Maxillary Expansion and Timing of Secondary Alveolar Bone Grafting: A Review of the Current Literature
Problem:
What is the current literature and stance on maxillary expansion related to timing of secondary alveolar bone grafting in patients with cleft lip and palate?
Materials/Methods:
Literature review of past 10 years using PubMed and Ovid Medline searching “SARPE”, “SARME”, “palatal expansion”, “maxillary expansion”, and “cleft”.
Methods of data analysis:
Review of relevant literature regarding timing of maxillary expansion and pre or post alveolar bone grafting. The relevant literature was subjectively determined based on the title of the article and the likelihood of acquisition of age and timing data of expansion related to secondary bone grafting. Descriptive statistics of age of maxillary expansion in related literature was conducted.
Results:
Literature search yielded 226 papers. Of these papers, 28 relevant articles had data explicitly stating that palatal expansion was prior to, or after secondary alveolar grafting. Of these papers, 9 articles specifically stated the age at the time of palatal expansion. The average age of maxillary expansion was 9 years 7 months. The average age of expansion prior to secondary bone grafting was 8 years 2 months. The average age of expansion post secondary bone grafting was 12 years 8 months.
Conclusions:
Timing of maxillary expansion in patients with cleft lip and palate is debated. Proponents of expanding the maxilla prior to secondary alveolar bone grafting state it is beneficial to align the segments prior to bone grafting, however more recent literature shows maxillary expansion after secondary bone grafting is possible. This literature review reveals that there are no randomized clinical trials showing stability and outcome comparing palatal expansion before and after secondary alveolar bone grafting. Further research should be conducted with long-term stability data to be able to determine the ideal timing of maxillary expansion in the overall comprehensive care for patients with cleft lip and palate.