The intricate 3-dimensional (3D) anatomy of the head and neck combined with the requirement for precise facial symmetry is an obstacle facing maxillofacial surgeons. 3D imaging has enabled an accurate visualization of the craniofacial region allowing detailed evaluation of facial discrepancies, including maxillary transverse deficiencies (MTD). Use of 3D intraoperative navigation has been increasingly demonstrated in craniofacial surgery. Our study's aim is to report our experiences using surgical navigation for surgically assisted rapid palatal expansion (SARPE) procedures to correct MTD, focusing on comparing outcomes to a more historical surgical technique. We retrospectively investigated 34 adults with MTD who underwent SARPE by the same surgeon over a 3-year period from 2008 to 2011 at the Hospital of the University of Pennsylvania. SARPE was performed under general anesthesia with nasotracheal intubation. For each patient, a modified LeFort I maxillary osteotomy was performed, including separation of the pterygomaxillary sutures. In conjunction, a sagittal palatal osteotomy, separation of nasal septum from the maxilla, and osteotomy of the anterior lateral nasal wall was completed. Immediate activation of the Hyrax appliance at 1.5 mm allowed diastema formation. After a latency period, activations were performed according to varying schedules. The navigation system VectorVision (BrainLAB, Germany) was used on 11 patients, and 23 underwent non-navigated surgery. Excluded were 11 patients (1 navigated and 11 non-navigated) receiving third molar extractions at time of surgery and those lacking corresponding records. Estimated blood loss (EBL), surgical time (ST), and symmetrical maxillary expansion was compared after placing the 22 patients into two categories: 12 non-navigated vs 10 navigated. Posteroanterior cephalometric radiographs were traced at pre- (T1) and 6 months post-SARPE (T2) and left and right transverse maxillary widths (J-midline, mm) were measured. Symmetric expansion between the 2 maxillary halves from T1 to T2 was determined by calculating the difference between each half. Student t test was used. P ≤ .05 established significance. Mean EBL was 102 ml (50-300 ml) in navigated vs 120 ml (50-400 ml) in non-navigated, P = .6. Mean ST was 73.5 min (60-90 min) in navigated vs 55 min (35-90 min) in non-navigated, P = .001. Mean total expansion was 5.84 mm in navigated vs 5.29 mm non-navigated. In the navigated group, mean difference between the maxillary halves was 0.92 mm (0-1.29 mm) vs 1.13 mm (0-1.54 mm) non-navigated, P = .1. SARPE is the method of choice to correct significant MTD. Decision to release the pterygomaxillary suture has risks owing to proximity to vital structures, being terminal branches of the maxillary artery, especially the descending palatine or sphenopalatine arteries, posterior superior alveolar artery and pterygoid venous plexus, which could result in greater intraoperative bleeding. Lack of proportionality in skeletal expansion is attributable to lack of pterygomaxillary suture release, distractor type, operative technique and deformity type. Due to higher resolution and accuracy, use of 3D intraoperative navigation could improve nonuniformity of maxillary expansion by allowing osteotomies at the most efficient sites. We did not see a significant difference in symmetry between techniques; however, studies with larger sample size and 3D radiographic data analysis may allow more accurate results. While our study did not show a difference in EBL, the potential for lowering the likelihood of life-threatening hemorrhage with use of surgical navigation exists, however, slightly increasing amount of surgical and anesthetic time. This can be attributed to knowledge of the technique which could likely improve with experience.