International Journal of Scientific Research in Dental and Medical Sciences

International Journal of Scientific Research in Dental and Medical Sciences

Effects of Rapid Maxillary Expansion on Upper Airway Airflow Characteristics: A Systematic Review and Meta-analysis

Document Type : Review Article

Authors
Faeze Shams 1
Faezeh Niroumandfar 2
Parisa Doroudgar 3
Zahra Mardani 4
Shiva Safari 5
1 Department of Orthodontics, Faculty of Dentistry, Tehran Azad University of Medical Sciences, Tehran, Iran
2 Faculty of Dentistry, Isf. C, Islamic Azad University, Isfahan, Iran
3 Department of public health, UFR of medicine and paramedical professions, Clermont Auvergne University, France
4 Orthodontics Unit, Department of Plastic Surgery, Hospital and Burn Research Center, Iran University of Medical Sciences, Tehran, Iran
5 Independent Researcher, Tehran, Iran
10.30485/ijsrdms.2025.528110.1662
Abstract
Background and aim: After rapid maxillary expansion, there is evidence that nasal airflow resistance is reduced. In the developmental age, it is unclear how RME affects upper airway airflow characteristics. Therefore, the aim pf present study was to evaluate the effects of rapid maxillary expansion on upper airway airflow characteristics.
Material and methods: The present systematic review and meta-analysis included three randomized clinical trials and sixteen cohort studies international databases, PubMed, Scopus, Web of Science, and Embase, from January 1, 2015 to May 10, 2025, using keywords aligned with the study objective. Data extracted included numbers of participants, mean age, gender, Midpalatal suture maturation stage, nasal septum deviation, Intervention, and upper airway assessment. For each study that included, the mean value of airway pressure, nasal cavity volume, nasopharyngeal volume, and oropharyngeal volume was calculated between before and after rapid maxillary expansion. The statistical analysis was performed with Stata/MP.v17 as fixed effect models.
Results: A significant reduction of airway pressure was found after RME (MD = -152.25; 95%CI -154.59 Pa to -149.92 Pa; p<0.001). there was a significant increase in nasal cavity volume after RME compared before RME (MD = 1.88; 95%CI 1.82 to 1.95; p<0.001), mean differences of oropharyngeal volume was 0.87 (MD = 0.87; 95%CI 0.75 to 0.99; p<0.001), and mean differences of nasopharyngeal volume was 0.80 (MD = 0.80; 95%CI 0.73 to 0.88; p<0.001).

Conclusions: In children of growing age, rapid maxillary expansion can be an effective method on upper airway airflow characteristics.
Keywords
Meta-Analysis
Palatal Expansion Technique
Sleep Apnea Syndromes

