically assisted rapid palatal expansion

Abstract

We thank Drs Suri and Taneja for their excellent article, “Surgically assisted rapid palatal expansion: A literature review” (Am J Orthod Dentofacial Orthop 2008;133:290-302). We appreciate being referenced. However, for this article to be accurate and part of evidence-based knowledge, we want to correct misstatements regarding our article. In Table II, “Chronological listing of studies reporting surgical procedures and treatment protocols (no studies used controls),” we are listed as having performed LeFort I osteotomies. On page 258 of our original article (Alpern MC, Yurosko JJ. Rapid palatal expansion in adults with and without surgery. Angle Orthod 1987;57:245-63), the caption for Figure 9 states, “Model of a horizontal section through the maxilla at the level of the osteotomy, with the osteotomy cut marked on the side. Note that the midline structures are untouched in the surgical procedure.” Thus, this cannot be considered a LeFort I procedure. Furthermore, describing the surgical procedure, we wrote, “Utilizing a No. 702 fissure bur, a horizontal osteotomy is made well above the apices of the teeth, parallel to the occlusal plane from the piriform aperture to the pterygoid fissure. This osteotomy is carried intranasally along the lateral nasal wall. In the area of the pterygomaxillary fissure, small curved osteotomes are used to effect separation of the pterygoid plates.” Continuing on the next page (259, second paragraph), we wrote, “No midline, palatal suture, medial nasal wall, or nasal septum surgery have been required. Patients tolerate the procedure well, with a minimum of blood loss or surgical risk. Postoperative edema is moderate and pain is minimal.” This surgical procedure should not be labeled “LeFort I.” Also in Table II, the columns “Latency period” and “Postoperative protocol” indicate that this information was not reported in our article. Our article was published in 1987, and the concept of a latency period did not exist. We activated the expansion screw 6 to 8 times in the operating room. The patient turned the expansion screw once per day without interruption until adequate expansion was achieved. Then, the expansion screw was ligated to prevent it from vibrating closed. The palatal expansion with the bite plane appliance was maintained for 4 months and then removed, and a palatal bar was immediately placed. We clearly described our procedures (pages 259-61 of our article) and thoroughly discussed all our results. This technique has been successfully followed since 1987 without any changes and without complications or sequelae. Surgically assisted rapid palatal expansion: A literature reviewAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 133Issue 2PreviewTransverse maxillomandibular discrepancies are a major component of several malocclusions. Orthopedic and orthodontic forces are used routinely to correct a maxillary transverse deficiency (MTD) in a young patient. Correction of MTD in a skeletally mature patient is more challenging because of changes in the osseous articulations of the maxilla with the adjoining bones. Surgically assisted rapid palatal expansion (SARPE) has gradually gained popularity as a treatment option to correct MTD. It allows clinicians to achieve effective maxillary expansion in a skeletally mature patient. Full-Text PDF Authors' responseAmerican Journal of Orthodontics and Dentofacial OrthopedicsVol. 133Issue 6PreviewWe thank Drs Alpern and Yurosko for their letter regarding their reference that is quoted in our article, “Surgically assisted rapid palatal expansion: A literature review” (Am J Orthod Dentofacial Orthop 2008;133:290-302). Drs Alpern and Yurosko disagree with the term LeFort I osteotomy for the surgical expansion technique outlined in their article. To clarify, we quote: “LeFort I fracture separates the maxilla from the pterygoid plates and nasal and zygomatic structures. This type of procedure may separate the maxilla in one piece from the other structures, split the palate or fragment the maxilla.”1 Full-Text PDF