Update of the classification of midpalatal suture behaviour after surgically assisted rapid maxillary expansion using computed tomography

Published:November 03, 2022DOI:


      The aim of this study was to update the midpalatal suture classification after surgically assisted rapid maxillary expansion (SARME) using computed tomography (CT). Thirty-five patients with a transverse maxillary deficiency and unilateral or bilateral posterior crossbite underwent SARME with osteotomy of the pterygoid apophysis of the sphenoid. CT was performed before installation of the Hyrax expander appliance and after the final activation. Opening of the midpalatal suture was classified into three types: type I, total midpalatal suture opening from anterior nasal spine (ANS) to posterior nasal spine (PNS); type II, partial midpalatal suture opening from ANS to the transverse palatine suture, with partial or non-existent opening of the midpalatal suture posterior to the transverse palatine suture; type III, complete maxillary opening from ANS, but not of PNS, because a paramedian fracture completed the opening of the hard palate. Type I was observed in 42.8% of the patients, type II in 40%, and type III in 17.2%. Opening of the transverse palatine suture was found in all midpalatal suture opening patterns and was more frequent in type III, followed by type II and type I. CT was used to update the classification of midpalatal suture patterns, with the inclusion of type III: total opening of the hard palate due partly to opening of the midpalatal suture and partly to a paramedian fracture.

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        • Colak O.
        • Paredes N.A.
        • Elkenawy I.
        • Torres M.
        • Bui J.
        • Jahangiri N.A.
        • Moon W.
        Tomographic assessment of palatal suture opening pattern and pterygopalatine suture disarticulation in the axial plane after midfacial skeletal expansion.
        Prog Orthod. 2020; 2121
        • Moura L.B.
        • Spin-Neto R.
        • Sverzut C.E.
        • Monnazzi Mda S.
        • Trivellato A.E.
        • Gabrielli M.A.
        • Pereira-Filho V.A.
        Evaluation of the palatal split pattern in surgically rapid maxillary expansion—comparison of two techniques.
        Oral Maxillofac Surg. 2016; 20: 255-258
        • Bell W.H.
        • Guerrero C.A.
        Distração Osteogênica do Esqueleto Facial.
        First edidion. Artmed–Grupo A, Brazil2008: 25-31
        • Sygouros A.
        • Motro M.
        • Ugurlu F.
        • Acar A.
        Surgically assisted rapid maxillary expansion: cone-beam computed tomography evaluation of different surgical techniques and their effects on the maxillary dentoskeletal complex.
        Am J Orthod Dentofac Orthop. 2014; 146: 748-757
        • Kurt G.
        • Altuǧ A.T.
        • Türker G.
        • Kiliç B.
        • Kiliç E.
        • Alkan A.
        Effects of surgical and nonsurgical rapid maxillary expansion on palatal structures.
        J Craniofac Surg. 2017; 28: 775-780
        • Loddi P.P.
        • Pereira M.D.
        • Wolosker A.B.
        • Hino C.T.
        • Kreniski T.M.
        • Ferreira L.M.
        Transverse effects after surgically assisted rapid maxillary expansion in the midpalatal suture using computed tomography.
        J Craniofac Surg. 2008; 19: 433-438
        • Pereira M.D.
        • Prado G.P.R.
        • Abramoff M.M.F.
        • Aloise A.C.
        • Masako Ferreira L.
        Classification of midpalatal suture opening after surgically assisted rapid maxillary expansion using computed tomography.
        Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010; 110: 41-45
        • Laudemann K.
        • Petruchin O.
        • Mack M.G.
        • Kopp S.
        • Sader R.
        • Landes C.A.
        Evaluation of surgically assisted rapid maxillary expansion with or without pterygomaxillary disjunction based upon preoperative and post-expansion 3D computed tomography data.
        Oral Maxillofac Surg. 2009; 13: 159-169
        • Koudstaal M.J.
        • Poort L.J.
        • van der Wal K.G.H.
        • Wolvius E.B.
        • Prahl-Andersen B.
        • Schulten A.J.M.
        Surgically assisted rapid maxillary expansion (SARME): a review of the literature.
        Int J Oral Maxillofac Surg. 2006; 34: 709-714
        • Weissheimer A.
        • de Menezes L.M.
        • Sameshima G.T.
        • Enciso R.
        • Pham J.
        • Grauer D.
        Imaging software accuracy for 3-dimensional analysis of the upper airway.
        Am J Orthod Dentofac Orthop. 2012; 142: 801-813