Does Palate Expansion Improve Nasal Airway Resistance?

Relevant quotes from scientific papers as of 28 December 2019.

The studies below indicate that palate expansion usually improves nasal airway resistance.

Since palate expansion has historically only been successful with children or young adolescents, most of the studies are on them. SARME, MARPE and DOME have made palate expansion possible in adults but there are less studies available as the techniques haven’t been in use anywhere near as long. The studies that are available indicate that even mature adults can derive similar improvements in nasal airway resistance to those historically documented in children.

Glossary

DOME: Distraction Osteogenesis Maxillary Expansion: A protocol combining minimally invasive palatal osteotomy with MARPE.

MARPE: Micro-implant/Miniscrew Assisted Rapid Palate Exansion: A non-surgical technique for expanding the upper palate in adults using a jackscrew expander appliance attached to the palatal bone using miniature screws.

MSE: Maxiliary Skeletal Expander: A popular MARPE invented by Won Moon from UCLA.
https://docs.wixstatic.com/ugd/87f545_e7c83401dd5846faa06689ce5794fba0.pdf

NAR: Nasal Airway Resistance

RME: Rapid Maxiliary Expansion: A technique for expanding the upper palate using an oral appliance, typically limited to children prior to fusion of the upper palate suture.

Rapid Maxillary Expander

SARME: Surgically Assisted Rapid Maxillary Expansion

Meta-Analyses

“Eysel in 1886 – cited by Haas in 1961 – was the first rhinologist to study the effects of RME on the nasal cavity. He found that many changes occurred in the maxillary and adjacent bones during the post-expansion period, and that RME caused a decrease in the NAR.
…
RESULT: Rapid Maxillary Expansion and Surgically Assisted Rapid Maxillary Expansion cause dentofacial changes, especially in the nasal cavity. Consequently, the nose width enlarges, reducing Nasal Airflow Resistance.
…
CONCLUSION: … In general, both the subjective assessments by patients and the objective evaluations that use methods for measuring the nasal airflow and the NAR demonstrate that there is significant improvement in nasal breathing following maxillary expansion. …”
Tatiana Ramires; Roberto Alcântara Maia; José Roberto Barone (2008). Nasal cavity changes and the respiratory standard after maxillary expansion. Revista Brasileira de Otorrinolaringologia v.74 n.5 São Paulo set./out. 2008
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-72992008000500019&lng=pt&nrm=iso&tlng=en

“Historically, RME was believed to primarily affect airway function through changes to nasal volume. For example, Haas [13] reported RME resulted in an increased nasal width of 2–4.5 mm with an expansion protocol of 0.4 to 0.5 mm per day for 12 to 27 days in his patient cohort. It was postulated that the alteration in nasal dimensions following RME is related to the lateral movement of the nasal walls [22], increase in the vertical dimension of the nasal cavity secondary to inferior rotation of the palate [12].
…
Like Haas, many investigators have focused on changes in nasal volume or the secondary effect of changing nasal airflow resistance after RME. These studies yielded inconclusive findings. Some demonstrated positive nasal changes after RME [23, 24], others found no difference [25], while some found such small differences that the clinical relevance was questioned [26, 27]. However, more clinically directed inquiries, such as subjective patient experience [28, 29] and polysomnography changes with sleep apnea [30], have provided growing support to potential functional airway benefits of RME.
…
The earliest indication of the potential effect of palatal expansion over the nasal septum anatomy came from Gray [20]. While evaluating 140 cases (mostly between 3 and 14 years of age), he noted a significant improvement in the nasal airway (84 % of the cases)”
Tehnia Aziz, Kal Ansari, Manuel O. Lagravere, Michael P. Major, and Carlos Flores-Mir (2015). Effect of non-surgical maxillary expansion on the nasal septum deviation: a systematic review. Prog Orthod.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456578/

“The main finding of the present review was that RME is associated with an increase in the total volume of the upper airway as well as the volume of the various regions of the upper airway.”
Lloyd M Buck, Oyku Dalci, M Ali Darendeliler, Spyridon N Papageorgiou, Alexandra K Papadopoulou, Volumetric upper airway changes after rapid maxillary expansion: a systematic review and meta-analysis, European Journal of Orthodontics, Volume 39, Issue 5, October 2017, Pages 463–473
https://doi.org/10.1093/ejo/cjw048