Subjects

[1] Yang J, Tang Z, Shan Z, Leung YY. Maxillary Deficiency: Treatments and Applications for Adolescents. Applied Sciences. 2025;15(6):3256. https://doi.org/10.3390/app15063256.
[2] Lo Giudice A, Polizzi A, Lagravere M, Flores-Mir C, Isola G, Ronsivalle V, et al. Changes in upper airway airflow after rapid maxillary expansion considering normal craniofacial development as a factor: a retrospective study using computer fluid dynamics. European Journal of Orthodontics. 2025;47(1):cjae077. https://doi.org/10.1093/ejo/cjae077.
[3] Cerritelli L, Hatzopoulos S, Catalano A, Bianchini C, Cammaroto G, Meccariello G, et al. Rapid maxillary expansion (RME): an otolaryngologic perspective. Journal of clinical medicine. 2022;11(17):5243. https://doi.org/10.3390/jcm11175243.
[4] Xie B, Zhang L, Lu Y. The role of rapid maxillary expansion in pediatric obstructive sleep apnea: efficacy, mechanism and multidisciplinary collaboration. Sleep medicine reviews. 2023;67:101733. https://doi.org/10.1016/j.smrv.2022.101733.
[5] Lima Illescas MV, Aucapina Aguilar DC, Vallejo Ledesma LP. A review on the influence of rapid maxillary expansion and mandibular advancement for treating obstructive sleep apnea in children. Journal of Clinical Pediatric Dentistry. 2023;47(1). http://doi.org/10.22514/jocpd.2022.035.
[6] Brunetto DP, Moschik CE, Dominguez-Mompell R, Jaria E, Sant’Anna EF, Moon W. Mini-implant assisted rapid palatal expansion (MARPE) effects on adult obstructive sleep apnea (OSA) and quality of life: a multi-center prospective controlled trial. Progress in orthodontics. 2022;23(1):3. https://doi.org/10.1186/s40510-021-00397-x.
[7] Bariani RC, Badreddine FR, Yamamoto LH, Shido FT, Hoppe DP, Tufik S, et al. Rapid maxillary expansion in patient with obstructive sleep apnea: case report. Sleep Science. 2022;15(S 01):293-9. https://doi.org/10.5935/1984-0063.20220026.
[8] Oliveira LT, Abreu LG, Silveira GS, de Araújo VE, Oliveira DD. Does surgically assisted maxillary expansion improve obstructive sleep apnoea in adults? A systematic review and meta-analysis. Evidence-Based Dentistry. 2022:1-8. https://doi.org/10.1038/s41432-022-0829-7.
[9] Sun Y, Jia Y, Wang S, Xu C, Qu Y, Hu M, et al. Effectiveness of mandibular advancement orthodontic appliances with maxillary expansion device in children with obstructive sleep apnea: a systematic review. BMC Oral Health. 2024;24(1):1303. https://doi.org/10.1186/s12903-024-04931-1.
[10] Ferati K, Bexheti-Ferati A, Palermo A, Pezzolla C, Trilli I, Sardano R, et al. Diagnosis and Orthodontic Treatment of Obstructive Sleep Apnea Syndrome Children: A Systematic Review. Diagnostics. 2024;14(3):289. https://doi.org/10.3390/diagnostics14030289.
[11] Liu SY-C, Schwartz K. Maxillofacial Surgery in OSA.  Obstructive Sleep Apnea: A Multidisciplinary Approach: Springer. 2023;487-510. https://doi.org/10.1007/978-3-031-35225-6.
[12] Quinlan CM, Beck SE. Obstructive Sleep Apnea Syndrome. 2023. https://doi.org/10.1542/9781610026536-33.
[13] Carra MC, Romandini P, Romandini M. Risk of Bias Evaluation of Cross‐Sectional Studies: Adaptation of the Newcastle‐Ottawa Scale. Journal of Periodontal Research. 2025. https://doi.org/10.1111/jre.13405.
[14] Palazzo G, Leonardi R, Isola G, Lagravere M, Lo Giudice A. Changes in Upper Airway Airflow After Rapid Maxillary Expansion Beyond the Peak Period of Adenoidal Growth—A CBCT Study Using Computer Fluid Dynamics and Considering Adenoidal Dimensions as a Factor. Dentistry Journal. 2025;13(5):209. https://doi.org/10.3390/dj13050209.
