Surgically Assisted Rapid Maxillary Expansion Research Articles

Microimplant assisted rapid palatal expansion vs surgically assisted rapid palatal expansion for maxillary transverse discrepancy treatment

This study compared the skeletal and dental changes of microimplant assisted rapid palatal expansion (MARPE) with those produced by surgically assisted rapid maxillary expansion (SARPE) in postpeak adolescents and adults. The sample comprised 17 patients (mean age, 26±11years) selected for the MARPE group and 15 (mean age, 28.5±10.5years) selected for the SARPE group. Cone-beam computed tomography scans taken just before and after the expansion were used to assess dental and skeletal changes and compare the changes between the groups. MARPE showed greater transversal skeletal changes in the midface and posterior and anterior maxillary base measurements. The transverse displacement of the alveolar process was greater but not significant for the SARPE group than the MARPE group. Regarding dental effects, the root distance measurements did not differ between the groups, but SARPE produced a significantly greater increase in intermolar and interpremolar distance and a greater buccal inclination of the alveolar process and supporting teeth than MARPE. The MARPE technique showed an increase in skeletal transverse maxillary expansion at the midface and basal bone compared with SARPE, especially at the posterior palatal region; however, no difference was found in the expansion of the alveolar process between the 2 methods. MARPE presented a more parallel expansion in both a coronal and axial view, whereas SARPE led to a V-shaped opening. The greater buccal inclination of the alveolar process and supporting teeth was observed in the SARPE group.

Correlation between the transverse dimension of the maxilla, upper airway obstructive site, and OSA severity.

Acquiring a better comprehension of obstructive sleep apnea physiopathology can contribute to improving patient selection for surgical treatments. We hypothesize that maxillary transverse deficiency restricts the space available for the tongue, leading to upper airway obstruction during sleep. Our primary hypothesis was that maxillary transverse deficiency increases the prevalence of tongue collapse during drug-induced sleep endoscopy (DISE). The secondary hypothesis was that maxillary transverse deficiency will also increase the prevalence of circumferential collapse at the velopharynx. The exploratory hypothesis was that maxillary transverse deficiency is associated with increased obstructive sleep apnea severity. The objectives of this study were to correlate maxillary morphometric measurements with (1) the anatomic level of obstruction during DISE and (2) the apnea-hypopnea index on polysomnography. We made a cross-sectional analysis of patients with obstructive sleep apnea undergoing DISE in search of positive airway pressure alternative treatment. Maxillary measurements were collected from a computed tomography scan (interpremolar distance, intermolar distance [IMD] and sella-nasion A point angle), findings from DISE, and sleep study variables from polysomnography. Correlation between computed tomography, DISE, and polysomnography data was assessed using Pearson's correlation, and receiver operating characteristic curves were determined for each facial measurement. Sixty-nine patients were included in the study. The group with velopharyngeal circumferential collapse had mean IMD = 26.30 mm (25.5-31.45), and the group with anteroposterior collapse had mean IMD = 29.20 mm (26.8-33.10; P = .040). The group with complete tongue-base obstruction had mean interpremolar distance = 26.40 mm (25.1-28) and IMD = 26.30 mm (25.6-28.4), and the group without obstruction had mean interpremolar distance = 28.7 mm (27.2-30; P = .003) and IMD = 34.06 mm (32.1-37; P < .001). The receiver operating characteristic curve determined an IMD cutoff of 29.8 mm for predicting tongue-base obstruction. The maxillary transverse deficiency, identified by reduction in interpremolar distance and IMD, predicted the occurrence of complete tongue-base obstruction, complete concentric collapse at the velopharynx, and multilevel obstruction during DISE. We did not find an association between the maxillary measurements and obstructive sleep apnea severity. These associations hold some promise in ultimately supplanting insights previously available only through DISE.

Comparison of Tooth- and Bone-Borne Appliances on the Stress Distributions and Displacement Patterns in the Facial Skeleton in Surgically Assisted Rapid Maxillary Expansion-A Finite Element Analysis (FEA) Study.

