• Anterior > posterior
  • When >10mm expansion required
  • Requires osteotomies where potential resistance to lateral expansion will be encountered
  • Palatal suture, lateral buttresses, and pterygomaxillary junction
  • During surgically assisted rapid palatal expansion (SARPE), there is greater widening within the anterior maxilla than there is posteriorly. By contrast, a segmental osteotomy will produce more expansion posteriorly than anteriorly. This is the result of each procedure having a distinctive “hinge” pattern during the actual maxillary widening. The SARPE procedure is reserved for cases in which greater than 8 to 10 mm of widening is necessary. If segmental osteotomy is undertaken for widening of greater than 10 mm, the likelihood of soft tissue dehiscence, periodontal defects, and poor long term stability increases. 
  • The surgical approach requires that osteotomies be created at all of the points where potential resistance to lateral expansion will be encountered. These include the palatal suture, lateral buttresses, and pterygomaxillary junction. Complete maxillary downfracture is not required.
  • Anterior > posterior
  • When >10mm expansion required
  • Requires osteotomies where potential resistance to lateral expansion will be encountered
  • Palatal suture, lateral buttresses, and pterygomaxillary junction

2PM to 2PM with vertical extensions
dont go to molar molar bc you’re too far back and may expose buccal fat when you extend
must see infraorabital and buttress
dissect to pterygoid, will feel a hard stop
dissect nasal mucose all the way back
release tissue from ANS
may need to take ANS off with rongeur
obwegaser tents the mucosal tissue down
make your osteotomy with recip, it will go slow through the btutress which is fat, then fast as you’re int he sinus
its lower than the lefort, kind of near the lower piriform aperture
do both sides
use the spatula chisel down the midline, must be sure you’re in between roots. tap tap. finger on palate to feel it move
used singule guarded flat against the buttress FACIAL, not all the way back
may need straight chisel
then go in the nose, ball in the nose with singule guarded
do the other wise
double guarded goes in, doesn’t need to go all the way back to the palate
used curved to take off the pterygoids
B sometimes takes this, sometimes doesn’t
activate it 10 turns
MUST TAKE INTERFERENCES because as you start activating this, it has a tendency to flare out
so you take a triangluar wedge superior to your initial osteotomy
its a thin piece of bone you remove
overclose the appliace (like negative 12 turns if you can), should be at preop occlusion
corticotomy —> latency (activate day 5), —> activation —> consolidation
close with alar cinch 3-0 prolene
take deep bite, come out through skin so you see it, as you pull you should see the alar bases cinch
VY closure
3-0 vicryl deep
3-0 CG runnin mucosa