Endoscopically-assisted surgical expansion (EASE)

Endoscopically-assisted surgical expansion (EASE)

Widening of the upper jaw yields to a bigger airway space. Due to skull maturation in adolescents’ maxillary expansion is challenging without any surgical support. The usual method for maxillary expansion is SARPE (surgically-assisted rapid palatal expansion). The Endoscopically-assisted surgical expansion (EASE) by using the a MSE (Maxillary Skeletal Expander / Midfacial Skeletal Expander) or a distractor device TPD (transpalatal distractor).

Implements the cuts of the EASE technique, developed by Dr. Kasey Li, which is minimally invasive surgery and only weakens the areas of resistance with incison in the posterior tuberosity, the ptygomaxillary suture and the midpalatal osteotomy allowing to maximize the effect of expansion on the nasal cavity with alle the benefits for breathing.

The MSE should be inserted by an orthodontic. It is a unique type of micro-implant assisted rapid palatal expander. It does bring many benefits over the traditional expanders:

  • Non-surgical expansion in adults of all ages
  • Beneficial effects on nasal breathing
  • Can help in cases of airway restrictions
  • Allows the treatment of many complex cases without surgery
  • Can reduce the severity of obstructive sleep apnea in many cases

What is a narrow airway and why should I care about it?

The human airway consists of three major sections: the nasal cavity, the throat and the lower airways. While the lower one is well protected by the tissues, the upper two are directly influenced by upper jaw size, facial development and the position of the jaw and tongue. If the upper airway is too narrow or the tissue is very loose, it can lead to obstructive sleep apnea. This means that the upper airway gets obstructed during sleep and your body is not able to breath.

Depending on the length of this breathing interruption, your body does get stressed during the night and your sleep can get fragmented with low oxygen levels in blood. Usually that causes you to wake up in the morning feeling still tired and in severe cases even more tired than the evening before. In the long run this can lead to hypertension, heart disease and mood as well as memory problems.

What is the cause of obstructive sleep apnea or a narrow upper jaw?

There are many factors contributing to a normal facial development between the ages of 4 to 14 years. The most important factors are an adequate breathing through the nose, a correct position of the tongue in the palate, swallowing properly and avoiding any inadequate oral habits like thumb sucking. If there are any problems with one of the functions, the upper jaw is likely to under develop and result in a narrow nasal cavity, crossbites and breathing problems.

This insufficient development is often missed as it happens slowly over time. Once you are fully grown, other factors such as overweight, alcoholism, genetics, a narrow upper airway, large tonsils or uvula, and a small lower jaw with a recessed chin can lead to obstructive sleep apnea.

While functional changes are often enough to solve the problem in children, adults need additional development with EASE. This appliance allows to widen the upper jaw and increases the size of the nasal cavity, allowing air to flow more easily.

Signs there may be an airway issue:

  • Poor sleep or sleep apnea
  • Attention problems and unease (ADHD)
  • Trouble breathing through the nose
  • Dark circles around your eyes
  • Severe snoring
  • Frequently falling asleep during the day (e.g. when driving)

When is a MSE appliance indicated? Do I need a MSE/TPD?

The Maxillary Skeletal Expander(picture) or TPD (transpalatal distractor) allows to widen the upper jaw. In contrary to many other expansion appliances it results in a true skeletal expansion and no dental tipping.

MSE Apparatur 1
MSE Apparatur 1

Very obvious signs for a narrow maxilla are crossbites on one or on both sides. However, sometimes there is no crossbite but teeth tend to tip to compensate for the skeletal discrepancy resulting.

MSE Apparatur 2
MSE Apparatur 2
MSE Apparatur 3
MSE Apparatur 3

Additionally, recent studies show, that MSE/TPD expansion can help to widen the nasal cavity and improve nasal breathing or reduce the severity of obstructive sleep apnea. These effects of improved breathing though depend on many different factors and need to be evaluated individually. Feel free to ask us about more details.

Does EASE help with obstructive sleep apnea (OSA)?

Obstructive sleep apnea is a multifactorial disease and many times there is no single solution. Many patients though have a narrow upper jaw with a narrow nasal cavity. This can lead to a lot of airway resistance when breathing and can affect the soft tissues in the throat. In those cases, where the upper jaw is very narrow EASE has shown to decrease the severity of obstructive sleep apnea significantly.

However, a thorough analysis of your individual case is necessary to determine if we can help you.

MSE Apparatur 4
MSE Apparatur 4

Can I do MMA (maxillo-mandibular-advancement) surgery after the Maxillary Skeletal Expansion?

If you do have obstructive sleep apnea (OSA) the EASE can improve your situation and help to get good sleep. Sometimes though, the expansion of the nasal cavity by itself is not sufficient to fully resolve OSA. In these cases we need to start with the orthodontic treatment and prepare you for (maxillo-mandibular-advancement) MMA surgery.

With an additionally counter-clockwise-rotation (CCW) the lower jaw rotates forward and upward while the tongue is being brought forward. This can help to improve the posterior airway.

As well we can offer a genioplasty to stretch the muscles in your mouthfloor and open the airway space a little bit more.