“In 1886, Eysell⁵⁶ was the first to report nasal vault widening after RME with concomitant reduction in nasal airway resistance. According to the Poiseuille equation, a small increase in the cross section of the nasal lumen results in significant reduction in nasal airway resistance.⁵³ RME provides a significant increase in the transalar width, causing expansion of the liminal valve that accounts for roughly half of nasal resistance.⁵³ Several studies have found significant reduction in nasal airway resistance after RME with concomitant improvement in nasal breathing.53, 57”
Jon-Erik C. Holty, Christian Guilleminault. “Maxillomandibular Expansion and Advancement for the Treatment of Sleep-Disordered Breathing in Children and Adults”. Seminars in Orthodontics Volume 18, Issue 2, June 2012, Pages 162-170
https://www.sciencedirect.com/science/article/pii/S1073874611001113

Studies In Adults:

“Microimplant-assisted RPE in adults, in addition to an efficient solution for maxillary transverse deficiency in a substantial number of patients, seems to have an important impact on the reduction of upper airway resistance.”
Daniel Paludo Brunetto, Eduardo Franzzotti Sant’Anna, Andre Wilson Machado, Won Moon (2017). Non-surgical treatment of transverse deficiency in adults using Microimplant-assisted Rapid Palatal Expansion (MARPE). Dental Press Journal of Orthodontics
http://www.scielo.br/scielo.php?pid=S2176-94512017000100110&script=sci_arttext

“MARPE improves airflow and decreases resistance in UA; therefore, it may be an effective treatment modality for adult patients with moderate OSAS.”
Jae-Sik Hur, Hyoung-Ho Kim, Jin-Young Choi, Sang-Ho Suh, and Seung-Hak Baek (2017). Investigation of the effects of miniscrew-assisted rapid palatal expansion on airflow in the upper airway of an adult patient with obstructive sleep apnea syndrome using computational fluid-structure interaction analysis. Korean J Orthod. 2017 Nov;47(6):353-364.
https://synapse.koreamed.org/Synapse/Data/PDFData/1123KJOD/kjod-47-353.pdf

“The MSE appliance can enlarge the size of nasal cavity and significantly increase the airflow through the nasal airway.”
Aguinaldo S. Garcez, Selly S. Suzuki, Camilla J. Storto, Karla G. Cusmanich, Islam Elkenawy, Won Moon. Effects of maxillary skeletal expansion on respiratory function and sport performance in a para-athlete – A case report https://www.researchgate.net/publication/330390934_Effects_of_maxillary_skeletal_expansion_on_respiratory_function_and_sport_performance_in_a_para-athlete_-_A_case_report

“The radiographic findings in this case report show the widening of the entire nasomaxillary complex and reaffirm the observations in previous expansion studies. It can therefore be reasoned that the effects on the airway can be replicated in older patients with the current MARPE treatment.
…
By effectively increasing the nasal cavity volume, MARPE treatment can improve the constricted airway and facilitate nasal breathing.”
Chuck Carlson, Jay Sung, Ryan W. McComb, Andre Wilson Machado, and Won Moon. Microimplant-assisted rapid palatal expansion appliance to orthopedically correct transverse maxillary deficiency in an adult. Am J Ortho Dentofacial Orthop 2016;149:716-28
http://pdf.xuebalib.com:1262/xuebalib.com.23188.pdf?down
https://www.facebook.com/biomaterialskorea/photos/pcb.1410974292292815/1410973255626252/

“Mean inspiratory and expiratory pressure values decreased over time, showing that respiratory airflow resistance is decreased by SARME.”
C.E. Zambon, M.M. Ceccheti, E.R. Utumi, et al. Orthodontic measurements and nasal respiratory function after surgically assisted rapid maxillary expansion: an acoustic rhinometry and rhinomanometry study. Int J Oral Maxillofac Surg, 41 (2012), pp. 1120-1126
https://www.sciencedirect.com/science/article/pii/S090150271200121X

Studies In Children and Adolescents:

“In cases of maxillary constriction and nasal airway obstruction, RME has proved to be efficient for the improvement of nasal respiration in children via a widening effect on the nasopharyngeal cavity.”
Simonetta Monini, MD; Caterina Malagola, MD; Maria Pia Villa, MD; Caterina Tripodi, MD; Silvia Tarentini, PhD; Irene Malagnino, MD; Vania Marrone, PhD; Antonio Ivan Lazzarino, MD; Maurizio Barbara, MD, PhD. “Rapid Maxillary Expansion for the Treatment of Nasal Obstruction in Children Younger Than 12 Years”. Arch Otolaryngol Head Neck Surg. 2009;135(1):22-27. doi:10.1001/archoto.2008.521
https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/409747

