Long Term Functional Breathing Improvement Following Maxillary Skeletal Expander Treatment
- Author(s): Combs, Andrew
- Advisor(s): Wu, Benjamin
- et al.
Maxillary transverse deficiency is a highly prevalent skeletal problem characterized by a narrow maxilla in relation to the mandible. Although the etiology is multifactorial, the malocclusion develops during facial growth and usually progresses to the permanent dentition if there is no intervention. Furthermore, serious health problems are thought to be related to the occlusal disharmony including narrowing of the pharyngeal airway and nasal cavity, increased nasal resistance, and alteration of tongue posture.In patients with the desire to avoid surgery, a new design of palatal expansion termed the Maxillary Skeletal Expander (MSE) has been utilized to achieve maxillary expansion. MSE utilizes bone borne temporary anchorage devices (TADs) to expand maxillary transverse deficient patients with an interdigitated palatal suture. A preliminary study performed at UCLA demonstrated that patients treated with MSE had significant breathing improvement immediately following skeletal expansion. This study investigated the long-term effects of MSE in airway improvement using peak nasal inspiratory flow (PNIF), peak oral inspiratory flow (POIF), and subjective measures of breathing such as the Visual Analog Scale (VAS) and Nasal Obstruction Symptom Evaluation (NOSE). We examined seventeen patients at the UCLA Orthodontics Clinic at three timepoints: pre-expansion (T0), post-expansion (T1), and post orthodontic treatment (T2). Following MSE expansion, increases in PNIF total, PNIF left, PNIF right and POIF total were found to be significantly improved at the post orthodontic timepoint T2 when compared to T0. Also, VAS total, VAS left, and VAS right were significantly improved at T2 showing a decrease in the feeling of troubled breathing. Additionally, several of the objective and subjective clinical measures positively correlate with the magnitude of expansion determined by critical landmarks on Cone beam computed tomography radiographs (CBCTs). Overall, MSE treatment produces an increased objective and subjective airway improvement that continues to remain stable post expansion. Based on the clinical improvement and correlations with CBCT data, MSE offers a non-surgical alternative to achieve skeletal expansion that may benefit patients with airway issues.