Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review
  • Published:

Does surgically assisted maxillary expansion improve obstructive sleep apnoea in adults? A systematic review and meta-analysis


Introduction The aim of this systematic review and meta-analysis was to evaluate the effects of maxillary expansion on adults with obstructive sleep apnoea (OSA).

Methods Electronic searches up to July 2021 in eight electronic databases were conducted. Study selection, data extraction, risk of bias evaluation using ROBINS-I, quality of evidence assessment using GRADE and meta-analyses were performed.

Results The electronic searches yielded 1,007 studies. Following the application of the eligibility criteria, 15 articles were fully read and five studies were included. The studies evaluated the effects of surgically assisted rapid maxillary expansion in adults with OSA. The meta-analysis demonstrated an improvement in Apnoea-Hypopnea Index (AHI) (MD = -9.91, CI = -14.57 to -5.25), Oxygen Desaturation Index (ODI) (MD = -7.95, CI = -12.23 to -3.67), and Epworth Sleepiness Scale (ESS) (MD = -4.40, CI = -6.39 to -2.40). ROBINS-I indicated serious, no information and critical risk of bias for the included studies. The quality of the evidence was very low.

Conclusion The findings herein suggest that maxillary expansion could improve OSA in adults in the short term.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others


  1. Punjabi N M. The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 2008; 5: 136-143.

  2. Kohler M, Stradling J R. Mechanisms of vascular damage in obstructive sleep apnea. Nat Rev Cardiol 2010; 7: 677-685.

  3. Jannini E A, Lenzi A. Introduction to the integrated model: medical, surgical and psychological therapies for the couple. J Endocrinol Invest 2003; 26: 128-131.

  4. Coughlin S R, Mawdsley L, Mugarza J A, Calverley P M A, Wilding J P H. Obstructive sleep apnoea is independently associated with an increased prevalence of metabolic syndrome. Eur Heart J 2004; 25: 735-741.

  5. Ozbek M M, Memikoglu U T, Altug-Atac A T, Lowe A A. Stability of maxillary expansion and tongue posture. Angle Orthod 2009; 79: 214-220.

  6. Aloufi F, Preston C B, Zawawi K H. Changes in the upper and lower pharyngeal airway spaces associated with rapid maxillary expansion. ISRN Dent 2012; 2012: 290964.

  7. Hershey H G, Stewart B L, Warren D W. Changes in nasal airway resistance associated with rapid maxillary expansion. Am J Orthod 1976; 69: 274-284.

  8. Agostino P, Ugolini A, Signori A, Silvestrini-Biavati A, Harrison J E, Riley P. Orthodontic treatment for posterior crossbites. Cochrane Database Syst Rev 2014; DOI: 10.1002/14651858.CD000979.pub2.

  9. Suri L, Taneja P. Surgically assisted rapid palatal expansion: a literature review. Am J Orthod Dentofac Orthop 2008; 133: 290-302.

  10. da Silva Filho O G, Boas M C, Capelozza Filho L. Rapid maxillary expansion in the primary and mixed dentitions: a cephalometric evaluation. Am J Orthod Dentofacial Orthop 1991; 100: 171-179.

  11. Garib D G, Henriques J F C, Janson G, Freitas M R, Coelho R A. Rapid maxillary expansion-tooth tissue-borne versus tooth-borne expanders: a computed tomography evaluation of dentoskeletal effects. Angle Orthod 2005; 75: 548-557.

  12. Cistulli P A, Palmisano R G, Poole M D. Treatment of obstructive sleep apnea syndrome by rapid maxillary expansion. Sleep 1998; 21: 831-835.

  13. Pirelli P, Saponara M, Guilleminault C. Rapid maxillary expansion in children with obstructive. Sleep 2004; 27: 761-766.

  14. Baraldi C E, Pretto S M, Puricelli E. Evaluation of surgically assisted maxillary expansion using acoustic rhinometry and postero-anterior cephalometry. Int J Oral Maxillofac Surg 2007; 36: 305-309.

