{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T23:20:41Z","timestamp":1778800841474,"version":"3.51.4"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T00:00:00Z","timestamp":1695945600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01HL144859\u201003"],"award-info":[{"award-number":["R01HL144859\u201003"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Surgically assisted rapid palatal expansion (SARPE) addresses transverse maxillary deficiency, a known contributor to nasal obstruction. The purpose of this study was to assess the feasibility, preliminary outcomes, and safety of posterior palatal expansion via subnasal endoscopy (2PENN), a modified SARPE procedure, aimed at achieving anterior and posterior maxillary expansion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This prospective case series included consecutive adult patients with findings of transverse maxillary deficiency that underwent the 2PENN procedure from 4\/2021 to 4\/2022. Patients completed pre\u2010 and post\u2010operative clinical evaluations, Nasal Obstruction and Septoplasty Effectiveness (NOSE) questionnaires, and computed tomography (CT), with measures including expansion at the level of the posterior nasal spine (PNS), first maxillary inter\u2010molar distance (IMD), and anterior nasal spine (ANS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The cohort (<jats:italic>N<\/jats:italic>\u2009=\u200920) was middle\u2010aged (39\u2009\u00b1\u200911\u2009years), predominantly male (80%), and overweight (BMI 28\u2009\u00b1\u20094\u2009kg\/m<jats:sup>2<\/jats:sup>). The majority (85%) of patients had sleep breathing issues, of which 10 (59%) had polysomnography\u2010confirmed obstructive sleep apnea (OSA). Full anterior\u2013posterior separation of the mid\u2010palatal suture line was evident on all post\u2010operative CT scans, with mean expansion at the PNS of 3.6\u2009\u00b1\u20091.3\u2009mm, IMD of 6.1\u2009\u00b1\u20091.6\u2009mm and ANS of 7.0\u2009\u00b1\u20091.6\u2009mm (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Following surgery, mean NOSE scores improved from 57\u2009\u00b1\u200923 to 14\u2009\u00b1\u200913 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). One patient required maxillary antrostomy for post\u2010operative sinusitis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>2PENN is an effective and safe technique for achieving both anterior and posterior maxillary expansion in patients with transverse maxillary deficiency. Further study is warranted to better understand the effect of 2PENN in patients with OSA, particularly as it relates to improving pharyngeal patency.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 134:1970\u20131977, 2024<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.31060","type":"journal-article","created":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T13:38:27Z","timestamp":1695994707000},"page":"1970-1977","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Posterior Palatal Expansion via Subnasal Endoscopy (<scp>2PENN<\/scp>) for Maxillary Deficiency: A Pilot Study"],"prefix":"10.1002","volume":"134","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7143-395X","authenticated-orcid":false,"given":"Sebastian M.","family":"Jara","sequence":"first","affiliation":[{"name":"Division of Sleep Surgery, Department of Otorhinolaryngology \u2013 Head and Neck Surgery, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania U.S.A."},{"name":"Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric R.","family":"Thuler","sequence":"additional","affiliation":[{"name":"Division of Sleep Surgery, Department of Otorhinolaryngology \u2013 Head and Neck Surgery, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Hutz","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology \u2013 Head and Neck Surgery Rush University Medical Center  Chicago Illinois U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason L.","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Emory University School of Medicine  Atlanta Georgia U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7238-327X","authenticated-orcid":false,"given":"Crystal S.","family":"Cheong","sequence":"additional","affiliation":[{"name":"Division of Sleep Surgery, Department of Otorhinolaryngology \u2013 Head and Neck Surgery, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania U.S.A."},{"name":"Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Normand","family":"Boucher","sequence":"additional","affiliation":[{"name":"Department of Orthodontics University of Pennsylvania School of Dental Medicine  Philadelphia Pennsylvania U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianna","family":"Evans","sequence":"additional","affiliation":[{"name":"Division of Sleep Surgery, Department of Otorhinolaryngology \u2013 Head and Neck Surgery, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5568-0427","authenticated-orcid":false,"given":"Raj C.","family":"Dedhia","sequence":"additional","affiliation":[{"name":"Division of Sleep Surgery, Department of Otorhinolaryngology \u2013 Head and Neck Surgery, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania U.S.A."},{"name":"Division of Sleep Medicine, Department of Medicine, Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania U.S.A."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,9,29]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2016.02.001"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1590\/S1806-83242008000100009"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000003409"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp-journals-10005-1069"},{"key":"e_1_2_7_6_1","unstructured":"ChangY.Effects of rapid maxillary expansion on upper airway; 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