Effects of Rapid Maxillary Expansion on Upper Airway Parameters in Children With Unilateral Cleft Lip and Palate: A Cone-Beam Computed Tomography (CBCT) Study
Restricted accessResearch articleFirst published online 2026
Effects of Rapid Maxillary Expansion on Upper Airway Parameters in Children With Unilateral Cleft Lip and Palate: A Cone-Beam Computed Tomography (CBCT) Study
To evaluate the effect of rapid maxillary expansion (RME) on nasopharyngeal dimensions in children with unilateral cleft lip and palate (UCLP).
Design
A prospective case-series longitudinal study.
Setting
Orthodontic Department, School of Dental Sciences.
Participants
Forty-eight children (30 males and 18 females) aged 8 to 10 years old with UCLP who had maxillary transverse constriction and need maxillary expansion.
Intervention
RME followed by retention phase.
Main outcome
Changes in 3-dimensional nasopharyngeal parameters after RME using cephalometric radiographs and cone-beam computed tomography (CBCT).
Results
The CBCT analysis revealed that the nasal cavity increased by 1907 mm3 (P < .001), the nasopharynx (NP) increased by 707 mm3 (P = .027), the minimum cross-sectional area increased by 29.98 mm2 (P < .001), and the distance between the right and left maxillary sinuses increased by 7.98 mm (P < .001), although the change in the sinus volume was insignificant (P > .05). Cephalometric measurements revealed a statistically significant inferior dislocation of the maxilla after treatment (S-S1, P = .024; N-ANS, P = .017), increase in the inferior anterior and posterior facial height (S-Go, P = .017; ANS-Me, P = .041; N-Me, P = .020).
Conclusion
RME treatment increased some nasopharyngeal dimensions in children with UCLP and maxillary constriction.
SalariNDarvishiNHeydariMBokaeeSDarvishiFMohammadiM. Global prevalence of cleft palate, cleft lip and cleft palate and lip: a comprehensive systematic review and meta-analysis. J Stomatol Oral Maxillofac Surg. 2022;123(2):110-120.
2.
Semb . A study of facial growth in patients with unilateral cleft lip and palate treated by the Oslo CLP team. Cleft Palate Craniofac J. 1991 Jan;28(1):1-21.
3.
KarstenALarsonMLarsonO. Dental occlusion after Veau-Wardill- Kilner versus minimal incision technique repair of isolated clefts of the hard and soft palate. Cleft Palate Craniofac J. 2003;40(5):504-510.
4.
LiaoYFMarsM. Long-term effects of clefts on craniofacial morphology in patients with unilateral cleft lip and palate. Cleft Palate Craniofac J. 2005 Nov;42(6):601-609. doi:10.1597/04-163r.1. PMID: 16241171.
5.
Toro-IbacacheVCortés ArayaJDíaz MuñozAManríquez SotoG. Morphologic variability of nonsyndromic operated patients affected by cleft lip and palate: a geometric morphometric study. Am J Orthod Dentofacial Orthop. 2014 Sep;146(3):346-354. doi:10.1016/j.ajodo.2014.06.002. PMID: 25172257.
6.
FisherAHStanisceLNelsonZJCohenMAMatthewsMS. Risk assessment of sleep disordered breathing in cleft lip and/or palate. Cleft Palate Craniofac J. 2024 Dec;61(12):2074-2078. doi:10.1177/10556656231193552. Epub 2023 Aug 6. PMID: 37545192.
7.
XieBZhangLLuY. The role of rapid maxillary expansion in pediatric obstructive sleep apnea: Efficacy, mechanism and multidisciplinary collaboration. Sleep Med Rev. 2023 Feb;67:101733. doi:10.1016/j.smrv.2022.101733
8.
CaldasLDTakeshitaWMMachadoAWBittencourtMAV. Effect of rapid maxillary expansion on nasal cavity assessed with cone-beam computed tomography. Dental Press J Orthod. 2020 May;25(3):39-45.
9.
HaasAJ. Rapid expansion of the maxillary dental arch and nasal cavity by opening the midpalatal suture. Angle Orthod. 1961;31:73-90.
10.
KrüsiMEliadesTPapageorgiouSN. Are there benefits from using bone-borne maxillary expansion instead of tooth-borne maxillary expansion? A systematic review with meta-analysis. Prog. Orthod. 2019;20:9. doi:10.1186/s40510-019-0261-5.
11.
JainDShrivastavSJainNK. Maxillary expansion in cleft lip and palate cases—a review. Int. J. 2015;3:1455-1461.
12.
ZreaqatMHassanRSamsudinRStasYHanounA. Three-dimensional analysis of upper airways in Class II malocclusion children with obstructive sleep apnea. J World Fed Orthod. 2022 Oct;11(5):156-163.
13.
FonsecaCCavadasFFonsecaP. Upper airway assessment in cone-beam computed tomography for screening of obstructive sleep apnea syndrome: development of an evaluation protocol in dentistry. JMIR Res Protoc. 2023 May 5;12:e41049.
14.