The aim of this study was to compare the reduced stresses according to Huber’s hypothesis and the displacement pattern in the region of the facial skeleton using a tooth- or bone-borne appliance in surgically assisted rapid maxillary expansion (SARME). In the current literature, the lack of updated reports about biomechanical effects in bone-borne appliances used in SARME is noticeable. Finite element analysis (FEA) was used for this study. Six facial skeleton models were created, five with various variants of osteotomy and one without osteotomy. Two different appliances for maxillary expansion were used for each model. The three-dimensional (3D) model of the facial skeleton was created on the basis of spiral computed tomography (CT) scans of a 32-year-old patient with maxillary constriction. The finite element model was built using ANSYS 15.0 software, in which the computations were carried out. Stress distributions and displacement values along the 3D axes were found for each osteotomy variant with the expansion of the tooth- and the bone-borne devices at a level of 0.5 mm. The investigation showed that in the case of a full osteotomy of the maxilla, as described by Bell and Epker in 1976, the method of fixing the appliance for maxillary expansion had no impact on the distribution of the reduced stresses according to Huber’s hypothesis in the facial skeleton. In the case of the bone-borne appliance, the load on the teeth, which may lead to periodontal and orthodontic complications, was eliminated. In the case of a full osteotomy of the maxilla, displacements in the buccolingual direction for all the variables of the bone-borne appliance were slightly bigger than for the tooth-borne appliance.

Patient experience and satisfaction of surgically assisted rapid maxillary expansion and mandibular midline distraction

Little is known regarding patient experience and satisfaction with surgically assisted rapid maxillary expansion (SARME) and mandibular midline distraction (MMD). This study therefore aimed to assess patient experience and satisfaction with these techniques in two different groups. The first group answered the post-surgical patient satisfaction questionnaire on a 7-point Likert scale during a long-term follow-up recall. The second group answered a visual analogue scale questionnaire (range: 0–10) with different questions regarding experience and satisfaction, at different time points during the first year of treatment. In both groups, 17 patients were included. Regarding the post-surgical patient satisfaction questionnaire, a mean satisfaction rate of 6.4 (range: 4–7) was reported, with a mean follow-up of 6.5 years post-operatively. In the visual analogue scale group, the mean satisfaction rate was 8.0 and did not significantly differ from the expectations pre-operative (P = 0.96). Both procedures showed relatively low pain scores, although a significant higher score was observed in MMD post-operatively (P = 0.00051). Regarding hindrance, the scores were moderate; the bone-borne distractor in the mandible gained higher scores than the tooth-borne distractor in the mandible. In conclusion, both SARME and MMD gain high satisfaction rates.

Influence of surgically assisted rapid maxillary expansion on the interdental papilla height of maxillary central incisors.

PurposeTo evaluate the influence of orthodontic treatment with surgically assisted rapid maxillary expansion (SARME) on the interdental papilla height of maxillary central incisors.MethodsIn this retrospective study, patients who completed orthodontic treatment including SARME at the Radboud University Medical Center Orthodontic Department before December 2019 were included. Frontal intraoral photographs taken before (T1) and after completion of treatment (T2) were examined to determine the papilla height between the maxillary central incisors using the Jemt classification. The difference between the Jemt classification at T1 and T2 (∆Jemt) was defined as the primary outcome variable. Secondary outcome variables were gender, age, treatment duration, type of expansion appliance, maximal central diastema during expansion, pretreatment overlapping between the central incisors, gingival biotype, crown morphology and the distance between the bone crest and incisal contact point. Kappa statistics and paired t‑tests were used to determine reliability of the measurements. Pearson’s Χ2 test and independent t‑tests were used to compare the variables between the groups of patients with and without papillary recession. Finally, multiple logistic regression analysis was performed.ResultsIn all, 93 patients fulfilled the inclusion criteria and were included in the study. The Jemt score worsened for 30 patients (32%) between T1 and T2, indicating the occurrence of papillary recession. Incisal overlapping, crown morphology, small width to length ratio, increasing age and an increasing distance between crestal bone and the incisal contact point were factors associated with papillary recession.ConclusionAfter orthodontic treatment including SARME, one third of patients exhibited recession of papilla height of the maxillary central incisors.

Skeletal posterior crossbite in patient with mandibular asymmetry: an alternative solution.

ABSTRACTIntroduction: Skeletal posterior crossbite (SPCB) has a multifactorial etiology, as it may be caused by parafunctional habits, atypical position of the tongue, tooth losses and maxillary or mandibular transverse skeletal asymmetries. Skeletal involvement may lead to facial changes and an unfavorable aesthetic appearance. The treatment of SPCB diagnosed in an adult patient should be correctly approached after the identification of its etiologic factor. Surgically-assisted rapid maxillary expansion (SARME), one of the techniques used to correct SPCB in skeletally mature individuals, is an efficient and stable procedure for the correction of transverse discrepancies that may be performed in the office or in a hospital. Objective: This study discusses the results of asymmetrical SARME used to correct unilateral SPCB associated with transverse mandibular asymmetry. Conclusion: The treatment alternative used in the reported case was quite effective. At the end of the treatment, the patient presented adequate occlusion and facial aesthetics.

