{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T11:57:25Z","timestamp":1775044645098,"version":"3.50.1"},"reference-count":17,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: This case report describes an unusual complication in an 8-year-old female patient undergoing ME (maxillary expansion) with a tooth-supported maxillary expander with the hyrax screw. Case presentation: After the 36th screw turn in the 5th week of treatment, the patient reported pressure and pain symptoms and the patient\u2019s parents observed a bone elevation at the bridge of the nose. The patient was referred to for clinical examination which revealed a bilateral infraorbital hematoma and a movable, and highly sensitive, nasal area upon palpation. A cone-beam computed tomography (CBCT) scan confirmed a displaced nasal bone fracture. Conservative treatment was immediately initiated by reversing the hyrax screw four times, followed by ten additional turns over the next 7 days for a total of 14 back-turns. This procedure led to an immediate improvement in symptoms. An 8-week follow-up CBCT confirmed the physiological repositioning of the nasal bones and healing of the fracture. Conclusions: Although nasal bone fracture is a rare complication of ME, particularly in children, clinicians should be aware of this potential risk and remain vigilant for symptoms of high pressure and pain in the orbito-nasal area. If a nasal fracture is suspected during orthodontic treatment, the orthodontist should immediately cease screw activation. In selected cases, careful reversal of the screw, as described in this report, may be considered as a conservative treatment.<\/jats:p>","DOI":"10.3390\/reports9020108","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T10:09:21Z","timestamp":1775038161000},"page":"108","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nasal Fracture During Maxillary Expansion\u2014A Rare Complication?"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3686-8322","authenticated-orcid":false,"given":"Katharina","family":"Obermeier","sequence":"first","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, LMU University Hospital, Ludwig Maximilian University of Munich, 80337 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenko","family":"Smolka","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, LMU University Hospital, Ludwig Maximilian University of Munich, 80337 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Poxleitner","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, LMU University Hospital, Ludwig Maximilian University of Munich, 80337 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natasa","family":"Puskar","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Clinic of Dental Medicine of Vojvodina, Faculty of Medicine Novi Sad, University of Novi Sad, 21137 Novi Sad, Serbia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9535-6901","authenticated-orcid":false,"given":"Hisham","family":"Sabbagh","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Dentofacial Orthopedics, LMU University Hospital, Ludwig Maximilian University of Munich, Goethestrasse 70, 80336 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ye, G., Li, Q., Guo, Z., Yu, X., Xu, Y., Ding, W., Wang, H., and Yu, M. (2024). Comparative Evaluation of Transverse Width Indices for Diagnosing Maxillary Transverse Deficiency. BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-04580-4"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"40.e1","DOI":"10.1590\/2177-6709.23.6.40.e1-10.onl","article-title":"Global Distribution of Malocclusion Traits: A Systematic Review","volume":"23","author":"Alhammadi","year":"2018","journal-title":"Dent. Press J. Orthod."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s40510-019-0278-9","article-title":"Rapid Maxillary Expansion Outcomes According to Midpalatal Suture Maturation Levels","volume":"20","author":"Sayar","year":"2019","journal-title":"Prog. Orthod."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Caprioglio, A., Fastuca, R., Zecca, P., Beretta, M., Mangano, C., Piattelli, A., Macchi, A., and Iezzi, G. (2017). Cellular Midpalatal Suture Changes after Rapid Maxillary Expansion in Growing Subjects: A Case Report. Int. J. Mol. Sci., 18.","DOI":"10.3390\/ijms18030615"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Bazargani, F., Ugolini, A., and Cobourne, M.T. (2025). Management of Posterior Crossbite with Maxillary Expansion: A Narrative Review of Contemporary Evidence. Semin. Orthod., in press.","DOI":"10.1053\/j.sodo.2025.08.011"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s40510-015-0105-x","article-title":"The Role of Rapid Maxillary Expansion in the Promotion of Oral and General Health","volume":"16","author":"McNamara","year":"2015","journal-title":"Prog. Orthod."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1093\/ejo\/cjad024","article-title":"Three-Dimensional Comparison of Tooth-Borne and Tooth-Bone-Borne Rme Appliances: A Randomized Controlled Trial with 5-Year Follow-Up","volume":"45","author":"Bazargani","year":"2023","journal-title":"Eur. J. Orthod."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s00056-005-0439-y","article-title":"Effects of Rapid Maxillary Expansion on the Cranial Base\u2014An Fem-Analysis","volume":"66","author":"Holberg","year":"2005","journal-title":"J. Orofac. Orthop."},{"key":"ref_9","first-page":"543","article-title":"Stresses at the Cranial Base Induced by Rapid Maxillary Expansion","volume":"76","author":"Holberg","year":"2006","journal-title":"Angle Orthod."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1093\/ejo\/cjl067","article-title":"Rapid Maxillary Expansion in Adults: Cranial Stress Reduction Depending on the Extent of Surgery","volume":"29","author":"Holberg","year":"2007","journal-title":"Eur. J. Orthod."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1186\/s13005-021-00301-2","article-title":"Success and Complication Rate of Miniscrew Assisted Non-Surgical Palatal Expansion in Adults\u2014A Consecutive Study Using a Novel Force-Controlled Polycyclic Activation Protocol","volume":"17","author":"Winsauer","year":"2021","journal-title":"Head Face Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s40510-025-00592-0","article-title":"Unwanted Creaniofacial Fractures in Marpe\/Maspe Patients: A Hidden Risk?","volume":"26","author":"Walter","year":"2025","journal-title":"Prog. Orthod."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1016\/j.ajodo.2013.04.022","article-title":"Midpalatal Suture Maturation: Classification Method for Individual Assessment before Rapid Maxillary Expansion","volume":"144","author":"Angelieri","year":"2013","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"71","DOI":"10.2319\/121317-859.1","article-title":"Reliability and Reproducibility of the Method of Assessment of Midpalatal Suture Maturation: A Tomographic Study","volume":"89","author":"Barbosa","year":"2019","journal-title":"Angle Orthod."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Chhatwani, S., Arman, A., M\u00f6hlhenrich, S.C., Ludwig, B., Jackowski, J., and Danesh, G. (2024). Performance of Dental Students, Orthodontic Residents, and Orthodontists for Classification of Midpalatal Suture Maturation Stages on Cone-Beam Computed Tomography Scans\u2014A Preliminary Study. BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-04163-3"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s13005-017-0144-2","article-title":"Novel Methodologies and Technologies to Assess Mid-Palatal Suture Maturation: A Systematic Review","volume":"13","author":"Isfeld","year":"2017","journal-title":"Head Face Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1055\/s-0041-1728840","article-title":"Rapid Palatal Expansion Should Not Be Trivialized: Two Case Reports of Unexpected Complications","volume":"15","author":"Lopponi","year":"2021","journal-title":"Eur. J. Dent."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/2\/108\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T10:41:30Z","timestamp":1775040090000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/9\/2\/108"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,1]]},"references-count":17,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["reports9020108"],"URL":"https:\/\/doi.org\/10.3390\/reports9020108","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,1]]}}}