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Impact of rapid palatal expansion on the internal nasal valve and obstructive nasal symptoms in children

Abstract

Objective

The aim of this study is to evaluate the impact of rapid palatal expansion (RPE) on the nasal airway subjectively by utilizing patient-reported outcome measures (PROM) and objectively by evaluating validated internal nasal valve (INV) measurements obtained from cone beam computed tomography (CBCT) in pediatrics.

Materials and methods

In this retrospective cohort study, subjects who underwent RPE from March to December 2018 with cone beam CT and Nasal Obstruction Symptom Evaluation (NOSE) scores were included. Exclusion criteria included craniofacial deformity, allergies, asthma, recent nasal trauma, or surgery. INV measurements (angle and cross-sectional area), diastema, midpalatal suture opening, and NOSE scores were evaluated.

Results

Fifty-one subjects met the inclusion criteria with a mean age of 10.1 ± 2.6. Pre-expansion mean NOSE score was 32.55 (moderate) while post-expansion was 13.92 (mild). Mean NOSE score improved significantly by an average of 18.63 following post-expansion (P < 0.0001). The patients’ right and left INV angles increased significantly by a mean of 2.42° and 2.65° respectively (P < 0.0001). Right and left INV cross-sectional areas increased significantly by an average of 14.35 mm2 (P < 0.0001) and 14.17 mm2 (P < 0.0001) respectively. An average expansion of the diastema and the suture was 1.60 mm and 3.05 mm respectively (P < 0.0001), with an average of 6.29 mm of expansion. We found the amount of diastema expansion to correlate with change in NOSE score (R = − 0.32, P = 0.022). Age and diastema showed a negative correlation (R = − 0.44, P = 0.0019), while INV angle and diastema showed a statistically significant positive correlation (R = 0.28, P = 0.048).

Conclusions

RPE showed improvement in both NOSE scores and objective measures of the INV. This may show the possibility of considering RPE in managing resistant pediatric nasal airways. Future studies should include collaboration with pediatric otolaryngologists, with the inclusion of pediatric patients with persistent nasal obstruction.

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Acknowledgments

The authors would like to thank Dr. Myung Shim Sim for her valuable statistical assistance.

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Correspondence to Daniela Silva.

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The authors declare that they have no conflict of interest.

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This retrospective study was approved by University of California, Los Angeles Institutional Review Board (IRB#18-001326).

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Informed consent was obtained from all individual participants included in the study.

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Yoon, A., Abdelwahab, M., Liu, S. et al. Impact of rapid palatal expansion on the internal nasal valve and obstructive nasal symptoms in children. Sleep Breath 25, 1019–1027 (2021). https://doi.org/10.1007/s11325-020-02140-y

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Keywords

  • Rapid palatal expansion
  • Internal nasal valve
  • Midpalatal suture
  • Nasal obstruction in children
  • Rapid maxillary expander
  • Nasal breathing