Additional surgical considerations for maxillary transverse discrepancies in orthognathic patients

I read with great interest the recent narrative review by Johnson King et al. (1) on the surgical management of maxillary transverse deficiency in orthognathic patients. The authors deserve commendation for providing a comprehensive and clinically useful overview of current surgical approaches, including surgically assisted rapid palatal expansion (SARPE), surgically assisted micro-implant-supported rapid palatal expansion (SAMARPE), and segmental Le Fort I osteotomy, in patients with maxillary deficiency.

The authors emphasized that SARPE provides greater transverse expansion, although increased relapse has been observed in long-term follow-up. This finding is consistent with the widely accepted view in the literature that maxillary expansion achieved with SARPE includes not only a skeletal component but also a substantial dentoalveolar component. Although dentoalveolar expansion may lead to an overestimation of the true transverse gain, it may also represent one of the major factors contributing to the observed tendency for relapse (2).

As also noted in the review, segmental Le Fort I osteotomy tends to provide more controlled skeletal expansion and less dental tipping (1). In segmental Le Fort I surgery, complete mobilization of the maxillary segments is achieved. In contrast, although the sutures are surgically released in SARPE, the objective is gradual expansion through distraction osteogenesis rather than full mobilization and repositioning of the segments (3).

During treatment planning, distinguishing whether maxillary expansion will be primarily skeletal or dentoalveolar, depending on the selected technique, is critical for both treatment success and long-term stability. This distinction may be particularly important in patients with a thin periodontal biotype or in cases in which excessive buccal tipping could adversely affect long-term stability (4).

In clinical practice, when performed with careful surgical planning and rigid fixation, segmental Le Fort I osteotomy can provide predictable correction in cases of moderate transverse deficiency. Nevertheless, posterior dental relapse remains a possible postoperative concern. It is therefore important that, as emphasized in the review, overcorrection and retention protocols continue to be regarded as essential components of treatment in order to minimize this problem.

The discussion of SAMARPE as a minimally invasive alternative is also noteworthy. However, no clear quantitative protocol regarding the duration and type of retention has yet been defined in the current literature for this technique. Although stability may be favorable when true sutural opening is achieved and appropriate retention is applied, the available evidence, as the authors also pointed out, is still largely based on short- and medium-term outcomes. Therefore, studies with longer follow-up periods are needed to better define its indications and long-term stability.

Finally, it should be emphasized that treatment outcomes are influenced not only by the surgical technique itself, but also by factors such as the amount of expansion, the appliances used for fixation, soft tissue resistance, and patient age. For this reason, individualized treatment planning remains fundamentally important for optimizing both functional and esthetic outcomes.

In conclusion, this review provides a valuable overview of current surgical strategies. Future research focusing on long-term follow-up data will further strengthen the evidence base in this field.

Acknowledgments

None.

Footnote

Provenance and Peer Review: This article was a standard submission to the journal. The article did not undergo external peer review.

Funding: None.

Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at https://fomm.amegroups.com/article/view/10.21037/fomm-2026-0016/coif). The author has no conflicts of interest to declare.

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References

1. Johnson King O, Jones F, Sharma PK. Surgical management of maxillary transverse discrepancies in the orthognathic patient: a narrative review. Front Oral Maxillofac Med 2026;8:3.
2. Chen KY, Yang CY, Fan CN, et al. The effects of pterygomaxillary disjunction in surgically assisted rapid maxillary expansion: A systematic review and meta-analysis. Orthod Craniofac Res 2024;27:750-7. [Crossref] [PubMed]
3. Pary A, Cal-Neto JP. A simple method to treat asymmetric expansions in three-segment surgically assisted rapid maxillary expansion. J Oral Maxillofac Surg 2013;71:2130-6. [Crossref] [PubMed]
4. Oliveira TF, Pereira-Filho VA, Gabrielli MA, et al. Effects of lateral osteotomy on surgically assisted rapid maxillary expansion. Int J Oral Maxillofac Surg 2016;45:490-6. [Crossref] [PubMed]