What goes wrong with MARPE? Audrey Yoon

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)

· 61.05% in male

· 94.17% 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

o More male than female

o Planned Vs achieved

a. 20 years old = 1:1  M:F

b. 30 years old = 0.5:1  : 0.8:1

c. 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

· 83.9% of patients

· Design = flush

o Change to 1mm from palate and arms 3mm from palate = reduce

· Greater inflammation in retention

o 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

Consent

Audrey Yoon – youtube patient instruction video / leaflet

Growing consent

Audrey Yoon paper AJODO clinical companion – open access

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