Displacement and stress distribution of the maxilla under different surgical conditions in three typical models with bone-borne distraction: athree-dimensional finite element analysis.

The present study compared the skeletal effects of surgically assisted rapid maxillary expansion (SARME) with different surgeries in three representative finite element (FE) models. According to the ossification level of midpalatal suture, three FE models, with different elasticity moduli of sutures (E = 1 MPa, 500 MPa, and 13,700 MPa) were constructed, to represent three age groups of patients. Within each model, four groups were set up according to different surgeries: groupI (control group without surgery), II (paramedian osteotomy), III (pterygomaxillary separation), and IV (paramedian osteotomy and pterygomaxillary separation). An expansion force of 100 N and 1mm displacement were applied via abone-borne distraction to simulate the expansion process. By analyzing these models, the maximum displacement of maxilla was observed in groupIV, with E = 1 MPa model exhibiting the most displacement (28.5 × 10-6 mm), followed by groupII (21.4 × 10-6 mm). GroupIV showed aunique backward-downward rotation with minimum stress distributions in three models (9 MPa, 131 MPa, and 140 MPa, respectively), and groupII exhibited comparable low stress distributions (12 MPa, 151 MPa, and 230 MPa, respectively). Lowest stress was found in E = 1 MPa model, compared with the other two models. There is no need to perform surgeries when the midpalatal suture is open, and surgery guidelines are the same for partial and complete fusion sutures. Furthermore, exclusive use of partial paramedian osteotomy is sufficient enough to reduce stress and expand the posterior part of maxilla, and it is less invasive.

The stability of surgically assisted rapid maxillary expansion (SARME): A systematic review

BackgroundThis systematic review was conducted to determine the stability of surgically assisted rapid maxillary expansion (SARME) for correction of transverse maxillary deficiency, the effect of distractor type (tooth-borne vs. bone-borne) and the influence of a retainer on post-expansion stability. MethodsThe review was conducted applying the PICO criteria. Electronic database searches of published literature (MEDLINE via PubMed), Ovid via MEDLINE, the Cochrane Oral Health Group's Trial Register, Cochrane Central Register of Controlled Trials, (CENTRAL) and unpublished literature were accessed until January 2019. Search terms included SARME, ‘stability’, ‘relapse’, ‘surgery’, ‘expansion’ and ‘maxillary expansion’. ResultsFive hundred and ten studies were identified overall and 15 studies were included (3 RCTs, 2 prospective & 10 retrospective) following initial screening and data extraction of full texts. The quality of evidence was assessed using the Cochrane Risk of Bias tool for RCTs and the Newcastle–Ottawa Scale for prospective & retrospective studies. The heterogeneity of the retrieved articles prohibited quantitative analysis. Overall, the studies were either of high risk of bias or low quality. Qualitative analysis reveals SARPE to achieve expansion at the inter-canine region of 4–for inter 6 mm, inter-molar region of 6–8.9 mm, and skeletal level of 2.3–3.1 mm with relapse rates in the region of 0.1–2.3 mm (inter-canine), 0.2–3 mm (inter-molar) and 0–1.8 mm (skeletal) reported. ConclusionQualitative evaluation suggests SARPE results in significant expansion at the dental and skeletal level and that this appears to be stable. Existing literature is equivocal on the clinical benefits of a retention device or distractor type (bone-borne vs. tooth borne) on stability. This review has unearthed the need for high quality prospective RCTs to fully understand the stability of SARME, particularly with relation to varying distractor types and use of retention devices. As such, the inferences drawn should be considered with some discretion based on the quality of the available evidence.

Does Nasal Cavity Enlargement Associated With Respiratory Function Improvement After Surgically Assisted Rapid Maxillary Expansion?

