Distraction Osteogenesis Maxillary Expansion (DOME) for Adult Obstructive Sleep Apnea Patients with High Arched Palate

Abstract

A narrow maxilla with high arched palate characterizes a phenotype of obstructive sleep apnea (OSA) patients that is associated with increased nasal resistance and posterior tongue displacement. Current maxillary expansion techniques for adults are designed to correct dentofacial deformity. We describe distraction osteogenesis maxillary expansion (DOME) tailored to adult patients with OSA with narrow nasal floor and high arched palate without soft tissue redundancy. DOME is performed with placement of maxillary expanders secured by mini-implants along the midpalatal suture. This minimizes the maxillary osteotomies necessary to re-create sutural separation for reliable expansion at the nasal floor and palatal vault. We report the safety and efficacy profile of the first 20 patients at Stanford who underwent DOME.

Obstructive sleep apnea and orthodontics: An American Association of Orthodontists White Paper

“…In OSA patients with maxillary transverse deficiency, normalizing the width of the maxilla with the use of SARME and developing a functional and esthetic occlusion with comprehensive orthodontic treatment afterward has been suggested to improve PSG parameters. 23…”

Surgical Algorithm for Obstructive Sleep Apnea: An Update

“…Patients with this phenotype tend struggle with both nasal obstruction and lack of intraoral volume for the tongue during sleep. Maxillary expansion directed at the nasal floor by way of distraction osteogenesis with maxillary expansion (distraction osteogenesis maxillary expansion [DOME]) has shown promise [55][56][57][58]. Minimally invasive osteotomies can be made at the LeFort I level via an intranasal incision.…”

Oral dysfunction as a cause of malocclusion

“…Unresolved OMD can contribute to serious dental and medical conditions that threaten the quality and length of a person's life. If the jaw is rotated back into the airway and the hard palate invades and deviates the sinuses, it may be difficult to breathe nasally. As the face grows, unbalanced pressure on the craniofacial bones can contribute to temporomandibular dysfunction.…”