“Patients will usually notice from slight to marked improvement in nasal respiration depending on the severity of the nasal stenosis at the start of therapy.”
Haas AJ. Rapid expansion of the maxillary dental arch and nasal cavity by opening the midpalatal suture. Angle Orthod. 1961;31:73–90.
https://www.angle.org/doi/pdf/10.1043/0003-3219%281961%29031%3C0073%3AREOTMD%3E2.0.CO%3B2

“Reductions (in NAR) were recorded in all cases with an average of 36·2 per cent”
Timms, Donald J. (1986). The Effect of Rapid Maxillary Expansion on Nasal Airway Resistance. Journal of Orthodontics
https://journals.sagepub.com/doi/abs/10.1179/bjo.13.4.221?journalCode=jooc

“Findings indicate an average reduction in nasal airway resistance of 48.7 per cent which was statistically significant at the 0.005 level.”
White, B. C., Woodside, D. G., & Cole, P. (1989). The effect of rapid maxillary expansion on nasal airway resistance. Journal of Otolaryngology, 18(4), 137-143. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2472491.

“The statistically significant short-term effects of RME were (1) mean increases in palatal area, volume, and intermolar distance; (2) a mean reduction of nasal airway resistance; and (3) mean increases in total nasal volume and nasal valve area. Our long-term findings were the following: (1) mean palatal area and intermolar distance were reduced, while palatal volume was stable, and (2) nasal airway resistance was stable, whereas mean nasal cavity volume and minimal cross-sectional area increased. Additionally, 61.3% of our subjects reported subjective improvement in nasal respiration.”
Oliveira De Felippe NL, Da Silveira AC, Viana G, Kusnoto B, Smith B, Evans CA. Relationship between rapid maxillary expansion and nasal cavity size and airway resistance: short- and long-term effects. Am J Orthod Dentofacial Orthop. 2008 Sept;134(3):370-82
https://giuntamirabella.com/wp-content/uploads/2018/01/RPE.pdf
https://www.sciencedirect.com/science/article/abs/pii/S0889540608005568

“There was a significant median reduction in nasal resistance following rapid maxillary expansion, measured in the natural state only, and this appeared to be stable up to 1 year after maximum expansion was obtained. Rapid maxillary expansion appeared to effect an expansion at the anterior nares, which contributes to nasal resistance reduction. Individual variation in nasal resistance values was considerable and hence the median response for the group was not a reliable estimate of individual response. Due to the high individual response variability, rapid maxillary expansion is not a predictable means of decreasing nasal resistance.”
D V Hartgerink, Peter S. Vig, Dean Abbott (1987) The effect of rapid maxillary expansion on nasal airway resistance. American Journal of Orthodontics & Dentofacial Orthopedics
https://www.ajodo.org/article/0889-5406(87)90258-7/pdf

“rapid palatal expansion is usually accompanied by increases in area and volume of the nasal cavity”
Palaisa J, Ngan P, Martin C, Razmus T. Use of conventional tomography to evaluate changes in the nasal cavity with rapid palatal expansion. Am J Orthod Dentofacial Orthop. 2007 Oct;132(4):458-66.
https://www.sciencedirect.com/science/article/abs/pii/S0889540607005823

“There is moderate evidence that changes after RME in growing children improve the conditions for nasal breathing and the results can be expected to be stable for at least 11 months after therapy.”
Baratieri C, Alves M Jr, de Souza MM, de Souza Araújo MT, Maia LC. Does rapid maxillary expansion have long-term effects on airway dimensions and breathing? Am J Orthod Dentofacial Orthop. 2011 Aug;140(2):146-56. doi: 10.1016/j.ajodo.2011.02.019.
https://www.ncbi.nlm.nih.gov/pubmed/21803251/

“The results showed that NAR was significantly reduced with the use of RME, with the main decrease observed during expansion (P < 0.05).”
Doruk C, Sökücü O, Sezer H, Canbay EI. Evaluation of nasal airway resistance during rapid maxillary expansion using acoustic rhinometry. Eur J Orthod. 2004 Aug; 26(4):397-401.
https://www.ncbi.nlm.nih.gov/pubmed/15366384/

“Thirty children underwent treatment 2 [rapid maxillary distraction], with an overall significant improvement shown for PSG findings compared to baseline”
Guilleminault C, Monteyrol PJ, Huynh NT, Pirelli P, Quo S, Li K. Adeno-tonsillectomy and rapid maxillary distraction in pre-pubertal children, a pilot study. Sleep Breath. 2011 May; 15(2):173-7.
https://www.ncbi.nlm.nih.gov/pubmed/20848317/

