Minimal Invasive Subspinal SARPE Technique: A Comparative Review with Conventional Methods

Abstract

Objective: The aim of this review is to compare the classical surgically assisted rapid palatal expansion (SARPE) technique and the minimally invasive subspinal SARPE (MISSARPE) method used in the treatment of maxillary transverse deficiency in adults, and to highlight the advantages and limitations of both approaches. Materials and Methods: Clinical studies, systematic reviews, and case series published in the literature were examined. The surgical characteristics, esthetic and functional outcomes, and complication profiles of both techniques were evaluated. Special emphasis was placed on soft tissue analyses performed using 3D stereophotogrammetry. Results: Although conventional SARPE provides stable skeletal expansion in adult patients, it presents significant disadvantages in terms of operative time, intraoperative bleeding, postoperative edema, and soft tissue deformities. In contrast, MISSARPE, through its limited osteotomy line, shortens the operative duration, reduces blood loss, and minimizes postoperative morbidity. Findings in the literature indicate that MISSARPE induces less alteration in esthetic parameters such as the nasolabial angle and columellar height, thereby enhancing patient comfort. However, it may be insufficient in cases of severe skeletal constriction, and data on its long-term stability remain limited. Conclusion: MISSARPE appears to be a reliable and effective treatment option for adult patients with moderate transverse deficiency and high esthetic demands. Nevertheless, patient selection remains crucial, as conventional SARPE continues to play an important role in cases with severe constriction. Future prospective, randomized clinical studies evaluating long-term stability and patient satisfaction are needed to better define the clinical role of MISSARPE. Keywords: Maxillary transverse deficiency, surgically assisted rapid palatal expansion, minimally invasive surgery, subspinal SARPE, 3D stereophotogrammetry

Keywords

• Maxillary transverse deficiency
• Surgically assisted rapid maxillary expansion (SARPE)
• Minimally invasive surgery
• Subspinal SARPE
• Three-dimensional (3D) stereophotogrammetry

Minimal İnvaziv Subspinal SARPE Tekniği: Konvansiyonel Yöntemlerle Karşılaştırmalı Derleme

Abstract

Amaç: Bu derlemenin amacı, erişkin bireylerde maksiller transvers darlık tedavisinde kullanılan klasik cerrahi destekli hızlı maksiller genişletme (SARPE) yöntemi ile minimal invaziv subspinal SARPE (MISSARPE) tekniğini karşılaştırarak, her iki yaklaşımın avantaj ve sınırlılıklarını ortaya koymaktır. Gereç ve Yöntem: Literatürde yayımlanmış klinik araştırmalar, sistematik derlemeler ve vaka serileri incelenmiş; her iki yöntemin cerrahi özellikleri, estetik ve fonksiyonel sonuçları ile komplikasyon profilleri değerlendirilmiştir. Ayrıca 3D stereofotogrametri ile yapılan yumuşak doku analizlerine özel vurgu yapılmıştır. Bulgular: Klasik SARPE erişkin hastalarda stabil iskeletsel genişletme sağlamakla birlikte, operasyon süresi, intraoperatif kanama, postoperatif ödem ve yumuşak doku deformasyonları açısından belirgin dezavantajlara sahiptir. MISSARPE ise sınırlı osteotomi hattı sayesinde operasyon süresini kısaltmakta, kan kaybını azaltmakta ve postoperatif morbiditeyi düşürmektedir. Literatürdeki bulgular, MISSARPE’nin nazolabial açı ve kolumella yüksekliği gibi estetik parametrelerde daha minimal değişiklikler oluşturduğunu ve hasta konforunu artırdığını göstermektedir. Ancak şiddetli iskeletsel darlık olgularında klasik yönteme kıyasla yetersiz kalabileceği ve uzun dönem stabiliteye ilişkin verilerin kısıtlı olduğu belirtilmektedir. Sonuç: MISSARPE, estetik kaygıları ön planda olan ve orta düzeyde transvers defisiti bulunan erişkin bireylerde güvenilir ve etkili bir tedavi seçeneği olarak öne çıkmaktadır. Bununla birlikte, hasta seçimi kritik öneme sahiptir ve ileri derecede darlık vakalarında klasik SARPE’nin halen önemli bir rolü bulunmaktadır. Gelecekte prospektif, randomize klinik çalışmalarla uzun dönem stabilite ve hasta memnuniyetinin değerlendirilmesi, MISSARPE’nin klinik uygulamalardaki yerini daha netleştirecektir. Anahtar Kelimeler: Maksiller transvers darlık, cerrahi destekli hızlı maksiller genişletme, minimal invaziv cerrahi, subspinal SARPE, 3D stereofotogrametri

Keywords

• Maksiller transvers darlık
• cerrahi destekli hızlı maksiller genişletme
• minimal invaziv cerrahi
• subspinal SARPE
• 3D stereofotogrametri

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