Maxillary vestibular incision for surgically assisted rapid palatal expansion: Evidence for a conservative approach.

Aim: To evaluate the soft tissue changes in upper lip, vermilion, and alar bases after surgically assisted rapid palatal expansion (SARPE). A new flap design was proposed to obtain more esthetic results. Methods: Sixteen patients who had undergone SARPE for skeletal deformities were evaluated. None of the patients treated had any previous maxillary or nasal surgery, nor did they have any previous trauma to the midface. The soft tissue was clinically evaluated before and after surgery. Lip length and width were traced and measured on the radiograph, both preoperatively and postoperatively, by the same investigator. Preoperative and 6-month postoperative photographs were added. Results: The data suggested that the greater the stability in the soft tissue, particularly in the vermilion width and alar base, the more conservative the maxillary vestibular incision could be. Conclusion: A conservative anterior vestibular incision at 6 months resulted in better esthetics, influencing a smaller loss of vermilion and less widening of alar bases. Otherwise, a traditional incision associated with decreased lip length slightly increased with the modified incision. SARPE can be effectively performed with a more conservative vestibular incision to prevent excessive scarring and shortening of the lip to achieve predictable results.