Transpalatal vs anterior approach for pterygomaxillary disjunction in the context of surgically assisted MARPE: CBCT assessment

This study aimed to evaluate the effects on skeletal, dentoalveolar, and craniomaxillofacial sutures, and on upper airway changes, of performing minimally invasive surgically assisted rapid palatal expansion (SARPE) with pterygomaxillary disjunction through an anterior approach, or using a combination of anterior and transpalatal pterygomaxillary osteotomy (TPMO) in maxillary expansion procedures. Pre- and postoperative cone-beam computed tomography (CBCT) images were obtained for each patient. Fifty patients were included: 25 in the control group (minimally invasive twist technique) and 25 in the test group (minimally invasive twist technique combined with TPMO). Both groups showed statistically significant maxillary expansion, with the test group exhibiting a greater anterior maxillary increase (5.60 mm versus 4.10 mm). Both groups experienced an increase in nasal cavity width, upper airway area, and pterygomaxillary disjunction. Buccal tooth inclination and increased palatal bone thickness were present in both groups. The frontonasal suture and zygomatic bone width remained equally stable. The results of study indicate that pterygomaxillary disjunction guarantees posterior palatal expansion, whilst other craniomaxillofacial sutures are not affected. However, transpalatal pterygomaxillary osteotomy allows a more precise split of the pterygoid suture, facilitates down-fracture of the maxilla, and ultimately decreases associated morbidity.