ZreaqatMHassanRAlforaidiSKassimNK. Effects of rapid maxillary expansion on upper airway parameters in OSA children with maxillary restriction: a CBCT study. Pediatr Pulmonol. 2024;59(10):2490-2498.
15.
CrossDLMcDonaldJP. Effect of rapid maxillary expansion on skeletal, dental, and nasal structures: a postero-anterior cephalometric study. Eur J Orthod. 2000;22(5):519-528.
16.
Conroy-PiskaiCGalang-BoquirenMTSObrezA. Assessment of vertical changes during maxillary expansion using quad helix or bonded rapid maxillary expander. Angle Orthod. 2016;86(6):925-933.
17.
FastucaRPerinettiGZeccaPA. Airway compartments volume and oxygen saturation changes after rapid maxillary expansion: a longitudinal correlation study. Angle Orthod. 2015 Nov;85(6):955-961. doi:10.2319/072014-504.1
18.
FigueiredoDSBartolomeoFURomualdoCRPalomoJMHortaMCAndradeIJrOliveiraDD. Dentoskeletal effects of 3 maxillary expanders in patients with clefts: a cone-beam computed tomography study. Am J Orthod Dentofacial Orthop. 2014 Jul;146(1):73-81.
19.
MordenteCMPalomoJMHortaMCSoukiBQOliveiraDDAndradeIJr. Upper airway assessment using four different maxillary expanders in cleft patients: a cone-beam computed tomography study. Angle Orthod. 2016 Jul;86(4):617-624.
20.
NiuXDi CarloGCornelisMACattaneoPM. Three-dimensional analyses of short- and long-term effects of rapid maxillary expansion on nasal cavity and upper airway: a systematic review and meta-analysis. Orthod Craniofac Res. 2020;23(3):250-276.
21.
BasciftciFAMutluNKaramanAIMalkocSKüçükkolbasiH. Does the timing and method of rapid maxillary expansion have rapid maxillary expansion have an effect on the changes in nasal dimensions? Nasal dimensions?Angle Orthod. 2002;72:118-123.
22.
DorukCSökücüOBiçakçiAAYilmazUTaşF. Comparison of nasal volume changes during rapid maxillary expansion using acoustic rhinometry and computed tomography. Eur J Orthod. 2007;29:251-255.
23.
GarrettBJCarusoJMRungcharassaengKFarrageJRKimJSTaylorGD. Skeletal effects to the maxilla after rapid maxillary expansion assessed with cone-beam computed tomography. Am J Orthod Dentofacial Orthop. 2008;134:8.e1-8.e11.
24.
SmithTGhoneimaAStewartK. Three-dimensional computed tomography analysis of airway volume changes after rapid maxillary expansion. Am J Orthod Dentofacial Orthop. 2012;141(5):618-626.
25.
LanteriVFarronatoMUgoliniACosselluGGaffuriFParisiFMRCavagnettoDAbateAMasperoC. Volumetric changes in the upper airways after rapid and slow maxillary expansion in growing patients: a case-control study. Materials (Basel). 2020 May 13;13(10):2239.
26.
Pangrazio-KulbershVWinePHaugheyMPajtasBKaczynskiR. Cone beam computed tomography evaluation of changes in the naso-maxillary complex associated with two types of maxillary expanders. Angle Orthod. 2012 May;82(3):448-457.
27.
DarseyDMEnglishJDKauCHEllisRKAkyalcinS. Does hyrax expansion therapy affect maxillary sinus volume? A cone-beam computed tomography report. Imaging Sci Dent. 2012 Jun;42(2):83-88. doi:10.5624/isd.2012.42.2.83
28.
AkkurtADoğruM. Three dimensional evaluation of the effect of rapid maxillary expansion on maxillary sinus volume. J Stomatol Oral Maxillofac Surg. 2022 Nov;123(6):e930-e935.
29.
CafferDGaribDFaberCMeireles BorbaAVolpatoLde Cássia Moura Carvalho LaurisRMalagodi de AlmeidaAGuerra LundR. Comparison of differential and conventional rapid maxillary expansion on upper airway dimensions in children with bilateral complete cleft lip and palate: a CBCT-based secondary analysis of a clinical trial. Int Orthod. 2025 Oct 8;24(1):101063. doi:10.1016/j.ortho.2025.101063. Epub ahead of print. PMID: 41066971.
30.
YoonAAbdelwahabMBockowRVakiliALovellKChangIGangulyRLiuSYKushidaCHongC. Impact of rapid palatal expansion on the size of adenoids and tonsils in children. Sleep Med. 2022;92:96-102.
31.
ZengJGaoX. A prospective CBCT study of upper airway changes after rapid maxillary expansion. Int J Pediatr Otorhinolaryngol. 2013 Nov;77(11):1805-1810.
32.
AljawadHLeeKMLimHJ. Three-dimensional evaluation of upper airway changes following rapid maxillary expansion: a retrospective comparison with propensity score matched controls. PLoS One. 2021 Dec 23;16(12):e0261579.