“Only four articles reached final selection, and their overall methodology scores were low, limiting the applicability of results. After rapid maxillary expansion, three of four studies found statistically significant increases in minimal cross-sectional area, and two of three studies reported statistically significant increases in nasal cavity volume as compared with control groups. … Although some increases in nasal dimensions have been reported, the changes in nasal volume were small and should not be presented to patients as a clinically significant indication for therapeutic maxillary expansion.”
Gordon JM, Rosenblatt M, Witmans M, Carey JP, Heo G, Major PW, Flores-Mir C. Rapid palatal expansion effects on nasal airway dimensions as measured by acoustic rhinometry. A systematic review. Angle Orthod. 2009 Sep; 79(5):1000-7.
https://www.ncbi.nlm.nih.gov/pubmed/19705938/

“Skeletal expansion observed in the present study included the expansion of the zygomatic arch as well as nasal cavity. While zygomatic arch expanded to a lesser extent, expansion of nasal cavity was much more evident, and thus can result in improvement of nasal breathing owing to increased air flow. Thus, by effectively increasing the nasal cavity volume, treatment with a MARPE appliance can improve the constricted airway, thus aiding in long-term stability.”
Neeraj Eknath Kolge, Vivek J Patni, Sheetal S Potnis, Swapnagandha Ravindra Kate, Floyd Stanley Fernandes and Chetna Dadarao Sirsat (2018). Pursuit for Optimum Skeletal Expansion: Case Reports on Miniscrew Assisted Rapid Palatal Expansion (MARPE). Journal of Orthodontics & Endodontics Vol. 4 No.2:9
http://orthodontics-endodontics.imedpub.com/pursuit-for-optimum-skeletal-expansion-casereports-on-miniscrew-assisted-rapid-palatalexpansion-marpe.pdf

“Rapid maxillary expansion causes significant increases in nasal cavity volume, nasopharynx volume, anterior and posterior facial heights, and palatal and mandibular planes.”
Smith T, Ghoneima A, Stewart K, Liu S, Eckert G, Halum S, et al. Three-dimensional computed tomography analysis of airway volume changes after rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2021:618-26
https://mirabellagiunta.com/wp-content/uploads/2018/01/rpe2.pdf

“These results confirm the findings of previous studies of the effect of rapid maxillary expansion on the maxilla. Additionally, we found that only the cross-sectional area of the upper airway at the posterior nasal spine to basion level significantly gains a moderate increase after rapid maxillary expansion.”
Chang Y, Koenig LJ, Pruszynski JE, Bradley TG, Bosio JA, Liu D. Dimensional changes of upper airway after rapid maxillary expansion: a prospective cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2013;143:462-70
http://tmjsnoring.ca/articles/Changes%20in%20upper%20airway%20after%20Maxillary%20palatal%20expansion.pdf

“The results show that the rapid palatal expansion produces an improvement of the transversal skeletal discrepancy, and an improvement of the permeability of the upper airways.”
Giuca MR, Pasini M, Galli V, Casani AP, Marchetti E, Marzo G. Correlations between transversal discrepancies of the upper maxilla and oral breathing. Eur J Paediatr Dent 2009;10:23-8
http://admin.ejpd.eu/download/2009-01-04.pdf

“Rapid maxillary expansion produced a significant reduction in nasal resistance measured at both 0.50 L. per second and 0.25 L. per second air flow. The reduction of nasal resistance by maxillary expansion was stable through a 3-month period of retention.”
Hershey H G, Stewart B L, Warren D W 1976 Changes in nasal airway resistance associated with rapid maxillary expansion. American Journal of Orthodontics 69: 274–284 https://www.sciencedirect.com/science/article/abs/pii/0002941676900762?via%3Dihub

“RME produced small, but statistically significant changes in maxillary width, upper and lower molar widths, the width between upper central incisor apices, and intra-nasal width.”
Cross DL, McDonald JP. Effect of rapid maxillary expansion on skeletal dental, and nasal structures: a postero-anterior cephalometric study. Eur J Orthod 2002;22(5):519-28.
https://academic.oup.com/ejo/article/22/5/519/426285

Timms, D. (1984). The reduction of nasal airway resistance by rapid maxillary expansion and its effect on respiratory disease. The Journal of Laryngology & Otology, 98(4), 357-362. https://doi.org/10.1017/S0022215100146730