  15. Mitsuda S T, Pereira M D, Passos A P, Hino C T, Ferreira L M. Effects of surgically assisted rapid maxillary expansion on nasal dimensions using acoustic rhinometry. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: 191-196.

  16. Ramires T, Maia R A, Barone J R. Nasal cavity changes and the respiratory standard after maxillary expansion. Braz J Otorhinolaryngol 2008; 74: 763-769.

  17. Pavoni C, Cretella Lombardo E, Lione R, Bollero P, Ottaviani F, Cozza P. Orthopaedic treatment effects of funtional therapy on the sagittal pharyngeal dimension in subjects with sleep-disordered breathing and Class II maloclusion. Acta Otorhinolaryngol Ital 2017; 37: 479-485.

  18. Huynh N T, Desplats E, Almeida F R. Orthodontics treatments for managing obstructive sleep apnea syndrome in children: a systematic review and met-analysis. Sleep Med Rev 2016; 25: 84-94.

  19. Vale F, Albergaria M, Carrilho E et al. Efficacy of rapid maxillary expansion in the treatment of obstructive sleep apnea syndrome: a systematic review with meta-analysis. J Evid Based Dent Pract 2017; 17: 159-168.

  20. Camacho M, Chang E T, Song S A et al. Rapid maxillary expansion for paediatric obstructive sleep apnea: a systematic review and meta-analysis. Laryngoscope 2017; 127: 1712-1719.

  21. Abdullatif J, Certal V, Zaghi S et al. Maxillary expansion and maxillomandibular expansion for adult OSA: a systematic review and meta-analysis. J Craniomaxillofac Surg 2016; 44: 574-578.

  22. Page M J, McKenzie J E, Bossuyt P M et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; DOI: 10.1136/bmj.n71.

  23. Haddaway N R, Collins A M, Coughlin D, Kirk S. The role of Google Scholar in evidence reviews and its applicability to grey literature searching. PLoS One 2015; DOI: 10.1371/journal.pone.0138237.

  24. Sterne J A, Hernán M A, Reeves B C et al. ROBINS-I: A tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016; DOI: 10.1136/bmj.i4919.

  25. Higgins J P, Thompson S G, Deeks J J, Altman D G. Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557-560.

  26. Balshem H, Helfand M, Schünemann H J et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 2011; 64: 401-406.

  27. Vinha P P, Eckeli A L, Faria A C, Xavier S P, de Mello-Filho F V. Effects of surgically assisted rapid maxillary expansion on obstructive sleep apnea and daytime sleepiness. Sleep Breath 2016; 20: 501-508.

  28. Liu S Y C, Guilleminault C, Huon L K, Yoon A. Distraction osteogenesis maxillary expansion (dome) for adult obstructive sleep apnea patients with high arched palate. Otolaryngol Head Neck Surg 2017; 157: 345-348.

  29. Iwasaki T, Yoon A, Guilleminault C, Yamasaki Y, Liu S Y. How does distraction osteogenesis maxillary expansion (DOME) reduce severity of obstructive sleep apnea? Sleep Breath 2020; 24: 287-296.

  30. Yoon A, Guilleminault C, Zahi S, Liu S Y. Distraction Osteogenesis Maxillary Expansion (DOME) for adult obstructive sleep apnea patients with narrow maxilla and nasal floor. Sleep Med 2020; 65: 172-176.

  31. Abdelwahab M, Yoon A, Okland T, Poomkonsarn S, Gouveia C, Liu S Y. Impact of distraction osteogenesis maxillary expansion on the internal nasal valve in obstructive sleep apnea. Otolaryngol Head Neck Surg 2019; 161: 362-367.

  32. American Academy of Sleep Medice. Manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Available at (accessed June 2019).

