The effect of rapid maxillary expansion on nasal airway resistance

._--ll_l_“l J Oral Maxillofac

-_.- ..__“..

.-

Surg

48:540-546.1990

Abstracts Doctors and Dentists: Review of a Symposium. J Otolaryngol 18:4, 1989

Cole P.

to normal size after expansion. In this particular study the authors selected 12 patients who required rapid palatal expansion as part of their orthodontic treatment. All were treated with fixed rapid palatal expansion devices. Maximum desired expansion was obtained in 2 to 3 weeks. The results showed that the mean nasal airway resistance was reduced by 45.9%. They agree that a more ideal sample size would be on the order of 60 subjects, but that even though the sample size was small, it indicates that rapid palatal expansion resulted in a significant real reduction in nasal airway resistance for the sample. Repeat airway studies at 12 months showed that this reduction in resistance remained stable. The authors feel that there is a relationship between nasal respiratory obstruction and narrow maxillary arches, and therefore suggest that individuals who need rapid palatal expansion may also have nasal resistance values which may be highly conductive to a mouth-breathing pattern of respiration. The mean first molar expansion in this study was 5.5 mms with a range from 3.5 to 8.7 mm.-E.L. MOSBY

Long face syndrome and/or chronic mouth breathing is increasingly recognized in patients with dental malocclusion. Questions have arisen concerning nasal and pharyngeal airway obstruction in these patients. It was noted that in some children obstruction to the upper airway contributed to abnormalities in facial growth and dental development and that this process may be halted by eliminating the nasal obstruction. The participants at this symposium felt that it was not wise to delay or protract treatment in alleviating airway symptoms. Analysis of 1,000 consecutive pediatric patients suspected of airway obstruction documented the condition in approximately 69%. Fifty-five per cent of these patients’ obstructions were reduced by topical decongestants. Twenty-five per cent were felt to be related to adenoid hypertrophy and 16% to structural abnormalities. Most of the patients in whom obstruction was confirmed had a history of chronic open-mouth posture. Orthodontic alternatives to the surgical methods most commonly used for the relief of nasal obstruction were presented. These consisted of rapid palatal expansion which provided benefits to airway patency. Medical management frequently provided spontaneous resolution so that orthodontic treatment could be initiated before the situation deteriorated further. There was inconsistency regarding the management of tonsil and adenoid problems, the use of antihistamines, desensitization, and topical steroids. It was suggested that exposure of predoctoral and graduate students of both medicine and dentistry to the management of the problems could benefit patients in whom special care is required.E.L. MOSBY

Reprint requests to Dr Woodside: Department of Orthodontics, Faculty of Dentistry, University of Toronto, 124 Edward St, Toronto, Ontario, Canada MSGlG6. Peripheral Ameloblastic Carcinoma: A Case Report of a Rare Neoplasm. McClatchey KD, Sullivan MJ, Paugh DR. J Otolaryngol 18:3, 1989

Peripheral ameloblastic carcinoma is a rare malignant neoplasm and in a report by Corio et al from the AFIP eight cases were reported, none of which were described to have been peripheral. These authors report the case of a 77-year-old white woman who had a 2 x 2 cm mucosalcovered concavity on the left posterior maxillary tuberosity with some granulation tissue at the depth of the concavity. CT scan revealed a neoplasm invading the maxillary tuberosity, but with no extension or involvement of the pterygoid plate. Surgery consisted of a wide local excision of the left posterior tuberosity and primary closure. The patient healed without complications and there was no recurrence on 2-year follow-up. Histopathology revealed a lesion which was typical of peripheral ameloblastoma except that the lesion contained frank histomorphologic evidence of anaplasia that extended to and invaded the underlying alveolar bone of the maxillary tuberosity. The authors feel that wide local excision of this type lesion is generally curative, as it appeared to be in this case, as this lesion tends to act like a well-differentiated squamous cell carcinoma.-E.L. MOSBY

Reprint requests to Dr Cole: The Gage Research Institute, 2223 College St, Toronto, Ontario, Canada M5TlR4.

The Effect of Rapid Maxillary Expansion on Nasal Airway Resistance. White BC, Woodside DG, Cole P. J Otolaryngo1 l&4, 1989 Orthodontic expansion of the maxilla is frequently used to coordinate maxillary and mandibular width to correct posterior crossbite. Some of the medical indications for rapid palatal expansion are a combination of poor nasal airway, septal deformity, recurrent ear or nasal infection, allergic rhinitis, asthma, and as a possible alternative to septoplasty. The dental as well as skeletal effects of such therapy have been well documented. This treatment moves the lateral wall of the nose outward, moving the inferior turbinate and enlarging the airway. Gray, in reporting 3 10 cases, found that 87% of the patients who had rapid palatal expansion changed from mouth breathing to nose breathing, and had a 60% reduction in upper respiratory infections. Timms reported on 237 cases with rapid palatal expansion, and a subjection impression showed improvement in nasal respiration in 91% of the patients. It is generally felt that the binasal cavity width will increase

Reprint requests to Dr McClatchey: Department of Pathology 2(3332/0054, University Hospital, 1500 E Medical Center Dr, Ann Arbor, MI 48109-0054. Rhahdomyosarcoma Moore GK, Hibbert Approximately rhabdomyosarcoma

540

of the Alveolar J. J Otolaryngol

Ridge in an Adult. 18:3, 1989

80% of the patients diagnosed with are under the age of 12 years. The