Improving breathing for patients with obstructed airway has been heavily researched in recent years but continues to be a challenge clinically for medical practitioners including otolaryngologists, plastic surgeons, and dentists. In children with enlarged tonsils, adenotonsillectomy, partial tonsillectomy and lingual tonsillectomy are effective treatments. There are also various non-surgical treatments for obstructive sleep apnea in children including intra-nasal steroids, other anti-inflammatory medications, and oral appliances, but none of them are proven to be safe and effective.
Various forms of rapid maxillary expansion have demonstrated airway improvement but further studies are necessary to show consistent and reproducible results. The Maxillary Skeletal Expander (MSE), anchored by four palatal mini-implants, has become an increasingly more common option for patients who may not respond to traditional RME. Additionally, expansion of the maxilla by the MSE occurs more by horizontal translation and less tipping than a RME expander. The goal of the study is to investigate the role of MSE in airway improvement using objective measurements including Peak Nasal Inspiratory Flow (PNIF) and Peak Oral Inspiratory Flow (POIF) as well as subjective measures of breathing such as the Visual Analog Scale (VAS) and Nasal Obstruction Symptom Evaluation (NOSE). Furthermore, nasal septum deviation will be measured and correlated with objective measurements of breathing.
The results indicated that MSE produced improved functional breathing. Following MSE treatment, increases in total PNIF, left PNIF and right PNIF were significant at p<0.0001. Increase in POIF was significant at p<0.01. Patients reported decreased troubled breathing based on total VAS (p<0.01), left VAS (p<0.01) and right VAS (p<0.001). PNIF and VAS were correlated on each side in pre- and post- MSE groups while PNIF change and VAS change were correlated on the right. Additionally, an increase in nasal septum deviation to the left was correlated with an increase in PNIF on the right although this was not seen in the contralateral side.
If treatment with an MSE indeed raises objective and subjective measurements of airway, we may conclude that MSE is a possible treatment alternative for obstructive sleep apnea. This study has the potential to reshape the current standards for treatment of OSA creating an innovative, but less invasive cure for a large proportion of the population who suffer from OSA during sleep, have loss of daytime functionality, and have a host of co-morbid conditions.
