# Maximally Deficiency: Treatments and Applications for Adolescents
## 3 Orthognathic Surgery Approaches  
Non-surgically assisted maxillary expansion is always a safe and effective alternative for treating maxillary deficiency. In adolescents, the bone sutures, such as the mid-palatal suture (MPS), remain open or exhibit minimal interdigitation. Therefore, by taking advantage of growth potential, orthopedic expansion often achieves good prognosis, especially for maxillary transverse deficiency. However, in some premature adolescent patients or those with congenital diseases such as cleft palate or craniosynostosis, the skeletal effects of non-surgical expansion might be significantly restricted due to abnormal or absent MPS fusion, as well as the influence of adjacent structures to the maxilla, particularly the zygomatic buttress and pterygopalatine regions. For these patients, non-surgical maxillary expansion can produce undesirable effects including compromised occlusion, excessive root resorption, fenestration of the buccal cortex or palatal tissues, failure to separate the MPS, pain, and instability of the expansion. Therefore, as we summarized in Table 2, surgically assisted approaches are alternative treatment options, as they effectively eliminate resistance within the maxilla.  
\begin{table}
\begin{tabular}{c c c c c c} \hline \hline
**Adolescent** & **Techniques** & **Modification** & **Indication** & **Advantages** & **Disadvantage** & **Study** \\ \hline \hline \multirow{8}{*}{Conventional SARME} & & & Transverse & & Temporary & \\  & & & maxillary & & aesthetic & \\  & & deficiency \(\geq\) & & & concerns; limited & \\  & & 6.0 mm; age \(\geq\) & & quick procedure; & bone expansion & \\  & & 18 years; no medical history & & periodontal tissues & at the palatal & \\  & & & medical history & & and long-term & level potential \\  & & & of cleft and & dental health. & complications & \\  & & & & & affecting the & \\  & & & surgery & & central incisors. & \\ \hline \multirow{8}{*}{Skeletally mature adolescents} & & Bone-borne & Enhances efficiency & Lack of & \\  & & & sutural & by reducing & evidence-based & \\  & & expansion & resistance. & research. & \\ \cline{2-6}  & & & Greater respiratory & More invasive & \\  & & Younger than & function; & surgical & \\  & & 20 years with & nasal adjustment & procedures; & \\  & & & bone-borne & reduced resistance; & associated with & \\  & & & devices & ideal tipping & increased & \\  & & & of molars. & complications. & \\ \cline{2-6}  & & & & & Potential for less & \\  & & & & & effectiveness; \\  & & & transverse & Reduces surgical & Resistance should & \\  & & discrepancies & invasiveness; & be released at & \\  & & with skeletally & potential for fewer & other sutures or & \\  & & & & complications. & buttress; & \\  & & & & lack of consensus & \\  & & & & and evidence. & \\ \cline{2-6}  & & & & Provides effective & \\  & & & & maxillary expansion; & Risk of relapse; \\  & & & reduces aesthetic & surgical & \\  & & & compromise; & complexity due & \\  & & & minimizes disruption & to multiple & \\  & & & of the midline dental & osteotomies; & \\  & & & & papilla; & larger transverse & \\  & & & allows for & displacement in & \\  & & & & asymmetric & the paranasal & \\  & & & expansions in a & area but less & \\  & & & conservative manner; & increase in nasal & \\  & & & improved dental & width. & \\  & & & alignment. & & \\ \hline \hline \end{tabular}
\end{table}
Table 2: Overview of available surgical options from reviewed studies.