What goes wrong with MARPE? Audrey Yoon

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