[15] Stjepan S, Martina Z, Vedrana T, Taner Ö, Ahmet Y, Martin PJ. Effect of Maxillary Expansion and Protraction in Class III Children on Quality of Life, Dentofacial and Upper Airway Characteristics: A Controlled Clinical Trial. Orthodontics and Craniofacial Research. 2025. https://doi.org/10.1111/ocr.12935.
[16] Satto RH, Sakuma ET, Ribeiro JD, Sakano E. Long-term structural and functional nasomaxillary evolution of children with mouth-breathing after rapid maxillary expansion: An 8-year follow-up study. Korean Journal of Orthodontics. 2025;55(2):95-104. https://doi.org/10.4041/kjod24.102.
[17] Maraabeh F, Shihabi R, He X, Zhan J, Zhang J, Hu L, et al. Three-dimensional volume changes of the palatal vault and pharyngeal airway following facemask therapy and maxillary expansion: a prospective comparative study. BMC Oral Health. 2025;25(1):1-11. https://doi.org/10.1186/s12903-025-05835-4.
[18] Crnković S, Šimac Pavičić D, Svirčić A, Trinajstić Zrinski M, Katić V. The Impact of Upper Jaw Expansion Treatment on Vertical Craniofacial Characteristics and Upper Airway Dimensions. Oral. 2025;5(2):33. https://doi.org/10.3390/oral5020033.
[19] Bastos RM, Junior OH, Piccoli V, da Rosa BM, de Oliveira RB, de Menezes LM. Effects of minimally invasive surgical and miniscrew-assisted rapid palatal expansion (MISMARPE) on the nasal cavity and upper airway: a comparative cohort study. International Journal of Oral and Maxillofacial Surgery. 2024;53(10):821-8. https://doi.org/10.1016/j.ijom.2024.03.012.
[20] Zreaqat M, Hassan R, Alforaidi S, Kassim NK. Effects of rapid maxillary expansion on upper airway parameters in OSA children with maxillary restriction: A CBCT study. Pediatric Pulmonology. 2024;59(10):2490-8. https://doi.org/10.1002/ppul.27050.
[21] Pirelli P, Fiaschetti V, Mampieri G, Condo' R, Ubaldi N, Pachi F, Giancotti A. Effect of rapid maxillary expansion on nasomaxillary structure and sleep disordered breathing in children with obstructive sleep apnoea. Australian Dental Journal. 2024;69:S112-20.
[22] Ronsivalle V, Leonardi R, Lagravere M, Flores-Mir C, Grippaudo C, Bonetti GA, et al. Medium-term effects of rapid maxillary expansion on nasal cavity and pharyngeal airway volumes considering age as a factor: A retrospective study. Journal of Dentistry. 2024;144:104934. https://doi.org/10.1016/j.jdent.2024.104934.
[23] Korayem MA. Effects of rapid maxillary expansion on upper airway volume in growing children: A three-dimensional cone-beam computed tomography study. Cureus. 2023;15(1). https://doi.org/10.7759/cureus.34274.
[24] de Julián-López C, Veres J, Marqués-Martínez L, García-Miralles E, Arias S, Guinot-Barona C. Upper airway changes after rapid maxillary expansion: three-dimensional analyses. BMC Oral Health. 2023;23(1):618. https://doi.org/10.1186/s12903-023-03324-0.
[25] Gokce G, Gode S, Ozturk A, Kirazlı T, Veli̇ I. Evaluation of the effects of different rapid maxillary expansion appliances on airway by acoustic rhinometry: a randomized clinical trial. International Journal of Pediatric Otorhinolaryngology. 2022;155:111074. https://doi.org/10.1016/j.ijporl.2022.111074.
[26] Shetty N, Nambiar S, Desai A, Ahmed J. Effect of Maxillary Expansion Treatment Protocols On Maxillary Sinus Volume, Pharyngeal Airway Volume, and Hyoid Bone Position: A Prospective, Cone Beam Computed Tomography (CBCT) Study. The Open Dentistry Journal. 2022;16(1).
[27] Almuzian M, Al Ghatam HM, Al-Muzian L. Assessing the validity of ITK-SNAP software package in measuring the volume of upper airway spaces secondary to rapid maxillary expansion. journal of orthodontic science. 2018;7(1):7. https://doi.org/10.4103/jos.JOS_93_17.
