Rhinofibroscopic and Rhinomanometric Evaluation of Patients with Maxillary Contraction Treated with Rapid Maxillary Expansion. A Prospective Pilot Study

Objective: The aim of this study was to evaluate through nasal fiber optic endoscopy and rhinomanometry the patency of upper nasal airways in patients treated with rapid palatal expansion Study design: 30 patients (12 males and 18 females) aged 7–11 years with transverse maxillary constriction underwent rhinomanometric and fiberoptic examination before (T0) and after rapid palatal expansion (T1).The amount of nasopharynx obstruction was quantified with reference to the full choanal surface. Nasal resistance was recorded separately for right and left sides, and combined for both sides. The differences in nasopharynx obstruction and in nasal resistance between T0 and T1 were statistically evaluated. Results: The amount of nasopharynx obstruction significantly decreased after palatal expansion (p<0.001). Total nasal inspiration and expiration resistance significantly decreased at T1 (p<0.001). The reduction ranged between 0. 23 and 0. 66 Pa/cm³/s for inspiration and between 0. 20 and 0,.58 Pa/cm³/s for expiration. A statistically significant positive correlation existed between the T1-T0 differences in the amount of nasopharynx obstruction and the T1-T0 differences in expiration nasal airway resistance (Spearman's correlation coefficient rho = 0.38; p = 0.03). Conclusions: Rapid maxillary expansion has an influence on nasal resistance and improves the patency of upper airways in patients with minor or moderate breathing problems.

rapid palatal expansion, maxillary contraction, rhinomanometry, nasal obstruction, fiberoptic endoscopy

1. Thilander B, Pena L, Infante C, Parada SS, deMayorga C. Prevalence of malocclusion and orthodontic treatment need in children and adolescents in Bogotà, Colombia. An epidemiological study related to different stages of dental development. Eur J Orthod; 23 (2):153—167. 2001

2. T.M. Graber, Dentofacial orthopedics, in: T.M. Graber (Ed.), 2 ed., Current Orthodontic Concepts and Techniques, vol. II, W.B. Sounders Company, Philadelphia, 1969, pp. 919—988.

3. B. Thilander, J. Ahlqvist-Rastad, O. Jacobsson, E. Hultcrantz, Breathing obstruction in relation to craniofacial and dental arch morphology in 4-year-old children, Eur J Orthod; 21, 323—332. 1999.

4. C.J. Oulis, G.P. Vadiakas, J. Ekonomides, J. Dratsa, The effect of hypertro-phic adenoids and tonsils on the develop- ment of posterior crossbite and oral habits, J. Clin. Pediatr. Dent. 18, 197—201. 1994.

5. Behlfelt, S. Linder-Aronson, J. McWilliam, P. Neander, J. Laage-Hellman, Cranio-facial morphology in children with and without enlarged tonsils, Eur. J. Orthod. 12, 233— 243. 1990.

6. K. Behlfelt, S. Linder-Aronson, J. McWilliam, P. Neander, J. Laage-Hellman, Dentition in children with enlarged tonsils compared to control children, Eur. J. Orthod. 11, 416— 429. 1989.

7. E.P. Harvold, G. Chierici, K. Vargervik, Experiments on the development of dental malocclusions, Am. J. Orthod. 61, 38—44. 1972.

8. Chandra RK, Patadia MO, Raviv J. Diagnosis of nasal airway obstruc-tion. Otolaryngol Clin North Am, Apr;42(2):207-25. 2009.

9. Angell EH. Treatment of irregularity of the permanent or adult teeth. Dental Cosmos; 1: 540-54.1860.

10. Hershey HG, Stewart BL, Warren DW. Changes in nasal airway resistance associated with rapid maxillary expansion. Am J Orthod ;69: 274-284.1976.

11. Warren DW, Hershey HG, Turvey TA, Hinton VA, Hairfield WM. The nasal airway following maxillary expansion. Am J of Orthod and Dentofac Orthop; 91: 111-116.1987.

