Distraction Osteogenesis Maxillary Expansion (DOME) and SFOT for Naso-Maxillary Expansion in Obstructive Sleep Apnea (OSA)

Individuals with obstructive sleep apnea (OSA) often present with a narrow maxilla and high arch palate, resulting in nasal obstruction which may not be resolved with traditional turbinate reduction, septoplasty, and valve procedures alone. Various expansion techniques are utilized depending on the patient’s growth and developmental stage. Distraction osteogenesis maxillary expansion (DOME) is a technique that predictably expands the maxilla, reduces nasal obstruction, increases intraoral volume, and creates more tongue space in adults with OSA. A minimally invasive nasal endoscopic (MINE) DOME technique has also been developed to reduce morbidity utilizing a nasal endoscopic approach compared to the classic degloving for the Le Fort I osteotomy. Surgically Facilitated Orthodontic Therapy (SFOT) and DOME can both be used to expand the maxilla in adults, but their characteristics and indications are different. This book chapter differentiates these expansion techniques. The amount of maxillary expansion is limited by the mandibular arch width, alveolar basal bone thickness, and periodontal status. SFOT is often planned with DOME to allow mandibular dentoalveolar expansion without compromising alveolar bone loss, root dehiscence, gingival attachment loss, and recession in the adult OSA population. Pairing these two techniques together maximizes the expansion potential of DOME, optimizing its efficacy in OSA treatment.