Pediatric maxillary expansion to treat nasal obstruction

An often neglected cause of nasal obstruction is maxillary constriction. Maxillary expansion (ME) has been proven to decrease nasal resistance and increase nasal volume and airflow thus improving nasal obstruction symptoms both in adults and children. However, up to the present, studies have reported on patients with an orthodontic indication for ME, but not being treated for nasal obstruction. In this study we report a case series of pediatric patients who have been diagnosed with nasal obstruction attributed to maxillary constriction and who have been treated with ME.

Participants were consecutively selected. All children performed anterior active rhinomanometry and SN-5 questionnaire before and after ME. The longest follow-up visit to otolaryngology was recorded for this study. The inclusion criteria were children without adenoid or turbinate enlargement with persistent oral breathing and nasal obstruction confirmed through rhinomanometry. All included children were referred to their odontologist who performed ME only if it was safe for the patient.

23 participants with a mean age of 10.1 (range 6.66-13.27) were included. 78.3% had been previously submitted to surgery to restore or improve nasal breathing. There was a mean decrease in nasal resistance of 0.13 Pa s/cm³, which is a reduction of 34.2% over the mean initial value (P < .001). There was a statistically significant correlation between the amount of expansion and the decrease in nasal resistance (Rho = 0.75; P < .001), and the increase in nasal airflow (rho = 0.71; P < .001). Participants demonstrated a statistically significant decrease in their nasal symptoms measured with the SN5 questionnaire (P = .033).

These are preliminary results that should be managed with caution. Considering previous reports which included ME performed for orthodontic reasons, and the case series herein presented, which includes ME performed for nasal breathing, it seems that ME could be used with this latter objective. Future controlled studies should corroborate these results before producing a general recommendation.