To systematically evaluate the effects of surgically assisted rapid maxillary expansion (SARME) on nasal cavity and its associated respiratory function changes. Multiple electronic databases were searched, authors were contacted as required, and reference lists of potentially relevant studies were screened. Articles that included patients older than 16 who had received SARME were considered. Data extraction and quality assessment were performed independently and in duplicate. Eight articles, including 161 patients, were finally selected and analyzed. Nasal cavity significantly augmentation after SARME has been recognized by 7 studies with moderate-quality evidence. Among them, the nasal cavity volume increased <20% in 4 studies, 20% to 40% in 1 study, and >40% in 2 studies. Totally, the range of increasing in nasal cavity volume was 7.6% to 99%. One study had recorded the nasal expiratory and inspiratory flow significantly increased 18.5% and 21.7%, respectively. SARME was found to produce meaningful volume augmentation in nasal cavity with adult patients. However, the improvement of nasal respiratory function has not been well elucidated; thus, SARME is not yet recommended for the purpose of improving nasal respiratory.

A comparison of tooth-borne and bone-anchored expansion devices in SARME.

Major adult maxillary transverse discrepancies are usually treated with surgically assisted rapid maxillary expansion (SARME), utilizing a combination of surgical and orthodontic techniques. Unfortunately, a consensus has not been reached on topics ranging from the best surgical technique that should be performed to the ideal expander type that should be installed. The present study sought to evaluate the efficiency and stability of the maxillary expansion achieved with two types of expanders following the same SARME procedure without pterygomaxillary disjunction (PMD). Twenty-four patients with a maxillary transverse deficiency were enrolled in the study. All patients underwent the same SARME, and 12 received a bone-anchored (KLS Martin®) and 12 were installed with a tooth-borne (Hyrax®) expander. Dental impressions were collected both preoperatively and 1year postoperatively. These casts were scanned and the distances between specific interdental and intergingival points were measured and analyzed. Statistical analyses were performed to assess the effects expander type had on the efficiency of the maxillary expansion and long-term stability. Expansion in the anterior maxillary and premolar regions was found to be similar in both groups. In contrast, the tooth-borne device resulted in a significantly greater expansion in the molar region. The SARME technique without PMD is highly effective at treating adults with maxillary transverse deficiencies, and the type of expander selected depends on the location of the larger maxillary constriction region of each patient.

Reliability of the Linear Measurement (Contact) Method Compared with Stereophotogrammetry (Optical Scanning) for the Evaluation of Edema after Surgically Assisted Rapid Maxillary Expansion.

Many techniques have been developed to evaluate facial swelling after maxillofacial surgeries. Patients who undergo surgically assisted rapid maxillary expansion (SARME) develop facial edema more often than those who undergo minor oral surgeries. Reliable systems to assess soft tissue dimensions offer many advantages for documentation and treatment planning across surgical fields. (1) Background: The objective assessment of facial swelling is advantageous as it allows the evaluation of the effect of anti-inflammatory drugs. Therefore, this study aimed to compare the reliabilities of linear measurement method and optical scanning for the objective assessment of facial swelling after SARME. (2) Methods: Sixteen (12 women and 4 men) patients were enrolled. Linear measurements between guide points and facial scans were obtained for the left and right sides preoperatively and 1, 2, and 5 days after SARME. Preoperative values were subtracted from each post-operative value and the differences were compared between the two measurement methods. (3) Results: There were no statistically significant differences between the right and left sides at any time point in the measurements with either method. (4) Conclusions: Recently, stereophotogrammetry has been considered the first choice method for evaluating facial swelling. Furthermore, we found a strong correlation between volumetric analysis and linear measurement at all time points and for both sides.

Effects of surgically assisted rapid maxillary expansion on the modification of the pharynx and hard palate and on obstructive sleep apnea, and their correlations

PurposeTo investigate the changes induced by surgically assisted rapid maxillary expansion (SARME) on palate and pharynx morphology as well as the correlation of these changes with the improvement of obstructive sleep apnea (OSA). Materials and methodsThe study was conducted in 16 patients, seven women and nine men, aged on average 40.23 ± 10.23 years, all of them with OSA confirmed by polysomnography (PSG) and with posterior crossbite. All participants underwent computed tomography (CT) and PSG before and after SARME. The CT scans were used to determine the dimensions of the palate and pharynx before and after surgery. Data were analyzed statistically by the paired t-test, Wilcoxon test and Pearson correlation, with the level of significance set at P < 0.05. ResultsA 56.24% reduction in apnea and hypopnea index was detected (from 33.23 ± 39.54 to 14.54 ± 19.48: P = 0.001). The total airway area increased on average by 23.99% (P = 0.016), although in a more expressive manner in its lower half (28.63%, P = 0.008). A 24% transverse bone increase was observed in the palate in the region of the first premolars and an 18% increase in the region of the first molars (from 2.42 ± 0.31 to 2.99 ± 0.26. P < 0.001, and from 3.11 ± 0.32 to 3.70 ± 0.41, P < 0.001, respectively), and a mean 15% reduction of its depth (from 1.07 ± 0.33 to 0.89 ± 0.18, P = 0.014). A moderate correlation was detected between palate depth and width and OSA severity, as well as a correlation of the reduction of palate depth and its transverse increase with the improvement of OSA, especially among patients with severe OSA. ConclusionIt appears that narrowing of the palate, especially in the premolar region, and its greater depth may be related to the severity of OSA. SARME promotes transverse maxillary widening and lowering of palate depth, thus reducing OSA among adults and expanding the airway, especially in its lower half.