  33. Alves S, Lopes I, Ferreira P L, Fonseca L, Malheiro D, Silva A. "NOSE" Validation in Portuguese and aplication in septoplasty. Rev Port Otorrino Cirur Cab Pes 2010; 48: 9-14.

  34. Menegat F, Monnazzi M S, Silva B N, de Moraes M, Gabrielli M A C, Pereira-Filho V A. Assessment of nasal obstruction symptoms using the NOSE scale after surgically assisted rapid maxillary expansion. Int J Oral Maxillofac Surg 2015; 44: 1346-1350.

  35. Li K K, Powell N B, Riley R W, Guilleminault C. Distraction osteogenesis in adult obstructive sleep apnea surgery: A preliminary report. J Oral Maxillofac Surg 2002; 60: 6-10.

  36. Bach N, Tuomilehto H, Gauthier C et al. The effect of surgically assisted rapid maxillary expansion on sleep architecture: an exploratory risk study in healthy young adults. J Oral Rehabil 2013; 40: 818-825.

  37. Bertolazi A N, Fagondes S C, Hoff L S, Pedro V D, Barreto S S M, Johns M W. Portuguese-language version of the Epworth sleepiness scale: validation for use in Brazil. J Bras Pneumol 2009; 35: 877-883.

  38. Basta M, Vgontzas A N. Metabolic abnormalities in obesity and sleep apnea are in a continuum. Sleep Med 2007; 8: 5-7.

  39. Kushida C A, Efron B, Guilleminault C. A predictive morphometric model for the obstructive sleep apnea syndrome. Ann Intern Med 1997; 127: 581-587.

  40. Seto B H, Gotsopoulos H, Sims M R et al. The reproducibility and accuracy of cephalometric analysis using different digital imaging modalities and image compression. Am J Orthod Dentofac Orthop 2002; 122: 118-119.

  41. El H, Palomo J M. Three-dimensional evaluation of upper airway following rapid maxillary expansion: a CBCT study. Angle Orthod 2014; 84: 265-273.

  42. Iwasaki T, Saitoh I, Takemoto Y et al. Tongue posture improvement and pharyngeal airway enlargement as secondary effects of rapid maxillary expansion: a cone-beam computed tomography study. Am J Orthod Dentofacial Orthop 2013; 143: 235-245.

  43. Guijarro-Martínez R, Swennen G R J. Three-dimensional cone beam computed tomography definition of the anatomical subregions of the upper airway: a validation study. Int J Oral Maxillofac Surg 2013; 42: 1140-1149.

  44. Di Carlo G, Saccucci M, Ierardo G et al. Rapid maxillary expansion and upper airway morphology: a systematic review on the role of cone beam computed tomography. Biomed Res Int 2017; 2017: 5460429.

  45. Hamedi-Sangsari A, Chinipardaz Z, Carrasco L. Following surgically assisted rapid palatal expansion, do tooth-borne or bone-borne appliances provide more skeletal expansion and dental expansion? J Oral Maxillofac Surg 2017; 75: 2211-2222.

  46. John M T. Health outcomes reported by dental patients. J Evid Based Dent Pract 2018; 18: 332-335.

Download references

Author information

Authors and Affiliations



LTO, LGA, and DDO designed the study and guided the protocol development. LTO, GSS, and LGA selected the studies and extracted data of the included articles. LTO and GSS assessed the risk of bias of included articles. LGA analysed the data. LTO, LGA, and GSS drafted the original version of the manuscript. VEA and DDO critically revised the manuscript. LTO, LGA, GSS, VEA, and DDO revised and approved the final version of the article.

Corresponding author

Correspondence to Giordani Santos Silveira.

Ethics declarations

The authors declare no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Oliveira, L., Abreu, L., Silveira, G. et al. Does surgically assisted maxillary expansion improve obstructive sleep apnoea in adults? A systematic review and meta-analysis. Evid Based Dent (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI:


Quick links