Ultrasound endoscopic bone cutting for rapid maxillary expansion

Purpose: This study evaluated the feasibility and morbidity of ultrasound endoscopic rapid maxillary expansion. Patients and Methods: Thirteen consecutive patients (7 women and 6 men; mean age at time of surgery, 22 yr 10 months; range, 15 yr 4 months to 26 yr 3 months) who required surgically assisted rapid palatal expansion were included in this study. Eight patients had Class III malocclusion and 5 had Class II malocclusion. All osteotomies were performed using ultrasound bone-cutting instruments under direct visualization with a rigid 30! 2.7-mm-diameter endoscope connected to a video system, with access through 3 small vertical incisions. Results: Satisfactory maxillary expansion was achieved in all patients, with minimal postsurgical sequelae. The average operative time for the 13 cases was 74 minutes (standard deviation, 11 minutes) and was not dependent on the quality of bone. Postoperative pain was measured using a visual analog scale ranging from 0 to 10 andwas found to be 1.5 "0.8 on the first postoperative day, which decreased to 0.9 " 0.4 on the second day. Mucosal healing was excellent and none of the patients had excessive edema, hematoma formation, or nerve injury. Conclusion: The procedure described is minimally invasive and has advantages over the usual technique in providing direct vision, creation of a precise and safe osteotomy, minimal bleeding risk, and decreased dissection.