Miniscrew-assisted rapid palatal expansion (MARPE) Therapy
Miniscrew-assisted rapid palatal expansion (MARPE) is an effective surgical-free and extraction-free treatment used to expand the upper jaw, or the maxilla. A narrow maxilla is associated with an obstructed nasal passage, crowded teeth, and can impact the facial development. These features are commonly characteristics of obstructive sleep apnea (OSA).
Conventional maxillary expander treatments are often used to treat a narrow maxilla. These traditional methods can only be used on children because the suture which holds the maxillary bone together fuses when patients are around 12-15 years-old. MARPE is innovative as it extends this time limitation by connecting the expander directly to the palatal bone. MARPE can be effective for young adults who already have a fused suture.
MARPE Procedure
The MARPE procedure works by expanding the maxillary bone. Once complete, this increases the volume of both the nasal cavity and oral cavity. The procedure also decreases nasal resistance and gives the tongue more room to sit upwards and forwards in the mouth. This ultimately makes the airway larger.
The process is completed by placing a custom maxillary expander and mini-screws along the midpalatal suture. The procedure typically takes 20-30 minutes to complete and is done under a local anesthesia. Any pain is minimal and can typically be managed using an over-the-counter painkiller for a few days. Once the installation is complete, the patient turns a screw to activate the expander daily for 4-6 weeks.
The expander splits the suture, and a gap forms between the front teeth. Orthodontic treatment can be used to close the gap and help create a stable bite. The expander remains in place until the new bone at the suture forms. This process typically takes 4-6 months.
In addition to its ability to treat a wider age range of patients, MARPE also has fewer side effects compared to a conventional expander. MARPE uses mini-screws to apply direct forces to the midpalatal suture. Conventional expanders anchor to the teeth. MARPE also avoids unintended tooth movement and can achieve greater bone expansion while minimizing the side effects. As a result, MARPE can achieve maximum airflow and reduce symptoms of sleep apnea.
While MARPE is an excellent option for treating sleep apnea, there are a variety of other treatment options available. For mild cases of sleep apnea, the doctor may suggest starting with lifestyle changes, such as weight loss or to refrain from smoking. Patients who have nasal allergies should first be treated for their allergies.
If these lifestyle changes do not improve your symptoms, or in the event your apnea is moderate to severe, there are other treatments available.
Continuous Positive Airway Pressure (CPAP)
Patients who have moderate to severe sleep apnea may benefit from using a machine which is designed to deliver air pressure through a mask while sleeping. With a CPAP, the air pressure is slightly greater than the surrounding air and keeps the upper airway passages open, ultimately preventing apnea and snoring.
While a CPAP is the most common and reliable method for treating sleep apnea, some people find it to be uncomfortable or cumbersome. Some people stop using the CPAP machine after a short trial. With practice, however, most people are able to adjust the straps on the mask to create a comfortable and secure fit.
It can be helpful to try various types of masks to find the most comfortable option. It is important not to stop using the CPAP machine if there are problems. Follow up with your doctor to determine what changes can help make the machine more comfortable.
You should follow up with your doctor if you are still snoring after use or start snoring again after treatment. If you experience any changes in your weight, you may need to adjust the pressure settings of the machine.
There are other airway pressure device options available. If using a CPAP machine is a continual issue for you, you may be able to use another type of airway pressure device which automatically adjusts the pressure while you are sleeping. This device is called an auto-CPAP. Another option is the BPAP. The BPAP is a unit that supplies bilevel positive airway pressure.
Another option is wearing an oral appliance which is designed to keep your throat open while you sleep. CPAP is a more reliable option compared to oral appliances, however, oral appliances can be easier to use. Some appliances are designed to open your throat by moving your jaw forward. In some cases, this can relieve snoring and mild obstructive sleep apnea.
A number of different devices are available through your dentist. Some patients need to try different options before they find one that works well. Once you find the right fit, you'll need to follow up with your dentist regularly to ensure that you have proper fit and to evaluate your signs and symptoms.
Surgery
Surgery is usually treated as a last resort after other treatments have not worked. There is generally a three-month trial of other treatment options is suggested prior to considering surgery. For a small number of patients with certain jaw structure issues, surgery is the best solution.
During the tissue removal procedure (uvulopalatopharyngoplasty), your doctor will remove tissue from the back of your mouth and at the top of your throat. Your tonsils and adenoids will likely be removed as well. This type of surgery can be successful in preventing the throat structures from vibrating and causing snoring. It is less effective than CPAP and is not considered a reliable solution for obstructive sleep apnea.
For patients who cannot tolerate CPAP or oral appliances, removing tissues in the back of your throat with radiofrequency energy (radiofrequency ablation) may be another option.
- Tissue shrinkage: Another option is to shrink the tissue located at the back of your mouth and throat using energy. This procedure is often used for mild to moderate cases of sleep apnea.
- Jaw repositioning: In this procedure, the jaw is moved forward from the remainder of your facial bones. This enlarges the space behind the tongue and soft palate, which minimizes any obstruction. This procedure is also referred to as maxillomandibular advancement.
- Nerve stimulation: This treatment requires surgery to insert a stimulator for the nerve which controls the tongue movement. The increased stimulation helps keep the tongue in a position which maintains an open airway.
- Creating a new air passageway (tracheostomy): This procedure is used in the event that other treatments have failed and you have severe or life-threatening sleep apnea. In this procedure, the surgeon makes an opening in your neck and inserts a tube to breathe through.
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