“…Disadvantages of these methods are their invasiveness, risk for infection, and necessity of a second surgical stage for appliance removal, after expansion. 14 Several different techniques are available to correct a maxillary transverse deficiency in adult patients, which are as follows: -Segmented Le Fort I osteotomy with down fracture, palatal expansion, and three-dimensional maxillary repositioning (Le Fort I-segmented expansion [LFI-E]) -Surgical-assisted RME by incomplete Le Fort I osteotomy (without down fracture) using dental-borne devices, the Hyrax (SARMEdental) -Surgical-assisted RME by incomplete Le Fort I osteotomy with bone-borne devices (SARME-bone), Pinto et al -Le Fort I osteotomy with down fracture, three-dimensional maxillary repositioning, and distraction osteogenesis with dental-borne devices (Le Fort I-Distraction Osteogenesis-Dental [LFI-DO]-dental) -Le Fort I osteotomy with down fracture, three-dimensional maxillary repositioning, and distraction osteogenesis with bone-borne devices (LFI-DO-bone) -Le Fort I osteotomy with down fracture, three-dimensional maxillary repositioning, and distraction osteogenesis with rigid boneborne devices (LFI-DO-bone-rigid) [15][16][17][18] The segmented Le Fort I osteotomy is a 1-step surgery that modifies maxillary dimensions and position in the 3 planes of the space; however, the limits of this technique are significant. Limits include the difficulty for a large amount of expansion because of the palatal fibromucosa tension, bone fragment tipping, root damage risk, bone necrosis of the premaxilla after periosteal elevation of the palatal bone, difficulties in the management of the bone fragments during fixation, 19,20 severe intraoperative and postoperative hemorrhage after damage of the descending palatine artery or other blood vessels, oroantral or oronasal communications, permanent instability of bone segments, and loss of gingival papillae after a large 1-step widening of the bone.…”