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Oral Surgery/Sarpe problem


Dear Doctor

I am an adult and had  a Sarpe some months ago. In spite of having the Malocclusion only on the left side, the surgery was practiced on both sides (bilateral cut).
Two days after the surgery, I myself started to activate the expander (Hyrax) at home, but since the very beginning, I noticed the right side started to expand extremely outwards, and the left side (with serious crossbite), remained blocked, with meaningless movement.
One week after the surgery I had an extreme asymmetry on the right side of my face, visible even externally.

Two weeks later, the doctor claimed he was able to make adjustments on the Hyrax, in order to keep the minimum expansion that occurred on the left side, and at the same time, reduced the excess of expansion on the right side, but it didnít happen and he didnít convince me at all.
As a result, I still have the malocclusion on the left side.

I started to go deep in the case by myself and could learn that the only screw the Hyrax has, allows only two actions, to activate or deactivate it, and this screw once activated, will open sidewards the four arms with equal force and simultaneously to both sides, causing the expansion (in a bilateral surgery like mine).
Based on this, I really cannot understand how the doctor may have executed adjustments on each side independently using only one screw, and my conclusion as an ignorant on the subject, is that any progress occurred during the activation of the screw, with symmetrical or asymmetrical result, must have the same equal and proportional progress during the deactivation.

In your opinion, is it possible to make adjustments on the Hyrax, in order to keep the minimum expansion that occurred on the left side, and at the same time, reduce the excess of expansion on the right side?
In other words, is it possible to work on the screw, to make independent adjustments on each side of the Hyrax to correct the asymmetry occurred during the expansion?
Thank you for your help

Dear Savio,

In my opinion, the problem is not the screw or the device. I think there is a possibility that the during the surgery the non expanding side was not cut and separated properly.  In these situations, the surgery on that side should be re-performed. If not done, then the expander could tilt the teeth rather than expand the bone. I hope this answered your question.

Good luck!


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Majid Jamali, D.M.D. Fellowship trained in corrective jaw surgery


Diplomate, American Board of Oral & Maxillofacial Surgery Full scope Oral & Maxillofacial Surgery, Orthognathic Surgery, Genioplasty and Anesthesiology I have completed an additional two years of fellowships in orthognathic surgery and anesthesiology field.


Faculty at numerous hospitals


New York Dental Society Journal

Tufts University: Dental School SUNY Down-State Medical Center: OMFS residency Robertwood Johnson Medical Center: Anesthesiology fellowship Lenox Hill hospital: Orthognathic fellowship

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