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What Goes Wrong With MARPE? Audrey Yoon

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Farooq Ahmed

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 Join me for a lecture summary from this years AAO by Audrey Yoon. Don’t Make the Same Mistake I Did/ MARPE Complication.

Success MARPE

Overall separation: 87.8% Success rate of sutural separation: (Jeon 2021)

  • 05% in male
  • 17% in female
  • Average expansion: 7.8 ± 2.4 mm.

Variation with age and gender

MARPE efficacy = Achieved Vs planned expansion

  • Greater negative correlation with age in general
    • More male than female
    • Planned Vs achieved
      1. 20 years old = 1:1 M:F
      2. 30 years old = 0.5:1 : 0.8:1
      3. 40 years old = 0! : 0.6:1 BUT NO DATA – extrapolation

No relationship with bicortical engagement

Asymmetric expansion

  • = 50% of cases ANS level greater than 1mm
  • 27% Greater than 2mm at ANS
  • Severe: Similar to tripod fracture
  • Causes of asymmetry Kim 2019
    • Nasal-maxillary suture opening / remain closed
      • 30% of case unilateral opening of suture

SARPE = 3-13% asymmetric expansion Williams 2012, Smeets 2020

 Pain

  • 45% report pain
    • 19% Around band of 1st maxillary molar band
    • 10% headaches

Gingival inflammation

  • 9% of patients
  • Design = flush
    • Change to 1mm from palate and arms 3mm from palate = reduce
  • Greater inflammation in retention
    • Possibly due to palatal vault relapse and therefore TADs imbed in palate

Breakages

  • 10%
  • Usually guide rod / arm

Rare:

Loss of vitality 2%

  • Required RCT maxillary incisors (SARPE 4.5%)

Fractures  – potential tripod fracture

Infra-orbital numbness

  • Temporary numbness 6 weeks
  • 3 cases
  • Management
    • Turn backwards slowly
    • Facial massage / myofascial
    • Folate, Vit b – aid nerve regeneration

Hearing loss

  • Zygomatic arch = hearing loss temporary, tetanus, trismus

Unexplained tears

  • Lateral orbital rim = sagging eyeball, lacrimal gland

Popping in the ear

Lateral pterygoid fracture

  • Click and popping to the ear – cheek shooting pain
  • Lateral pterygoid plate fracture – asymmetric expansion

Audrey Yoon – youtube patient instruction video / leaflet

A retrospective analysis of the complications associated with miniscrew-assisted rapid palatal expansion` Audrey Yoon 2022

 

#MARPE #orthodonticcomplications #SARPE #orthodonticsinsummary #Farooqahmed #Orthodontics

 

Contributions

Contents: Shanya Kapoor

Editing and production: Farooq Ahmed

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