Palatal expansion

Upper jaw, caudal view

Le-Fort-I

A palatal enlargement ( GNE , also palatal disruption, rapid palatal expansion, forced palatal enlargement ) is an orthodontic treatment of a narrow jaw . It serves for the transversal expansion of the upper jaw . The procedure is used when there are pronounced discrepancies between the upper and lower arches of the teeth and is carried out in adults with oral surgical support.

Conventional palatal expansion

To stretch the upper jaw, there is usually a support on the 1st premolars and 1st molars (e.g. by means of ligaments) and an expansion screw (hyrax screw), which is used for transversal expansion by unscrewing. There are numerous variants for the correct activation of this screw. Usually, the patient or a third party close to him or her loosen the screw one to three times a day at home and the success of the treatment is monitored at regular intervals.

Surgically assisted palatal expansion

During puberty, the median palatine suture between the two halves of the palate becomes ossified . Therefore, the suture must be weakened by oral surgery before the orthodontist can perform the treatment described above. The paramedian "weakening" procedure can be performed on an outpatient basis under local anesthesia .

In addition, a modified LeFort-1 osteotomy can be performed by the oral surgeon. This must be carried out in a stationary manner under intranasal intubation anesthesia . The orthodontic appliance is used by the orthodontist before the operation. After a vestibular incision in regions 12–15 and 22–25, the lateral osteotomy of the maxillary sinus wall from the piriform aperture to the maxillary tuberosity is performed and the tuber-pterygoid junction is then loosened by a chisel osteotomy. After a few days, the oral surgeon initiates the stretching and activates the screw by 1–2 mm daily.

Effects on nasal breathing

In patients who have a narrowing in the anterior and caudal parts of the nasal structures, the palatal dilation has an early positive effect on nasal breathing and is an effective treatment method for improving nasal passage with correction of transverse discrepancies in the upper jaw.

Common indications

Mismatch between the upper and lower jaw in the transversal extent
Cross bites
Malocclusions
Respiratory difficulties
Crowding

Individual evidence

^ ^A ^b Franz Günter Sander, Norbert Schwenzer, Michael Ehrenfeld: Orthodontics . Georg Thieme, 2011, ISBN 978-3-13-165132-7 , p. 197- ( google.com ).
↑ ^a ^b Wolfgang Stelzenmüller, Jan Wiesner: Therapy of temporomandibular joint pain: a treatment concept for dentists, orthodontists and physiotherapists; 94 tables . Georg Thieme, 2010, ISBN 978-3-13-131382-9 , p. 456- ( google.com ).
↑ Steffi Bössner, The effect of palatal expansion on nasal breathing in the course of active stretching in patients with transverse narrowing in the upper jaw. Dissertation, 2006. UB LMU, accessed on January 31, 2016.

[EhrenfeldSander2011-1] A ^b Franz Günter Sander, Norbert Schwenzer, Michael Ehrenfeld: Orthodontics . Georg Thieme, 2011, ISBN 978-3-13-165132-7 , p. 197- ( google.com ).

[StelzenmüllerWiesner2010-2] Wolfgang Stelzenmüller, Jan Wiesner: Therapy of temporomandibular joint pain: a treatment concept for dentists, orthodontists and physiotherapists; 94 tables . Georg Thieme, 2010, ISBN 978-3-13-131382-9 , p. 456- ( google.com ).

[3] Steffi Bössner, The effect of palatal expansion on nasal breathing in the course of active stretching in patients with transverse narrowing in the upper jaw. Dissertation, 2006. UB LMU, accessed on January 31, 2016.