What Goes Wrong With MARPE? Audrey Yoon

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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 1^st 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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