It must be taken into account that patients with maxillary tori must have them removed surgically (4-6 months beforehand or as part of the same surgery) and they must be considered when establishing the treatment protocol. If, in addition to the SARPE, any other surgery is necessary for vertical or sagittal problems, the osteotomies must be done at the same level as those planned for the next surgery to ensure the bone is intact for anchoring the tiny plates or screws.
Even though the surgically assisted rapid palatal expansion is more stable, there are cases that call for a segmental LeFort I osteotomy. In patients who need maxillary expansion associated with another sagittal or vertical problem. This is also the surgery of choice in cases with a discrepancy >7 mm who also need surgical levelling of the Spee curve.
If we want greater expansion at the canine level, we will do an SARPE; if we want greater expansion at the molar level, the best choice is the segmental LeFort osteotomy. Treatment with SARPE is faster and can prevent the need for extractions in arches with oseo-dental discrepancies. For patients that will be undergoing a LeFort treatment, an orthodontic levelling must be done beforehand and extractions in the case of negative discrepancies.
Each patient must be studied carefully to know exactly how much expansion we need. It is important to eliminate mandibular dento-alveolar compensations as they could mask proper maxillary expansion.
We must remember that, when operating on the maxillary area, we are altering the proportions of the middle third of the face, including the distance between the nose and its tips, the width of the base and the naso-labial angle.