Impact of Distraction Osteogenesis Maxillary Expansion on the Internal Nasal Valve in Obstructive Sleep Apnea

Abstract

Objective To assess the effect of distraction osteogenesis maxillary expansion (DOME) on objective parameters of the internal nasal valve and correlate findings with subjective outcomes. Study Design Retrospective cohort study. Setting Tertiary referral center. Subjects and Methods After Institutional Review Board approval, included subjects were those with obstructive sleep apnea, had undergone DOME from September 2014 to April 2018, and had cone beam computed tomography scans available before and after expansion. Measurement of the internal nasal valve parameters was performed with Invivo6 Software (version 6.0.3). Interrater reliability of all pre- and postexpansion parameters was measured. Patient-reported outcome measures included the Nasal Obstruction and Septoplasty Effectiveness Scale (NOSE) and Epworth Sleepiness Scale scores, and correlation between objective and subjective outcomes were evaluated by Spearman correlation analysis. Results Thirty-two subjects met inclusion criteria. All showed significant improvement in their subjective outcomes as well as an increase in their internal valve parameters. Significant correlation was observed between increased angles and improvement in postexpansion NOSE score (right angle, P = .024; left angle, P = .029). Conclusion DOME widens the internal nasal valve objectively (dimensions), which correlates significantly with subjective improvement (NOSE scores).

The miniature lateral crural strut graft: Efficacy of a novel technique in tip plasty

“…Zone 1 is more cephalad and corresponds to dynamic movement of the nasal sidewall anatomically at the level of the upper lateral cartilage and scroll region, and physiologically to the internal nasal valve. 17 Zone 2 is more caudal and corresponds anatomically to the level of the ala and physiologically to the classic external valve collapse. Three different grades are identified for each; grade 1 is <33%, grade 3 is >66%, and grade 2 is in between.…”

“…The LWI grading system is a validated tool for objective assessment of the nasal airway. Zone 1 is more cephalad and corresponds to dynamic movement of the nasal sidewall anatomically at the level of the upper lateral cartilage and scroll region, and physiologically to the internal nasal valve . Zone 2 is more caudal and corresponds anatomically to the level of the ala and physiologically to the classic external valve collapse.…”

Holistic care for obstructive sleep apnea (OSA) with an emphasis on restoring nasal breathing: A review and perspective

“…DOME contributes to nasal floor expansion, especially at the level of internal nasal valve, which is the major source of nasal resistance. 51 The procedure significantly relieves nasal obstruction, reduces AHI, and improves the amount of rapid eye movement sleep. 34 For patients with OSA with nasal obstruction and a narrow maxilla, DOME is an effective and safe treatment option with minimal adverse effects.…”

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

“…3,6 In addition, another study reported that DOME expands the internal nasal valve, which correlates significantly with improvement in NOSE scores. 8 Results from these studies suggest that the maxillary expansion in DOME can expand not only the nasal floor width but also the internal nasal valve, which can eventually reduce nasal resistance.…”