Impact of rapid maxillary expansion on mouth-breathing children and adolescents: A systematic review

Abstract

Background Rapid maxillary expansion (RME) is an orthodontic procedure used to correct transverse maxillary deficiency. Due to the anatomical relationship between the palate and the nasal cavity, RME promotes an increase in nasal dimensions, which should hypothetically improve nasal respiratory function. Objective: This review aimed to systematically verify studies that assessed the effects of RME on nasal patency in mouth-breathing children and adolescents. Material and Methods An electronic search was performed in the MEDLINE databases via OVID, Scopus and EMBASE. The terms were: “children and adolescents”, “rapid maxillary expansion” and “mouth breathing”. The search was conducted in October 2019, according to the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The assessment of the quality of the studies was conducted by two evaluators, using the Fowkes & Fulton´s guidelines for critical appraisal of medical research. Results 475 titles were identified and 18 articles were selected. All of them showed high methodological quality, but without randomized clinical trials. The instruments evaluated were: teleradiography, frontal postero-anterior radiography, computed tomography, acoustic rhinometry and computed rhinomanometry. Conclusions This review shows that RME promotes the enlargement of dental arches and of the nasal and maxillary structures, with improved mouth breathing in the short term. However, its long-term benefits could not be proved so far. More robust results of the effectiveness of RME in mouth breathing can be achieved with meta-analysis studies, with a consensual definition of the long-term follow-up period after RME. Key words: Child, adolescent, maxillary expansion, palatal expansion, mouth breathing.

Mouth breathing: A review

“…Rapid expansion corrects the transverse deficiency of the maxilla, and promotes increased nasal dimensions, which in the short term helps improve breathing [10] , [36] . Although rapid expansion increases the volume of the upper airway, it can change the anatomy of the soft tissues of the nose that influence aesthetics and functionality, the nasopharyngeal volume and the oropharyngeal volume do not show significant changes, so other treatments are needed [37][38] .…”

“…MB can also bring repercussions in craniofacial development and dental occlusion [9] . Among the treatments that can be performed to eliminate or reduce MB are myofunctional therapy, maxillary expansion, surgical treatments such as frenuloplasty and pharmacological treatments with intranasal steroids [10][11][12] . Knowing that MB is a problem that affects a large part of the child population and that has repercussions on the patient's oral and general health, as well as on their academic and social performance, as dentists we should be trained to be able to diagnose and treat, avoiding the affectation in the development and growth of the child patient.…”

Skeletal and dental effects of function‐generating bite appliance compared to rapid palatal expander and untreated controls

“…7 Moreover, some evidences suggest that the transverse discrepancy of maxillary bone could be associated with many stomatognathic functions, including speech and breathing, thus recommending an early intervention. [8][9][10] Many research articles based on clinical practice have shown how maxillary expansion can improve problems such as obstructive sleep apnoea, both in skeletal class I, II and III, [11][12][13] although the physiological mechanism is not well known. Some authors have tried to explain this improvement by analysing the modification of the hyoid bone and tongue position after treatment, 14 but their positional changes were not related to treatment of the maxillary deficiency.…”

“…The scientific literature suggests that the best timing for treating a maxillary transverse discrepancy is during the prepubertal growth stage, because the midpalatal suture can be readily opened and there is still some residual growth to exploit 7 . Moreover, some evidences suggest that the transverse discrepancy of maxillary bone could be associated with many stomatognathic functions, including speech and breathing, thus recommending an early intervention 8–10 . Many research articles based on clinical practice have shown how maxillary expansion can improve problems such as obstructive sleep apnoea, both in skeletal class I, II and III, 11–13 although the physiological mechanism is not well known.…”

Comparison of the Haas Expander and the Elastodontic Device for the Resolution of Transverse Discrepancies in Growing Patients: A Single-Centre Observational Study

“…[5]. A very important but incompletely characterized mechanism of action of palatal expansion is exerted at the level of the upper airway [6]. It is thought that, with a palatal expansion, there will be an increase in the size of the nasal passages, so there will be a reduction in air resistance.…”