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.
Rev. odontol. UNESP, vol.36, n3, p.267-273, 2007
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
1. Haas AJ. Rapid expansion of the maxillary dental arch and nasal cavity by opening the mid-palatal suture. Angle Orthod. 1961;31:73-90.
2. Melsen B. Palatal growth study on human autopsy material: A histologic microradiographic study. Am J Orthod. 1975;68:42-54.
3. Timms DJ. An occlusal analysis of lateral maxillary expansion with midpalatal suture opening. Dent Pract Dent Res. 1968;18:435-48.
4. Isaacson RJ, Murphy TD. Some effects of rapid maxillary expansion in cleft lip and palate patients. Angle Orthod. 1964;34:143-54.
5. Epker BN, Wolford LM. Dentofacial deformities: surgical- orthodontic correction. St. Louis: Mosby; 1980.
6. Glassman AS, Nahigian SJ, Medway JM, Aronowitz, HI. Conservative surgical orthodontic adult rapid palatal expansion: sixteen cases. Am J Orthod. 1984;86:207-13.
7. Bays RA, Greco JM. Surgically assisted rapid palatal expansion: An outpatient technique with long-term stability. J Oral Maxillofac Surg. 1992;50:110-3.
8. Jacobs JD, Bell WH, Willians CE, Kennedy 3rd JW. Control of the transverse dimension with surgery and orthodontics. Am J Orthod. 1980;77:284-306.
9. Bell WH, Epker BN. Surgical-Orthodontic expansion of the maxilla. Am J Orthod. 1976;70:517-28.
10. Betts NJ, Vanarsdall RL, Barber HD, Higgins-Barber K, Fonseca RJ. Diagnosis and treatment of transverse maxillary deficiency. Int J Adult Orthodon Orthognath Surg. 1995;10:75-96.
11. Bailey LJ, White RP, Proffit WR. Segmental Le Fort I osteotomy for management of transverse maxillary deficiency. J Oral Maxillofac Surg. 1997;55:728−31.
12. Proffit, WR, Ackerman JL. Diagnóstico e planejamento do tratamento ortodôntico. In: Graber TM, Vanarsdall, RL. Ortodontia: princípios e técnicas atuais. Rio de Janeiro: Guanabara Koogan; 1996.
13. Angell EH. Treatment of irregularities of the permanent or adult teeth. Dent Cosmos. 1860;1:540-4, 599-601.
14. Goddard CL. Separation of the superior maxilla at the symphysis. Dent Cosmos. 1893;35:880-2.
15. Landsberger R. Indications for the expansion of the maxilla. Dent Cosmos. 1910;52:121.
16. Koudstaal MJ, Poort LJ, van de Wal KGH, Wolvius EB, Prahl-Andersen B, Schulten AJM. Surgically assisted rapid maxillary expansion (SARME): a review of the literature. Int J Oral Maxillofac Surg. 2005;34:709-14.
17. Altug Atac AT, Karasu HA, Aytac D. Surgically assisted rapid maxillary expansion compared with orthopedic rapid maxillary expansion. Angle Orthod. 2006;76:353-9.
18. Dromer RB. The history of the “Le Fort I osteotomy”. J Maxillofac Surg. 1986;14:119-22.
19. Shetty V, Caridad JM, Caputo AA, Chaconas SJ. Biomechanical rationale for surgical-orthodontic expansion of the adult maxilla. J Oral Maxillofac Surg. 1994;52:742-9.
20. Isaacson RJ, Ingram AH. Forces produced by rapid maxillary expansion. III Forces present during retention. Angle Orthod. 1965;35:178-86.
21. Lines PA. Adult rapid maxillary expansion with corticotomy. Am J Orthod. 1975;67:44-56.
22. Steinhauser EW. Midline splitting of the maxilla for correction of malocclusion. J Oral Surg. 1972;30:413-22.
23. Kennedy JW, Bell WH, Kimbrough OL, James WB. Osteotomy as an adjunct to rapid maxillary expansion. Am J Orthod. 1976;70:123-37.
24. Bell WH. Le Fort I for correction of maxillary deformities. J Oral Surg. 1975;33:412-26.
25. Wolford LM, Epker BN. The combined anterior and posterior maxillary ostectomy: a new technique. J Oral Surg. 1975;33:842-51.
26. Epker BN, Schendel SA. Total maxillary surgery. Int J Oral Surg. 1980;9:1-24.
27. Alpern MC, Yurosko JJ. Rapid palatal expansion in adults with and without surgery. Angle Orthod. 1987;57:245‑63.
28. Lehman JA, Haas AJ, Haas DG. Surgical orthodontic correction of transverse maxillary deficiency: a simplified approach. Plast Recontr Surg. 1984;73:62-6.
29. Pogrel MA, Kaban LB, Vargervik K, Baumrind S. Surgically assisted rapid maxillary expansion in adults. Int J Adult Orthod Orthognat Surg. 1992;7:37- 41.
30. Berger JL, Pangrazio-Kulbersh V, Borgula T, Kaczynski R. Stability of orthopedic and surgically assisted rapid palatal expansion over time. Am J Orthod Dentofacial Orthop. 1998;114:638-45.
31. Rabelo LRS, Bastos EG, Germano AR, Passeri LA. Expansão de maxila cirurgicamente assistida sob anestesia local. Rev Dental Press Ortodon Ortop Facial. 2002;7:73-9.
32. Anttila A, Finne K, Keski-Nisula K, Somppi M, Panula K, Peltomaki T. Feasibility and long-term stability of surgically assisted rapid maxillary expansion with lateral osteotomy. Eur J Orthod. 2004;26:391-5.
33. Betts NJ, Sturtz DH, Aldrich DA. Treatment of transverse (width) discrepancies in patients who require isolated mandibular surgery: the case for maxillary expansion. J Oral Maxillofac Surg. 2004;62:361-4.
34. Araújo A. Cirurgia ortognática. São Paulo: Ed. Santos; 1999.
35. Ozturk M, Doruk C, Ozec I, Polat S, Babacan H, Bicakci AA. Pulpar blood flow: effects of corticotomy and midline osteotomy in surgically assisted rapid palatal expansion. J Craniomaxillofac Surg. 2003;31:97-100.
36. Northway WM, Meade JB Jr. Surgically assisted rapid maxillary: a comparison of technique, response, and stability. Angle Orthod. 1997;67:309-20.
37. Basdra EK, Zöller JE, Komposch G. Surgically assisted rapid palatal expansion. J Clin Orthod. 1995;29:762-6.
38. Proffit WR, White RP. Surgical-orthodontic treatment. St. Louis: Mosby; 1991.
39. Proffit WR, Turvey TA, Phillips C. Orthognathic surgery: a hierarchy of stability. Int J Adult Orthodon Orthognath Surg. 1996;11:191-204.
40. Racey GL. Surgically assisted rapid palatal expansion: An outpatient technique with long-term stability - discussion. J Oral Maxillofac Surg. 1992;50:114-5.
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