Corticotomy-Assisted Rapid Maxillary Expansion in Thai Adult Patient with Maxillary Transverse Discrepancy due to the Skeletal Malunion: A Case Report
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Abstract
This case report describes a 24-year old Thai male patient with misaligned teeth as a chief complaint. The major findings were maxillary transverse discrepancy with bilateral posterior crossbite, multiple tooth losses and collapsed maxillary arches due to a history of compounded fractures after a motorcycle accident and maxillary/mandibular malunion after surgical treatment with internal fixations. A multidisciplinary treatment plan was designed, agreed upon by the patient and implemented. An approach of corticotomy-assisted rapid maxillary expansion, using conventional corticotomy with a bone graft and Hyrax appliance as a maxillary expander, was performed. The Hyrax was actively expanded for 5 rounds (1 mm) per week for 8 weeks after the corticotomy. After which, a fixed orthodontic appliance (bidimensional edgewise appliance) was inserted for 6 weeks. Total duration of the treatment plan was 26 months to achieve: (1) a satisfactory intra-arch alignment, (2) sufficient interproximal spaces for final restorations, and (3) an acceptable inter-arch relationship in every spatial dimension. The outcomes of this case report can reassure dental clinicians that these complex maxillary and mandibular malunion scenarios in skeletal transverse discrepancies can be reversed with this comprehensive treatment protocol combining corticotomy with orthodontic treatment.
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