Revista de Odontologia da UNESP
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Revista de Odontologia da UNESP
Original Article

Expansão cirúrgica da maxila em pacientes adultos: expansão rápida assistida cirurgicamente ou osteotomia Le Fort I segmentar? Revista da literatura

Maxillary surgical expansion in adults patients: surgically assisted rapid maxillary expansion or segmental Le Fort I osteotomy? A review of the literature

Scartezini, G.R.; Saska, S.; Dantas, J.F.O.C.; Hochuli Vieira, E.; Gabrielli, M.A.C.

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Resumo

A correção da deficiência transversal maxilar em pacientes adultos pode ser feita de duas formas: 1) Expansão rápida de maxila assistida cirurgicamente (ERM-AC); 2) Osteotomia Le Fort I segmentar (OLF-IS). A ERM-AC é um procedimento que se utiliza de uma técnica ortodôntico-cirúrgica simplificada, que pode ser realizada sob anestesia local, com baixo índice de complicações. A OLF-IS por sua vez, permite uma maior expansão posterior da maxila. É realizada sob anestesia geral, com uma maior morbidade e tende a apresentar menor estabilidade, porém, permite a correção concomitante de problemas nos planos sagital, antero-posterior e vertical em apenas um ato cirúrgico. Objetivo: revisar as técnicas propostas e os critérios de indicação para a realização de uma EMR-AC e OLF-IS. Conclusão: concluímos que a ERM-AC pode ser realizada basicamente de duas formas: com a osteotomia completa dos pilares da maxila (Le Fort I subtotal) ou com a liberação parcial dos pilares (técnicas conservadoras); a OLF-IS pode ser realizada em dois, três e quatro segmentos. Os critérios de indicação para a ERM-AC são: discrepâncias superiores a 5 mm que não podem ser camufladas ortodonticamente e deficiências transversais isoladas; e para OLF-IS, deformidades transversais associadas às deficiências verticais e/ou antero-posteriores com discrepância transversal menor ou igual a 7 mm.

Palavras-chave

Técnica de expansão palatina, expansão maxilar, osteotomia Le Fort I.

Abstract

The transversal maxillary deficiency correction in adult patients can be performed by two ways: 1) surgically assisted rapid maxillary expansion (SARME) or by 2) segmental Le Fort I osteotomy. SARME is a procedure that uses a simplified orthodontic-surgical technique. It can be accomplished under local anesthesia with low rates of complications. Segmental Le Fort I osteotomy allows a larger posterior maxillary expansion. Nevertheless, it is a more complex procedure, performed under general anesthesia and presenting tendency to a higher morbidity and lesser stability. However, it allows simultaneous correction in the sagital and vertical plan with just one surgical procedure. Objective: the aim of this article is a revision of the technique and the indication criteria to perform the SARME and segmental Le Fort I osteotomy. Conclusion: we concluded that SARME can be accomplished basically by two methods: complete osteotomy of the maxillary buttresses (Le Fort I subtotal) or partial osteotomy of the maxillary buttresses (conservative techniques). Segmental Le Fort I osteotomy can be done in two, three and four segments. The indication criteria to SARME are discrepancies superior to 5 mm that can not be camouflaged by orthodontic treatment and isolated transverse deformities. For segmental Le Fort I osteotomy the indications are the transversal deformities associated with vertical and/or sagital deformities when the transversal discrepancy is less or equal to 7 mm.

Keywords

Palatal expansion technique, maxillary expansion, Le Fort osteotomy

References



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