Satisfactory outcomes after orthognathic surgery with surgically assisted rapid maxillary expansion using a hybrid device.

The self-reported functional outcomes, clinical findings, and results of dental cast analysis before and after orthognathic surgery with surgically assisted rapid maxillary expansion (SARME) using a hybrid rapid maxillary expander (RME) were evaluated. Data were collected from 43 patients who underwent orthognathic surgery with SARME using a hybrid RME between 2001 and 2013. The patients were recruited during a follow-up clinical examination and were required to complete a questionnaire about their opinions and self-reported functional outcomes. Dental casts were used to analyze posttreatment palatal expansion. The mean follow-up time was 68 months (range: 25-135 months). The most common indication for SARME was the presence of a crossbite. Of the 30 patients who underwent a follow-up clinical examination (69.8% answer rate), 4 (13.3%) had symptoms of temporomandibular disorder (TMD), 1 (3.3%) experienced myalgia, and 3 (10.0%) experienced arthralgia on clinical palpation. Cast analysis revealed significant palatal expansion. The intercanine distance, intermolar distance, and palatal height were increased by 3, 5, and 2 mm, respectively. Overall, the patients were satisfied with the preoperative information, improved functions, and aesthetic results. The prevalence of TMD symptoms and other side effects following orthognathic surgery with SARME using a hybrid RME was low, and significant palatal expansions were achieved.

Surgically-assisted rapid maxillary expansion (SARME): indications, planning and treatment of severe maxillary deficiency in an adult patient.

ABSTRACTIntroduction: Maxillary deficiency, also called transverse deficiency of the maxilla, may be associated with posterior crossbite, as well as with other functional changes, particularly respiratory. In adult patients, because of bone maturation and the midpalatal suture fusion, rapid maxillary expansion has to be combined with a previous surgical procedure to release the areas of resistance of the maxilla. This procedure is known as surgically-assisted rapid maxillary expansion (SARME). Objective: This study discusses the indications, characteristics and effects of SARME, and presents a clinical case of transverse and sagittal skeletal maxillary discrepancy treated using SARME and orthodontic camouflage.

Complications in surgically assisted rapid maxillary expansion: a systematic review of the medical literature

Our aim was to perform a systematic open-access review of various complications reported for surgically assisted rapid maxillary expansion (SARME) procedures. There were 37 articles found in Pubmed using the search equation. Twelve articles were initially excluded according to the exclusion criteria. The 25 remaining articles were read in full for their descriptions of complications related to the SARME procedure in mature patients. The main reversible complications of SARME were infection, postoperative pain, and bleeding. There were also complications related to distractors, to secondary surgeries, and pterygomaxillary junction. The main non-reversible complications of SARME were associated with teeth, periodontal bone loss, and skull base fractures. Large field-of-view cone beam computed tomography (maxilla and skull base) should be implemented as initial planning tool to prevent many potential complications. The current trend for “minimally invasive” surgery in SARME might be, from an ethical point of view, transformed onto “minimally complicated” surgery as complication is still more harmful for any given patient than any potential perioperative surgical invasiveness.

Skeletal and dental effects of surgically assisted rapid palatal expansion: a systematic review of randomized controlled trials.

