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British Journal of Oral and Maxillofacial Surgery 49 (2011) 65–66

Technical note
Surgically assisted rapid palatal expansion (SARPE)
R. Goddard ∗ , H. Witherow
Maxillo-facial Department, St. George’s Hospital, Blackshaw Road, Tooting, London, UK

Accepted 24 November 2009

Available online 18 February 2010

Keywords: Surgically assisted rapid palatal expansion (SARPE); Intermaxillary suture

SARPE is an effective and stable method of addressing severe

maxillary transverse discrepancy in patients over the age of
15 years of age.1 A number of modifications of the surgi-
cal technique have been described, although most utilise a
form of subtotal Le Fort I osteotomy with a midline palatal

Fig. 2. The split after the mucoperiosteal flap.

cut between the maxillary central incisors.1 The midline cut

Fig. 1. The anterior palatal suture split by the rapid pal.
∗ Corresponding author. Tel.: +44 07877745167.
E-mail address: goddard1998@aol.com (R. Goddard).
has potential to damage the roots of these teeth, adjacent
periosteum and compromise bone and soft tissue perfusion
(Figs. 1–3).2
Pre-operative orthodontics aids separation of convergent
incisor roots, helping to minimise risk of tooth damage. The
intermaxillary and other circummaxillary sutures generally

0266-4356/$ – see front matter © 2010 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.bjoms.2009.11.013
66 R. Goddard, H. Witherow / British Journal of Oral and Maxillofacial Surgery 49 (2011) 65–66
Fig. 3. The fine osteotome in the suture.
start to fuse after 15 years of age. Cases below this age are
therefore amenable to conventional rapid maxillary expan-
sion (RME). Above this age, without surgical separation,
RME results in tipping of the molars with little expansion of
the maxillary arch. It has been suggested that the intermax-
illary suture anterior to the incisive canal never ossifies until
very late in life.3 Consequently, SARPE can be performed
in adults in their 20s and 30s, although at this age, there is
large inter-individual variation in palatal suture closure. The
anterior portion closes somewhat later as this process ini-
tially commences posteriorly.1 Pre-operative rapid maxillary
expansion (RME) can therefore promote shelf separation. In
our experience, activating the RME appliance by 0.5 mm
twice a day for 1 week before SARPE opens the anterior
palatal suture. This creates an anterior groove for placement
of a fine osteotome in order to achieve “atraumatic” mid-
line osteotomy. We have successfully used this technique in
patients ranging from 15 to 27 years with no adverse sequelae.
We routinely carried out a standard Fe Fort I osteotomy,
ensuring pterygoid plate disjunction and midline maxillary
separation with a fine osteotome. We also confirmed separa-
tion of the midline maxillary suture by single turn activation
and de-activation of the expansion device intra-operatively,
noting change in the gap between the two segments.
We strongly recommend a 1 week period of pre-operative
RME prior to SARPE. This negated the need for orthodontic
root separation pre-operatively and decreases surgical mor-
bidity.
Conflict of interest
None.
References
1. Anttila A, et al. Feasibility and long-term stability of SARME with lateral
osteotomy. Eur J Orthod 2004;26:391–5.
2. Cureton and Cuenin. SARPE: orthodontic preparation for clinical
success. AJ of Orthodontics and Dento-facial Orthopaedics July
1999;vol./is.116/1(46–59):0889–5406.
3. Stomberg C, Holm J. SARME in adults. A retrospective long-term follow-
up study. J Craniomaxillofac Surg 1995;23(August (4)):222–7.