Surgically assisted maxillary expansion (SARPE)

A narrow upper jaw is a common cause of crossbite (upper back teeth closing inside the lower ones), crowded teeth, dark corners in the smile and sometimes difficult nose breathing. In children the jaw is widened with appliances while the suture in the middle of the palate is still open. In adults the bones have fused and an appliance alone is not enough: expansion needs surgical support. It is carried out jointly by an orthodontist and a maxillofacial surgeon in UKRMED's maxillofacial surgery department.

Photo: Ian Furst, Wikimedia Commons, CC BY-SA 4.0

When expansion is needed

• crossbite on the side teeth;
• crowding due to lack of space;
• wide dark spaces in the corners of the smile;
• a narrow high palate;
• preparation for braces or orthognathic surgery (surgery that repositions the jaws).

Why adults need SARPE surgery

In adults an expander without surgery mostly tilts the teeth rather than widening the bone. A literature review of surgically assisted rapid maxillary expansion describes it as a combination of orthodontics and surgery for skeletally mature patients (whose bones have stopped growing): the surgeon weakens the bony resistance and the appliance gradually separates the two halves of the jaw. This creates space to align the teeth and widens the palate. The plan is based on a CT scan of both jaws.

How treatment works

1. Diagnostics. Orthodontist and surgeon examination, CT of both jaws, models or scans.
2. Fitting the appliance. A Hyrax expander is fixed to bands (metal rings around the teeth) on the side teeth, or a surgical distractor is placed directly on the bone.
3. Surgery. The surgeon makes releasing bone cuts, including with a piezotome, an ultrasonic instrument that cuts bone precisely and protects soft tissue. Surgery is done with anaesthetist support.
4. Activation. A few days after surgery the appliance is gradually turned according to the doctor's schedule.
5. Stabilisation. Once the required width is reached, the appliance stays in place while the bone becomes solid.
6. Orthodontic stage. The teeth are then aligned with braces.

Who treats

The maxillofacial surgery department includes Anna Kravchenko, maxillofacial surgeon, PhD. The orthodontic stage is led by the clinic's orthodontists, including Olena Fedoriv, who works with orthodontic appliances. Please check which doctors will lead your case when booking.

After surgery

• swelling and discomfort in the first days, relieved with prescribed medicines;
• a temporary gap appears between the front teeth, a sign the jaw is widening; it is later closed with braces;
• soft food and careful cleaning around the appliance;
• regular check-ups.

If the jaws are also out of position relative to each other, orthognathic surgery is considered.

Prices

Sources

1. Koudstaal M. J., Poort L. J., van der Wal K. G. et al. Surgically assisted rapid maxillary expansion (SARME): a review of the literature. Int J Oral Maxillofac Surg, 2005. https://doi.org/10.1016/j.ijom.2005.04.025
2. Carvalho P. H. A., Moura L. B., Trento G. S. et al. Surgically assisted rapid maxillary expansion: a systematic review of complications. Int J Oral Maxillofac Surg, 2020. https://doi.org/10.1016/j.ijom.2019.08.011