Surgically assisted rapid maxillary expansion (SARME) is a surgical technique developed to correct transverse discrepancies in skeletally mature patients. However, there is limited evidence concerning the immediate skeletal and dental changes obtained only due to SARME. The aim of the present systematic review is to investigate the immediate skeletal and dental effects of SARME in adult patients with transverse maxillary hypoplasia. An electronic search of the literature in MEDLINE, The Cochrane Library, Lilacs and Scopus databases was performed. Only randomized controlled trials (RCTs) studies investigating the skeletal and dental effects of SARME procedures in adult patients were included. The included studies received a methodological quality scoring according to the revised Cochrane risk-of-bias tool for randomized trials. The quality of evidence was assessed by means of the Grading Recommendation Assessment, Development and Evaluation (GRADE) system. For each included study and for each analysed parameter, the difference in means and 95 per cent confidence interval was calculated between baseline and immediate post-expansion. A meta-analysis of original outcome data, if possible, was conducted. Nine articles were selected. The methodological quality ratings indicated that one study was at low risk of bias, seven presented some concerns and only one was at high risk of bias. In all the included studies, the SARME procedure resulted in a significant expansion of the maxillary transverse dimension. The meta-analysis compared skeletal and dental inter-molar width before and after treatment: the mean difference was of 3.3 mm (2.8-3.9) and 7.0 mm (6.1-7.8), respectively (P-value less than 0.001). The quality of evidence was low-moderate. SARME is effective in obtaining a significant expansion of the maxillary transverse dimension. However, the immediate SARME effect is mainly a molar expansion rather than a pure bone transverse widening of the maxilla. The review protocol was registered at PROSPERO database with the registration number CRD42018117967.

Tooth Tipping in Surgically Assisted Rapid Maxillary Expansion (SARME).

Tooth Tipping in Surgically Assisted Rapid Maxillary Expansion (SARME).

Is It Possible to Protract the Maxilla by Surgically Assisted Rapid Maxillary Expansion and Intermaxillary Class III Elastics?

The purpose of the present study was to evaluate skeletal and soft tissue changes with surgically assisted rapid maxillary expansion (SARME) and intermaxillary Class III elastics. A total of 15 patients (mean age: 19.58 years) were included in the study. Each patient underwent SARME with the use of Class III elastics (500 g) applied through miniscrews to stimulate maxillary advancement. Lateral cephalograms and posteroanterior radiographs obtained before treatment (T1), after SARME and elastic use (T2), and after treatment (T3) were analyzed to determine the changes in each phase of treatment. Planimeter was used to evaluate facial soft tissue changes. Wilcoxon signed-rank test was used to evaluate the changes that occur during treatment. SARME provided permanent and efficient maxillary expansion at both skeletal and dental levels (p<0.01). Maxillary skeletal (ANS-Ver and U1i-Ver; p<0.01) and soft tissue (Pr-Ver, Sn-Ver, and ULA-Ver; p<0.01) variables and superior upper labial area (Area 1; p<0.05) increased due to maxillary dental and skeletal changes. Superior lower labial area (Area 3; p<0.05) decreased as a result of slight increase in facial height and changes in maxillary-mandibular incisor relationship at the end of the treatment. The results suggest that the improvement in the facial profiles of the patients is related to the significant increase in the bony and dental support of the upper lip region together with the contribution of the superior lower lip area.

Quantification of asymmetry in maxillary expansion following surgically assisted rapid maxillary expansion (SARME)

Background: Asymmetrical expansion is one of the common complications following surgically assisted rapid maxillary expansion (SARME).

Nasal soft tissue changes after two different approaches for surgically assisted rapid maxillary expansion

The aim of the study was to evaluate the nasal soft tissue changes in patients who underwent surgically assisted rapid maxillary expansion (SARME) using two different surgical approaches. Thirty-two patients were included in the study, and divided into two groups according to the type of surgical approach: in group A (n=17), SARME performed with standard Le Fort I circumvestibular approach with alar base cinch and anterior nasal spine (ANS) exposure; and in group B (n=15) operations were performed with the same standard Le Fort I circumvestibular approach with only alar base cinch. Measurements of height and width of the philtrum, nasal and subnasal width, and columella width were taken from three-dimensional facial images obtained before surgery (T1), after the distraction phase (T2) and 6 months postoperatively (T3). The mean maxillary expansion was 7.3±0.7mm for group A and 7.5±1.5mm for group B, without any significant difference between groups (P=0.59). Both groups presented an increase in all vaules in T2 and T3. The approach used in group A resulted in smaller changes in the columella width. The results of the present study show that there is no need for intraoperative releasing of the soft tissues around the anterior nasal spine during SARME if columella width is sufficient. However, further randomized studies based on large patient groups are needed before final conclusions on this topic can be reached.