12. Ramires T, Maia RA, Barone JR. Nasal cavity changes and the respira-tory standard after maxillary expansion. Braz J Otorhinolaryngol. 2008 Sep-Oct;74(5):763-9. Review. PubMed PMID: 19082360.

13. Kiliç N, Oktay H. Effects of rapid maxillary expansion on nasal breathing and some naso-respiratory and breathing problems in growing children: a literature review. Int J Pediatr Otorhinolaryngol. Nov;72(11):1595-601. 2008.

14. Torre H, Alarcón JA. Changes in nasal air flow and school grades after rapid maxillary expansion in oral breathing children. Med Oral Patol Oral Cir Bucal. 2012 Sep 1;17(5):e865-70

15. 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 Dentofac Orthop. Aug;140(2):146-56. 2011.

16. Zeng J1, Gao X. A prospective CBCT study of upper airway changes after rapid maxillary expansion. Int J Pediatr Otorhinolaryngol. Nov;77(11):1805- 10. 2013.

17. Bouserhal, J., Bassil-Nassif, N., Tauk, A., Will, L., & Limme, M. Three-di-mensional changes of the naso-maxillary complex following rapid maxillary expansion. Angle Orthod, 84(1), 88-95.2013.

18. Chang, Y., Koenig, L. J., Pruszynski, J. E., Bradley, T. G., Bosio, J. A., & Liu, D. Dimensional changes of upper airway after rapid maxillary expansion: a prospective cone-beam computed tomography study. Am J Orthod Dentofac Orthop, 143(4), 462-470. 2013.

19. Buccheri A, Dilella G, Stella R. Rapid palatal expansion and pharyngeal space. Cephalometric evaluation. Prog Orthod. 5: 160-171. 2004.

20. Chiari S, Romsdorfer P, Swoboda H, Bantleon HP, Freudenthaler J. Effects of rapid maxillary expansion on the airways and ears – a pilot study. Eur J Orthod; 31: 131–141. 2009.

21. Iwasaki, T., Saitoh, I., Takemoto, Y., Inada, E., Kanomi, R., Hayasaki, H., & Yamasaki, Y. Improvement of nasal airway ventilation after rapid maxil-lary expansion evaluated with computational fluid dynamics. Am J Orthod Dentofac Orthop, 141(3), 269-278. 2012.

22. Enoki C, Valera FC, Lessa FC, Elias AM, Matsumoto MA, Anselmo-Lima WT. Effect of rapid maxillary expansion on the dimension of the nasal cavity and on nasal air resistance. Int J Pediatr Otorhinolaryngol;70:1225-30. 2006.

23. Doruk C, Sökücü O, Sezer H, Canbay E. Evaluation of nasal airway resis-tance during rapid maxillary expansion using acoustic rhinometry. Eur J Orthod; 26: 397-401.2004.

24. Clement PA, Gordts F. Consensus report on acoustic rhinometry and rhino-manometry. Rhinology; 43: 169—179.2005.

25. Pownell PH, Minoli JJ, Rohrich RJ. Diagnostic nasal endoscopy. Plast Reconstr Surg.;99 (5):1451-8. 1997.

26. Saedi B, Sadeghi M, Mojtahed M, Mahboubi H. Diagnostic efficacy of different methods in the assessment of adenoid hypertrophy. Am J Otolar-yngol. 2011 Mar-Apr;32(2):147-51

27. ZAPLETAL, A.; CHALUPOVA, J. Nasal airflow and resistance measured by active anterior rhinomanometry in healthy children and adolescents. Pediatric pulmonology, 33.3: 174-180. 2002.

28. da Silva Filho, O. G., do Prado Montes, L. A., & Torelly, L. F. Rapid maxillary expansion in the deciduous and mixed dentition evaluated through posteroan-terior cephalometric analysis. Am J Orthod Dentofa Orthop, 107(3), 268-275. 1995.

