Cerrahi Destekli Hızlı Maksiller Genişletme
Synopsis
Maksillanın transvers yöndeki darlıklarının tedavisinde, iskeletsel gelişimin tamamlandığı yetişkin bireylerde ortodontik yöntemler yetersiz kalmakta ve dişlerde eğilme, periodontal hasar ile kortikal kemikte fenestrasyon gibi ciddi komplikasyonlara yol açmaktadır; bu nedenle, 14-15 yaş sonrasındaki hastalarda anatomik direnç noktalarını (apertura piriformis, zigomatikomaksiller destek, pterigoid bağlantı ve sutura palatina media) cerrahi olarak serbest bırakan Cerrahi Destekli Hızlı Maksiller Genişletme (CDHMG) yöntemi tercih edilmektedir. Geleneksel segmental LeFort I osteotomisine kıyasla daha az morbidite, daha düşük avasküler nekroz riski ve daha estetik gülüş sonuçları sunan CDHMG, temelde osteojenik distraksiyon ile kontrollü yumuşak doku genişletmesinin bir kombinasyonudur; operasyon sırasında mukoperiostal insizyonu takiben bukkal vestibul bölgede horizontal düşük seviyeli osteotomiler, pterigomaksiller ayrılma ve sagittal palatal kesiler uygulanarak preoperatif yerleştirilen Hyrax apareyi aktive edilir. Başarılı bir kemik formasyonu için kan akımının korunması, stabilite, latent dönem (0-14 gün), günlük 0.25-1 mm aktivasyon hızı ve 1-6 aylık retansiyon periyodu gibi distraksiyon prensiplerine tam uyum gerekmektedir; nadiren epistaksis veya orbital kompartman sendromu gibi hayati komplikasyonlar bildirilmiş olsa da, CDHMG posterior çapraz kapanışların giderilmesinde, ark uzunluğunun artırılmasında ve stabil iskeletsel genişletme sağlanmasında oldukça etkili ve öngörülebilir bir tedavi seçeneğidir.
In adults with completed skeletal growth, orthodontic methods for treating transverse maxillary deficiencies are insufficient and cause severe complications such as tooth tipping, periodontal damage, and cortical bone fenestration; therefore, for patients over 14-15 years old, Surgically Assisted Rapid Maxillary Expansion (SARME), which surgically releases anatomical resistance areas (apertura piriformis, zygomaticomaxillary buttress, pterygoid junction, and midpalatal suture), is preferred. Offering lower morbidity, a reduced risk of avascular necrosis, and more aesthetic smile outcomes compared to traditional segmental LeFort I osteotomy, SARME combined osteogenic distraction and controlled soft tissue expansion; during the operation, horizontal low-level osteotomies, pterygomaxillary separation, and sagittal palatal incisions are performed following a mucoperiosteal incision to activate the pre-operatively placed Hyrax appliance. For successful bone formation, strict adherence to distraction principles is required, including preservation of blood flow, stability, a latency period (0-14 days), an activation rate of 0.25-1 mm daily, and a retention period of 1-6 months. Although life-threatening complications like epistaxis or orbital compartment syndrome are rarely reported, SARME is a highly effective and predictable treatment option for correcting posterior crossbites, increasing arch length, and providing stable skeletal expansion.
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