MARPE for a Patient With Severe Mandibular Prognathism and Hemangioma

Objective: In post-pubertal patients, two stages of surgical treatment are usually indicated to treat a severe transverse discrepancy and mandibular prognathism.  Surgically assisted rapid palatal expansion (SARPE) is the treatment of choice for unilateral crossbite resulting in a maxillary transverse discrepancy.  Orthognathic correction of mandibular prognathism can involve bi-jaw surgery where the maxilla and the mandible are surgically moved to correct the AP discrepancy. A hemangioma  (arteriovenous malformation) located in the right facial region increased the complications involved with surgery in a 19 year old patient with maxillary transverse discrepancy and mandibular prognathism.  The location of the hemangioma increases the risk of trauma to the hemangioma, which could result in hemorrhage during maxillary surgical treatment. To eliminate the surgical complications and risk of morbidity, a one stage surgical procedure was preferred. 

Method: Mini-implant assisted rapid palatal expansion (MARPE) was used to correct a maxillary transverse discrepancy to reduce the number of surgical procedures and thereby decrease the risk of surgical complications that could occur during surgery.

Result: Orthopedic correction of the unilateral crossbite was achieved using MARPE instead of SARPE, prior to BSSO set back and maxillary advancement.

Conclusion: The use of MARPE to correct maxillary transverse discrepancy in post adolescents and in patients past pubertal growth could potentially eliminate the need for a two stage surgery in patients who may be at risk for surgical complications.