Rapid palatal expansion in the young adult: time for a paradigm shift?

A 19-year-old man presented for correction of a malocclusion that included a transverse maxillary deficiency. The patient was informed that he required orthognathic surgery to expand his upper jaw and correct his malocclusion, but he refused surgical expansion. Recent evidence indicates that rapid palatal expansion can be used without surgery in young adults; the decision was therefore made to treat the patient nonsurgically. Rapid palatal expansion of the maxillary arch was accomplished by means of a Hyrax appliance, with post-treatment radiographs revealing an opening of the midpalatal suture. The belief still persists among some clinicians that young adult patients require orthognathic surgery for palatal expansion, despite recent evidence supporting a nonsurgical approach after closure of the midpalatal suture.