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VOLUME 14 , ISSUE 2 ( February, 2023 ) > List of Articles

REVIEW ARTICLE

Long-term Effects of Rapid Palatal Expansion on Airway and Nasal Cavity Using Three-dimensional Analysis: A Systematic Review

Thabassum Parakkal, Parvathy Ghosh, Nilambur Kovilakam Sapna Varma, Vallikat Velath Ajith, K Sarika

Keywords : Cone beam computer tomography, Rapid palatal expansion, Systematic review, Upper airway

Citation Information : Parakkal T, Ghosh P, Varma NK, Ajith VV, Sarika K. Long-term Effects of Rapid Palatal Expansion on Airway and Nasal Cavity Using Three-dimensional Analysis: A Systematic Review. World J Dent 2023; 14 (2):182-191.

DOI: 10.5005/jp-journals-10015-2186

License: CC BY-NC 4.0

Published Online: 17-04-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Aim: This review aims to evaluate the long-term effects of rapid palatal expansion (RPE) on the pharyngeal airway and nasal cavity using three-dimensional (3D) analysis. Background: Skeletal maxillary transverse deficiency is known to be an anatomic etiological factor for developing sleep-disordered breathing in growing patients. Also, rapid palatal expanders have been used for over a century for bringing transverse skeletal expansion, but their long-term stability on the nasal cavity and pharyngeal airway remains questionable. Results: Electronic search of different databases as well as manual search from inception to December 2020 yielded 529 articles. The search included a combination of the following keywords like “rapid maxillary expansion (RME),” “pharyngeal airway,” “nasal cavity,” and “3D evaluation.” To evaluate the long-term effect of RPE, studies with minimum retention of 6 months postexpansion were only included. After screening and selection based on Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, nine studies were included for the final qualitative analysis. ROBINS-I tool was used to assess the risk of bias in the included studies. Meta-analysis was not performed due to heterogeneity between studies. Conclusion: The existing evidence shows that in growing children, RPE expands nasal cavity volume, improving nasal breathing, and the results are stable. However, long-term stability on increasing pharyngeal airway volume could not be sustained. Clinical significance: The evidence seems to support RPE can be a useful method for increasing the nasal cavity volume in the long-term and appears to have a clinically similar long-term effect on the pharyngeal airway as the control group. Thus, RPE can be considered an effective method for the management of pediatric obstructive sleep apnea.


