Treatment options and limitations in transverse maxillary deficiency

Abstract

Maxillary constriction is clinically manifested as a narrow palate and a high palatal vault, a complete unilateral or bilateral crossbite, dark buccal corridors, unaesthetic appearance and a significant disproportion between the width of the upper and lower dental arches. Structural maxillary abnormality may also be associated with such functional impairments as food chewing disorder, nose breathing problems and a development of a mouth breathing habit. The purpose of this paper is to present and discuss the most common therapeutic approaches in the management of transverse maxillary deficiency. The increased transverse dimension may be achieved orthodontically by expansion, with surgical assistance – surgically assisted rapid maxillary expansion – or using purely surgical techniques. Surgical options include transpalatal distraction and segmented maxillary osteotomy. Orthodontic maxillary expansion is effective at developmental age due to the continuous bone growth, until the closure of the midpalatal suture. As the risk of orthodontic treatment failure is higher in adults with maxillary constriction, these patients make good candidates for surgery. The optimum maxillary expansion approach should be chosen based on such unambiguous criteria as patient’s age, severity of deformity and the skills of the therapeutic team.