[28] Lo Giudice A, Fastuca R, Portelli M, Militi A, Bellocchio M, Spinuzza P, et al. Effects of rapid vs slow maxillary expansion on nasal cavity dimensions in growing subjects: A methodological and reproducibility study. European Journal of Paediatric Dentistry. 2017;18(4):299-304. https://dx.doi.org/10.23804/ejpd.2017.18.04.07.
[29] Cappellette Jr M, Alves FE, Nagai LH, Fujita RR, Pignatari SS. Impact of rapid maxillary expansion on nasomaxillary complex volume in mouth-breathers. Dental press journal of orthodontics. 2017;22(03):79-88. https://doi.org/10.1590/2177-6709.22.3.079-088.oar.
[30] Almuzian M, Ju X, Almukhtar A, Ayoub A, Al-Muzian L, McDonald JP. Does rapid maxillary expansion affect nasopharyngeal airway? A prospective Cone Beam Computerised Tomography (CBCT) based study. the surgeon. 2018;16(1):1-1. https://doi.org/10.1016/j.surge.2015.12.006.
[31] Izuka EN, Feres MF, Pignatari SS. Immediate impact of rapid maxillary expansion on upper airway dimensions and on the quality of life of mouth breathers. Dental press journal of orthodontics. 2015;20(3):43-9. https://doi.org/10.1590/2176-9451.20.3.043-049.oar.
[32] Baratieri C, Alves Jr M, de Souza MM, de Souza Araujo MT, Maia LC. Does rapid maxillary expansion have long-term effects on airway dimensions and breathing?. American Journal of Orthodontics and Dentofacial Orthopedics. 2011;140(2):146-56. https://doi.org/10.1016/j.ajodo.2011.02.019.
[33] Behrents RG, Shelgikar AV, Conley RS, Flores-Mir C, Hans M, Levine M, et al. Obstructive sleep apnea and orthodontics: an American Association of Orthodontists White Paper. American journal of orthodontics and dentofacial orthopedics. 2019;156(1):13-28. https://doi.org/10.1016/j.ajodo.2019.04.009.
[34] Choudhari SM, Shrivastav S. Comparative evaluation of adenoids and airway space in 12 to 14-year-old children with different growth patterns using cephalometric methods commonly used by ENT specialists. Journal of Indian Orthodontic Society. 2022;56(1):23-8. https://doi.org/10.1177/0301574220966875.
[35] Pereira L, Monyror J, Almeida FT, Almeida FR, Guerra E, Flores-Mir C, et al. Prevalence of adenoid hypertrophy: A systematic review and meta-analysis. Sleep medicine reviews. 2018;38:101-12. https://doi.org/10.1016/j.smrv.2017.06.001.
[36] Leal MC, Seabra Ramos D, Pinto Bezerra T, Vilela AE, Maciel RJ, Rodrigues M, et al. The prevalence of adenoid hypertrophy among children with Zika related microcephaly. Viruses. 2021;13(1):62. https://doi.org/10.3390/v13010062.
[37] Lan Y, Chen J, Chen S, He Y, Huang F. Influences of adenoid hypertrophy on children’s maxillofacial development. InHealthcare 2023;11(21):2812. https://doi.org/10.3390/healthcare11212812.
[38] Balasubramanian S, Kalaskar R, Kalaskar A. Rapid maxillary expansion and upper airway volume: Systematic review and meta-analysis on the role of rapid maxillary expansion in mouth breathing. International Journal of Clinical Pediatric Dentistry. 2022;15(5):617-30. https://doi.org/10.5005/jp-journals-10005-2421.
[39] Iwasaki T, Papageorgiou SN, Yamasaki Y, Ali Darendeliler M, Papadopoulou AK. Nasal ventilation and rapid maxillary expansion (RME): a randomized trial. European Journal of Orthodontics. 2021;43(3):283-92. https://doi.org/10.1093/ejo/cjab001.
International Journal of Scientific Research in Dental and Medical Sciences
Volume 7, Issue 3
Summer 2025
Pages 117-119

  • Receive Date 03 June 2025
  • Revise Date 30 July 2025
  • Accept Date 21 August 2025
  • Publish Date 01 September 2025