Non-Surgical Expansion With Midfacial Skeletal Expander (MSE) For Upper Airway Obstructive Patients Won Moon. Episode 47. IOC 2020

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Farooq Ahmed

Won talks through the use of Midfacial Skeletal Expander (RME and TADs)

Midfacial Skeletal Expander (MSE) Vs other  Miniscrew Assisted Rapid Palatal Expansion (MARPE)

  • MSE designed to be posterior engage with the Zygomatic buttress, Pterygopalatine suture
  • = parallel transverse expansion Vs pyramid expansion with MARPE (greater anterior, less posterior) Colak 2020
  • Parallel vertical expansion Vs pyramid expansion with MARPE, due to force vector posterior and TADs vertical
  • Pterygopalatine suture shows separation with MSE in 84% – Colak 2020 Cantarella 2017


MSE and airway changes

  • Radius changes to nasopharynx = 4 x increase in airflow
  • Pre MSE 125 Vs 175 post – statistically significant Zhang
  • Reduction in air turbulence 28-48 PA improvement– Fraser
  • OSA: significant reduction in AHI Brunetto





Treatment Guideline For Adult Obstructive Sleep Apnea Patients In Perspective Of Sleep Function And Facial Aesthetics  Seung Hak Baek



Classification of phenotype in adults An 2020

  1. Obesity type
    1. 50%
    2. Moderate OSA, Obese – BMI 25+, no skeletal discrepancy, no soft tissue abnormality
    3. Treatment: Weight loss, sleep hygiene
  2. Skeletal type
    1. 33%
    2. Moderate OSA, severe skeletal 2, high angle, narrow pharyngeal space
    3. Treatment: Craniofacial modification, MAS or surgery
  3. Complex
    1. 16%
    2. Severe OSA, combining features of 1 and 2
    3. Treatment: Craniofacial modification, MAS or surgery


Cause of OSA

  1. Anatomical factors
  2. Poor response of upper airway muscles
  3. Low arousal threshold to airway
  4. Unstable ventilation control

Respiratory physician for 2-4


Mandibular advancement splint

  • Enlarge upper airway
  • Prevent from collapse
  • Can produce occlusal changes
  • TMJ should be healthy
  • Patient non-compliance: year 1 25%, year 5 63% Soose 2017



  • CPAP more effective at reducing AHI scores Cammaroto 2017

Orthognathic surgery

  • Posterior impaction alone does not trigger OSA
  • Posterior impaction and maxillary set back can trigger OSA
  • Maxillary-mandibular counter clockwise rotation increased airway space


RME and SARPE Systematic RV Adbulatif 2016

  • RME: Improvement of 60% AHI
  • SARPE: improvement of 77%
  • MARPE (miniscrew assisted expansion) can be used for nasopharyngeal obstruction


Seung proposed a segmental MMA for protrusive maxillary cases

  • Extraction of 4s at the time of surgery
  • Advancement of posterior segment
  • Maintain anterior segment in AP position
  • BSSO advancement


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