Feasibility of distraction osteogenesis maxillary expansion in patients with persistent nasal obstruction after septoplasty

Abstract

BackgroundDistraction osteogenesis maxillary expansion (DOME) is an emerging surgical concept for obstructive sleep apnea patients with a high‐arched and narrow hard palate presenting with nasal obstruction. Herein we demonstrate the feasibility of DOME in the treatment of patients with persistent nasal obstruction after primary septoplasty.MethodsA total of 32 consecutive patients with persistent nasal obstruction after septoplasty who underwent DOME were enrolled in this study. The efficacy of DOME in treating persistent nasal obstruction in septoplasty failure patients was evaluated using the validated Nasal Obstruction Symptom Evaluation (NOSE) scale. Pre‐ and postoperative computed tomography (CT) scans were performed to measure the change of nasal floor width after surgery.ResultsNOSE score improved significantly from 13.62 ± 4.74 to 5.15 ± 3.50 (p < 0.001) after DOME. The postoperative CT scan showed a significant increase of the nasal floor width from 22.4 ± 4.21 to 28.06 ± 4.52 (p < 0.01). No patient had major complications such as wound infection, oronasal fistula, sinusitis, loss of incisor teeth, or malunion.ConclusionWe found that DOME appears to improve persistent nasal obstruction after septoplasty in patients with a narrow and high‐arched hard palate.

The Association Between Transverse Maxillary Deficiency and Septal Deviation in Adults with Obstructive Sleep Apnea

“…These findings were followed by a second study from the same group evaluating additional skeletal remodeling procedures (i.e., surgically assisted rapid palatal expansion) on patients with persistent nasal obstruction following nasal surgery. They found significant improvement in NOSE score and objective increases in nasal floor width following a second‐stage maxillary expansion surgery (Distraction Osteogenesis Maxillary Expansion) with a significant improvement in nasal obstruction postoperatively 27 …”

Posterior Palatal Expansion via Subnasal Endoscopy (2PENN) for Maxillary Deficiency: A Pilot Study

“…Although other SARPE procedures have been shown to successfully address manifestation of transverse maxillary deficiency, each surgical variant of this procedure has its own limitations. Both traditional SARPE and DOME employ an anterior maxillary approach for achieving a midline split of the mid‐palatal suture and rely on a blind mid‐palatal split which terminates in the anterior aspect of the maxilla and does extend to the PNS 6,9–14,17 . Previous studies have demonstrated that the posterior region of the maxilla is particularly challenging to expand, even with surgical assistance.…”

“…Endoscopically assisted surgical expansion (EASE) uses minimally‐invasive pterygomaxillary disjunction combined with a trans‐nasal endoscopic mid‐palatal osteotomy to the level of the posterior nasal spine (PNS) 10 . DOME and EASE have been shown to increase nasal cavity dimensions, improve subjective nasal breathing, and potentially reduce OSA severity 9–16 …”

“…Distraction osteogenesis maxillary expansion (DOME) involves a limited LeFort 1 osteotomy and a mid‐palatal split at the anterior nasal spine (ANS) via a sublabial incision, with pterygomaxillary disjunction reserved for patient‐specific needs 9 . Endoscopically assisted surgical expansion (EASE) uses minimally‐invasive pterygomaxillary disjunction combined with a trans‐nasal endoscopic mid‐palatal osteotomy to the level of the posterior nasal spine (PNS) 10 . DOME and EASE have been shown to increase nasal cavity dimensions, improve subjective nasal breathing, and potentially reduce OSA severity 9–16 …”

“…9 Endoscopically assisted surgical expansion (EASE) uses minimally-invasive pterygomaxillary disjunction combined with a trans-nasal endoscopic mid-palatal osteotomy to the level of the posterior nasal spine (PNS). 10 DOME and EASE have been shown to increase nasal cavity dimensions, improve subjective nasal breathing, and potentially reduce OSA severity. [9][10][11][12][13][14][15][16] Although these techniques have been shown to improve breathing-related sequalae of transverse maxillary deficiency, limitations remain.…”