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