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  1. Zeng J, Gao X. A prospective CBCT study of upper airway changes after rapid maxillary expansion. Int J Pediatr Otorhinolaryngol 2013;77(11):1805–1810. DOI: 10.1016/j.ijporl.2013.07.028
  2. Erdur EA, Yıldırım M, Karatas RMC, et al. Effects of symmetric and asymmetric rapid maxillary expansion treatments on pharyngeal airway and sinus volume. Angle Orthod 2020;90(3):425–431. DOI: 10.2319/050819-320.1
  3. Wertz RA. Skeletal and dental changes accompanying rapid midpalatal suture opening. Am J Orthod 1970;58(1):41–66. DOI: 10.1016/0002-9416(70)90127-2
  4. El H, Palomo JM. Three-dimensional evaluation of upper airway following rapid maxillary expansion: a CBCT study. Angle Orthod 2014;84(2):265–273. DOI: 10.2319/012313-71.1
  5. Haas AJ. Palatal expansion: just the beginning of dentofacial orthopedics. Am J Orthod 1970;57(3):219–255. DOI: 10.1016/0002-9416(70)90241-1
  6. Garrett BJ, Caruso JM, Rungcharassaeng K, et al. Skeletal effects to the maxilla after rapid maxillary expansion assessed with cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2008;134(1):8–9. DOI: 10.1016/j.ajodo.2008.06.004
  7. Bicakci AA, Agar U, Sökücü O, et al. Nasal airway changes due to rapid maxillary expansion timing. Angle Orthod 2005;75(1):1–6. DOI: 10.1043/0003-3219(2005)075<0001:NACDTR>2.0.CO;2
  8. Linder-Aronson S, Aschan G. Nasal resistance to breathing and palatal height before and after expansion of the median palatine suture. Odontol Revy. 1963;14(3):254–270.
  9. Pirelli P, Saponara M, Attanasio G. Obstructive Sleep Apnoea Syndrome (OSAS) and rhinotubaric disfunction in children: therapeutic effects of RME therapy. Prog Orthod 2005;6(1):48–61. PMID: 15891784
  10. Baratieri C, Alves M Jr, de Souza MM, et al. Does rapid maxillary expansion have long-term effects on airway dimensions and breathing? Am J Orthod Dentofacial Orthop 2011;140(2):146–56. DOI: 10.1016/j.ajodo.2011.02.019
  11. Iwasaki T, Saitoh I, Takemoto Y, et al. Tongue posture improvement and pharyngeal airway enlargement as secondary effects of rapid maxillary expansion: a cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2013;143(2):235–245. DOI: 10.1016/j.ajodo.2012.09.014
  12. Pirilä-Parkkinen K, Löppönen H, Nieminen P, et al. Validity of upper airway assessment in children: a clinical, cephalometric, and MRI study. Angle Orthod 2011;81(3):433–439. DOI: 10.2319/063010-362.1
  13. Doruk C, S Sökücü O, Yilmaz U, et al. Comparison of nasal volume changes during rapid maxillary expansion using acoustic rhinometry and computed tomography. Eur J Orthod 2007;29(3):251–255. DOI: 10.1093/ejo/cjl069
  14. Compadretti GC, Tasca I, Bonetti GA. Nasal airway measurements in children treated by rapid maxillary expansion. Am J Rhinol 2006;20(4):385–393. DOI: 10.2500/ajr.2006.20.2881
  15. Vilella Bde S, Vilella Ode V, Koch HA. Growth of the nasopharynx and adenoidal development in Brazilian subjects. Braz Oral Res 2006;20(1):70–75. DOI: 10.1590/s1806-83242006000100013
  16. Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016 Oct 12;355:i4919.
  17. Zhao Y, Nguyen M, Gohl E, et al. Oropharyngeal airway changes after rapid palatal expansion evaluated with cone-beam computed tomography. Am J Orthod Dentofacial Orthop 2010;137(4):S71–S78. DOI: 10.1016/j.ajodo.2008.08.026
  18. Fastuca R, Zecca PA, Caprioglio A. Role of mandibular displacement and airway size in improving breathing after rapid maxillary expansion. Prog Orthod 2014;15(1):40. DOI: 10.1186/s40510-014-0040-2
  19. Abdalla Y, Brown L, Sonnesen L. Effects of rapid maxillary expansion on upper airway volume: A three-dimensional cone-beam computed tomography study. Angle Orthod 2019;89(6):917–923. DOI: 10.2319/101218-738.1
  20. Görgülü S, Gokce SM, Olmez H, et al. Nasal cavity volume changes after rapid maxillary expansion in adolescents evaluated with 3-dimensional simulation and modeling programs. Am J Orthod Dentofacial Orthop 2011;140(5):633–640. DOI: 10.1016/j.ajodo.2010.12.020
  21. Pangrazio-Kulbersh V, Wine P, Haughey M, et al. Cone beam computed tomography evaluation of changes in the naso-maxillary complex associated with two types of maxillary expanders. Angle Orthod 2012;82(3):448–457. DOI: 10.2319/072211-464.1
  22. Caprioglio A, Meneghel M, Fastuca R, et al. Rapid maxillary expansion in growing patients: correspondence between 3-dimensional airway changes and polysomnography. Int J Pediatr Otorhinolaryngol 2014;78(1):23–27. DOI: 10.1016/j.ijporl.2013.10.011
  23. Fastuca R, Perinetti G, Zecca PA, et al. Airway compartments volume and oxygen saturation changes after rapid maxillary expansion: a longitudinal correlation study. Angle Orthod 2015;85(6):955–961. DOI: 10.2319/072014-504.1
  24. Baratieri Cda L, Alves M Jr, Mattos CT, et al. Transverse effects on the nasomaxillary complex one year after rapid maxillary expansion as the only intervention: a controlled study. Dental Press J Orthod 2014;19(5):79–87. DOI: 10.1590/2176-9451.19.5.079-087.oar
  25. Smith T, Ghoneima A, Stewart K, et al. Three-dimensional computed tomography analysis of airway volume changes after rapid maxillary expansion. Am J Orthod Dentofacial Orthop 2012;141(5):618–626. DOI: 10.1016/j.ajodo.2011.12.017
  26. Cordasco G, Nucera R, Fastuca R, et al. Effects of orthopedic maxillary expansion on nasal cavity size in growing subjects: a low dose computer tomography clinical trial. Int J Pediatr Otorhinolaryngol 2012;76(11):1547–1551. DOI: 10.1016/j.ijporl.2012.07.008
  27. Zinreich SJ. Imaging of the nasal cavity and paranasal sinuses. Curr Opin Radiol 1992;4(1):112–116. PMID: 1739588
  28. Haralambidis A, Ari-Demirkaya A, Acar A, et al. Morphologic changes of the nasal cavity induced by rapid maxillary expansion: a study on 3-dimensional computed tomography models. Am J Orthod Dentofacial Orthop 2009;136(6):815–821. DOI: 10.1016/j.ajodo.2008.03.020
  29. Oliveira De Felippe NL, Da Silveira AC, Viana G, et al. Relationship between rapid maxillary expansion and nasal cavity size and airway resistance: short- and long-term effects. Am J Orthod Dentofac Orthop 2008;134(3):370–282. DOI: 10.1016/j.ajodo.2006.10.034
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