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What goes wrong with MARPE? Audrey Yoon
Manage episode 344608693 series 2830917
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
112 פרקים
Manage episode 344608693 series 2830917
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
112 פרקים
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