: Surgically assisted rapid maxillary expansion (SARME) is a well-established therapy for correction of maxillary transverse deficiency in adults, when consolidation of sutures has just been completed. It can be performed either under general or under local anesthesia and it can be accomplished with many surgical techniques. One of the most critical steps of SARME is the detachment of the pterygo-maxillary junction, due to the risks connected to such procedure. When required to obtain specific expansion patterns, the pterygo-maxillary separation has been suggested until now only for interventions under general anesthesia, due to the dangerousness and the rawness of this surgical step in awake patients. The authors introduce the use of an ultrasonic bone-cutting device to perform all osteotomic steps of SARME under local anesthesia on an outpatient basis, including pterygo-maxillary detachment. This ultrasonic device is unique in that the osteotomic action occurs only when the tool is employed on mineralized tissues, while it stops on soft tissues. It works in a linear pattern of vibration and it allows precise osteotomies without producing any heat damage to osteotomic surfaces and without any dangerous hammer-related stroke. Due to its precision and safety, this device named Piezosurgery, allows patients to undergo all the steps of SARME under local anesthesia, also without hospitalization.
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