Palatal distraction (SARPE)
Surgical palatal distraction (SARPE, surgically assisted rapid palatal expansion) gently weakens the upper jaw with an osteotomy, then widens it progressively with a distractor, to correct a palate that is too narrow. In children, the palatal suture is still flexible and the orthodontist widens the maxilla with a simple expander; after the end of growth, this suture has ossified and the osteotomy becomes necessary.
It is generally preceded and always followed by orthodontic treatment.
Indications
Narrow maxilla: deep, narrow palate, V-shaped arch.
Posterior crossbite (the upper teeth bite inside the lower teeth), on one or both sides.
Lack of space to align the teeth without extractions.
Difficult nasal breathing linked to a narrow nasal floor.
Preparation for orthognathic surgery when the widths of the arches do not match.
Expected benefits
A normal relationship between the teeth and normal chewing, preventing wear and loosening of the teeth; a normal transverse relationship between the jaws; a harmonious smile and face.
Principle
The operation, under general anaesthesia, is performed through an incision inside the mouth, on the gum above the upper teeth. The osteotomy gently separates the maxilla into two parts, without moving it.
The palatal distractor is fixed with one screw on each side of the palate, in the premolar and molar region.
The distractor is activated at the end of the operation: on waking, a gap of about 1 mm is already visible between the central incisors.
In some cases, the wisdom teeth are removed during the same operation.
Activating the distractor
The distractor module carries three markers (a circle, a triangle, a number) that make it possible to quantify the activation.
Activation generally starts 5 days after the operation. The key is placed in the middle of the module and moved downwards, from the incisors towards the tongue, until the next marker appears: about 1/3 mm per day.
Weekly check-ups until the planned widening is reached; the distractor is then locked, on the spot, without anaesthesia and without pain, to prevent any accidental deactivation.
The gap between the central incisors depends on the activation: several millimetres, sometimes more than a centimetre. It is the sign that the expansion is working; the orthodontist closes it afterwards.
Check the stability of the distractor every day (the end-of-activation marker stays in place).
The activation procedure is explained and demonstrated before you leave the hospital.
The distractor stays in place for about 3 months after the end of activation, while new bone forms, then is removed under local anaesthesia.
Specific points
Duration: 60 to 90 minutes.
Usually day surgery: home the same evening.
Moderate swelling of the middle third of the face and the upper lip, sometimes bruising.
Slight nosebleeds during the first few days; do not blow your nose for 2 weeks.
A feeling of pressure on the palate and nose during activation: normal.
Return to work: 1 week.
The distractor is a device not reimbursed by the INAMI/RIZIV; the operation itself is reimbursed on functional criteria.
Recovery
Days 0–4
Cold on the cheeks, painkillers and anti-inflammatories, liquid diet, careful brushing, cleaning of the distractor with an interdental brush, mouthwash. No smoking.
Days 5–21: activation
Activation according to the protocol provided, at fixed times. Weekly check-up. Blended or minced diet: the distractor makes chewing difficult and the expansion causes temporary mobility. A water flosser is recommended to clean under the appliance.
Months 1–3: consolidation
Distractor locked, diet gradually back to normal, rigorous hygiene around the appliance. Orthodontic treatment resumes or starts about 2 months after the operation; the orthodontist closes the diastema.
Risks specific to distraction
In addition to the common risks (see the orthognathic surgery page): infection that may require early removal of the distractor, replaced by a palatal orthodontic retainer; numbness of the upper lip, nose, upper teeth or palate, temporary in the vast majority of cases; exceptional delayed healing, which may be accompanied by loosening or loss of vitality of a tooth; a temporarily disturbed relationship between the upper and lower teeth, which improves with orthodontics.
FAQ
Is it painful?
The operation is not; activation causes pressure on the palate and nose for a few minutes after each turn, without real pain.
Is the gap between the front teeth permanent?
No, it closes partly on its own and then with orthodontics, over a few weeks to a few months.
How much expansion can be obtained?
Generally 6 to 10 mm, depending on the plan.
Can surgery be avoided with a mini-screw-anchored expander (MARPE)?
In young adults, an expander anchored on mini-screws may sometimes be enough; beyond a certain age or when the suture has ossified, SARPE remains necessary. The indication is decided with the orthodontist on the scan.
Is orthognathic surgery still needed afterwards?
Not always. When only the width is involved, SARPE is enough. When there are associated discrepancies, it is a first step before the osteotomy, 6 to 12 months later.