Surgery For Snoring & OSA

About Palatal Widening Procedures

The floor of the nose is formed primarily by the hard palate, which develops from the 2 sides,(left and right). The period of growth of the hard palate matches approximately the growth of the face. When the bone of the left and right side of the hard palate eventually join up in the midline at about age 16 (fusion of midpalatal suture line), this marks the end of the period of growth. 

In some patients, obstructive sleep apnoea (OSA) may be due to a very narrow nasal passage. The key features in these patients are a very high arched palate with a narrow nose. To correct this, the palate needs to be widened. This is achieved by pushing the 2 sides of the hard palate apart in a controlled fashion, a process known as maxillary expansion. Various methods of maxillary expansion have been developed.

Before growth of the hard palate is completed (patients 15 years and younger), maxillary expansion may be achieved by using dental expanders, in a way similar to how dental braces gradually correct dental misalignment.  For patients who are 16 years and older, the midpalatal suture line needs to be re-created surgically and this is followed by maxillary expansion. 

Recently. maxillary expansion using mini-implants along the suture line has been found to be the most reliable method for widening of the nasal floor for adult patients with OSA. The operation has been named Distraction Osteogenesis Maxillary Expansion (DOME).