29. Podesser B, Williams S, Crismani AG, Bantleon HP. Evaluation of the effects of rapid maxillary expansion in growing children using computer tomog-raphy scanning: a pilot study. Eur J Orthod. Feb;29(1):37-44. 2007.

30. Ceroni Compadretti G, Tasca I, Alessandri-Bonetti G, Peri S, D’Addario A. Acoustic rhinometric measurements in children undergoing rapid maxillary expansion. Int. J. Pediatr. Otorhinolaryngol; 70: 27-34. 2006.

31. Picchi F, Fiorelli G, Bolognini E, Piccini A. Otorhinological evaluations of patients undergoing rapid disjunction of the median palatine suture. Minerva Stomatol; 39: 15–18. 1990.

32. Langer MR, Itikawa CE, Valera FC, Matsumoto MA, Anselmo- Lima WT. Does rapid maxillary expansion increase nasopharyngeal space and improve nasal airway resistance? Int J Pediatr OtorhinolaryngolJan;75(1): 122-5 .2011.

33. Linder-Aronson, S., & Leighton, B. C. A longitudinal study of the develop-ment of the posterior nasopharyngeal wall between 3 and 16 years of age. Eur Orthod, 5(1), 47-58.1983.

34. B.S. Vilella, O.V. Vilella, H.A. Koch, Growth of the nasopharynx and adenoidal development in Brazilian subjects, Braz. Oral Res. 20, 70–75.2006.

35. Druce HM, Ledford DK. Fiberoptic rhinoscopy. Clin Allergy Immunol;15:233-45. .2000,

36. KIKUCHI, Makoto. Orthodontic treatment in children to prevent sleep-dis-ordered breathing in adulthood. Sleep and Breathing, , 9.4: 146-158. 2005.

37. ZUCCONI, M., et al. Craniofacial modifications in children with habitual snoring and obstructive sleep apnoea: a case–control study. Eur Resp J , 13.2: 411-417. 1999.

38. MOSS, Me.lvin L. The differential roles of periosteal and capsular functional matrices in orofacial growth. Eur J Orthod, , 29.suppl 1: i96-i101. 2007.

39. Timms DJ. Rapid maxillary expansion in the treatment of nasal obstruction and respiratory disease, Ear Nose Throat J; 66: 242-247. 1987.

40. Hartgerink DV, Vig PS, Abbott DW. The effect of rapid maxillary expansion on nasal airway resistance. Am J Orthod Dentofac Orthop; 92: 381-389. 1987.

41. White BC, Woodside DG, Cole P. The effect of rapid maxillary expansion on nasal airway resistance. J Otolaryngol. Jun;18(4):137-43. 1989.

42. 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 Mar;10(1):23-8. 2009.

43. B. Melsen, Palatal growth studied on human autopsy material. Am J Orthod Jul;68(1):42-54. 1975.

44. FENG, Xin, et al. Comparative analysis of upper airway volume with lateral cephalograms and cone-beam computed tomography. Am Orthod Dentof Orthop, 147.2: 197-204. 2015.

45. MAJOR, Michael P., et al. Agreement between cone-beam computed tomog-raphy and nasoendoscopy evaluations of adenoid hypertrophy. Ame J Orthod Dentofac Orthop, 146.4: 451-459. 2014.

46. KAPILA, S. D.; NERVINA, J. M. CBCT in orthodontics: assessment of treat-ment outcomes and indications for its use. Dentomaxillofacial Radiology, 2014, 44.1: 20140282.

47. GARIB, Daniela G., et al. Is there a consensus for CBCT use in Orthodon-tics?. Dental press J Orthod, 19.5: 136-149. 2014.

48. MAJOR, Michael P., et al. The accuracy of diagnostic tests for adenoid hypertrophy: a systematic review.JADA, 145.3: 247-254. 2014.