Transverse maxillomandibular discrepancies are a major component of several malocclusions. Orthopedic and orthodontic forces are used routinely to correct a maxillary transverse deficiency (MTD) in a young patient. Correction of MTD in a skeletally mature patient is more challenging because of changes in the osseous articulations of the maxilla with the adjoining bones. Surgically assisted rapid palatal expansion (SARPE) has gradually gained popularity as a treatment option to correct MTD. It allows clinicians to achieve effective maxillary expansion in a skeletally mature patient. The use of SARPE to treat MTD decreases unwanted effects of orthopedic or orthodontic expansion. Our aim in this article is to present a comprehensive review of the literature, including indications, diagnosis, guidelines for case selection, a brief overview of the surgical techniques, orthodontic considerations, complications, risks, and limitations of SARPE to better aid the clinician in the management of MTD in skeletally mature patients.