History - Orthodontic expansion first described by Emersen Angell about 145 years ago - Kole in 1959 first person to speak about corticotomy procedure in adults with maxillary constriction - Brown first described surgical technique for SARPE in 1938 - Steinhauser first described technique involving segmental left/right split of maxilla along with placement of graft in 1972

Indications - Skeletal maturity or adult patients - Fused intermaxillary suture - Transverse maxillary hypoplasia - Bilateral posterior crossbite - Previous failure of use of any other expansion devices

Procedure - SARPE performed to address transverse dimension changes in a patient - Surgery followed by Le Fort 1 in a second surgery to address vertical and anterior-posterior changes - Rapid maxillary expander device placed in maxilla for first surgery - Le Fort fracture of skull without downfracture of maxilla performed under local anaesthesia and iv sedation or general anaesthesia - Midpalatal osteotomy performed to allow break in inter-maxillary suture

Stability of Procedure - Chamberland and Profitt observed skeletal changes of about 3-4mm after SARPE, which were stable - One-third of transverse dental expansion obtained with SARPE may be lost, but skeletal expansion remains the same - Post-surgical relapse with SARPE similar to changes in dental arch dimensions after non-surgical rapid palatal expansion - Stability of procedure not superior to other known expansion techniques - Study by Northway et al. suggested long-term buccogingival expansion more acceptable in adults expanded with surgical augmentation

Disadvantages - Unaesthetic period after expansion with RME - Implementation of palatal expander post-operatively - Patient compliance necessary - Second surgery likely

[REFERENCES] - Koudstaal, M. J.; Poort, L. J.; van der Wal, K. G. H.; Wolvius, E. B.; Prahl-Andersen, B.; Schulten, A. J. M. (2005). Surgically assisted rapid maxillary expansion (SARME): a review of the literature. - Catalog of Copyright Entries. Part 1. A Group 1. Books. New Series. 1938. - Steinhauser, E. W. (1972). Midline splitting of the maxilla for correction of malocclusion. - Hamedi Sangsari, Adrien; Sadr-Eshkevari, Pooyan; Al-Dam, Ahmed; Friedrich, Reinhard E.; Freymiller, Earl; Rashad, Ashkan (2016). Surgically Assisted Rapid Palatomaxillary Expansion With or Without Pterygomaxillary Disjunction: A Systematic Review and Meta-Analysis. - Chamberland, Sylvain; Proffit, William R. (2016). Short-term and long-term stability of surgically assisted rapid palatal expansion revisited. - Chamberland, Sylvain; Proffit, William R. (2016). Closer Look at the Stability of Surgically Assisted Rapid Palatal Expansion. - Northway, W. M.; Meade, J. B. (1997). Surgically assisted rapid maxillary expansion: a comparison of technique, response, and stability.