Sarpe / Surgically Assisted Maxillary Expansion

Here you can find:

  • General description
  • FAQ: Frequently Asked Questions
  • Postoperative Instructions: ENGLISH
  • Postoperative Instructions: SPANISH


The orthodontist very frequently needs to expand the upper jaw in the adult. S/He does this in order to make the arch wider. As s/he makes it wider, s/he can fit more teeth into the arch and avoid the extraction of teeth. When you are younger, the orthodontist can stretch the bones apart because the bones are softer and not firmly attached together. As you grow older, this is not possible. In this case, he will enlist the help of the oral and maxillofacial surgeon.

An expander will be cemented into your mouth BEFORE SURGERY. Then, the upper jaw is surgically separated in two pieces and the expander then pushes the bones apart. This is a very COMMON procedure. The procedure is performed as an outpatient and is NOT painful. You will be able to go back to work/school two days afterwards. You will need to return to have Dr. Heffez check the progress of expansion.

As the upper jaw is expanded a gap will develop between your front teeth. This is where the new bone will form. It is important not to floss the area and to gently brush the area clean so as not to disturb the new bone and the teeth attachment to the bone.

A typical postoperative schedule looks like this:
5 days appliance is activated for first time, instructions are given for you to activate the appliance
1 week later the space that is being created between your two front teeth is checked and the bite is checked.
After another week the separation of teeth and the bite are checked one more time and activation is stopped.
You return to the orthodontist for a check.
The appliance remains in place for 3 months without further activation.
Orthodontic treatment is then resumed.


You should expect FOUR things:
1. The space between your two front teeth wiill widen
2. You will sense pressure in your cheek bones
3. The bit will change
4. The activation key will get harder to turn (but always able to be turned).

If this is not occurring, call Dr. Heffez on his cell number to make sure that everything is going well.

The pressure in your face is normal when the device is activated. Take a mild pain medication like Advil/ or ibuprofen or Tylenol 30 minutes before activating the appliance to help you.

Yes, the dissolvable stitches typically fall out and you end up spitting them out or swallowing them.

When separating the jaw using an expander, it is always possible that you will experience some opening of the bite. The open bite that occurs may not be able to be taken care of with orthodontics alone. In this case, you will need another surgical procedure to close the mouth opening. This surgery would be performed close to the end of the orthodontic treatment.

The surgery involves separating the jaw with fine saws and instruments into two pieces. The sectioning occurs through the sinuses. If you blow your nose, the air from your nasal city will be forced into your sinuses and your face will temporarily swell with air. This would resolve on its own, but it is best to allow the wounds to heal quietly. You should not blow your nose for two weeks.

I notice my nose bleeding after surgery.

Some nasal bleeding is normal in the first 24 hours. Thereafter some pink fluid may be seen coming from your nose as the clots shrink. Simply wipe the fluid away. For any bright persistent bleeding call Dr. Heffez on his cell number.

The jaw problem is typically covered under your medical insurance. A preauthorization letter is written to your insurance company before the procedure is performed. In this way you can understand your financial obligations before the procedure.

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