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Transpalatal Distraction (TPD)

Many children with obstructive sleep apnea have small and narrow jaws. Transpalatal distraction (TPD) is performed to enlarge the nasal and retropalatal airways while creating more intraoral space to improve breathing and sleep apnea.

The upper jaw is widened by inserting a distractor on the palate. The procedure is usually performed under sedation in the office and is completed in approximately 30 minutes. Children can typically return to school in 1-2 days with no dietary or activity restrictions. Over-the-counter pain medication can be used for 1-2 days if necessary.

The jaw widening process is painless and typically takes a few weeks to complete. The distractor is in place for about 3 months and then removed in the office under local anesthesia.

Some of the advantages of using TPD rather than placing an expander directly onto the teeth, or appliances that are attached to the palate with screws, include the following:

  1. TPD results in a much smaller gap between the front teeth (usually 2-3 mm) that can then be eliminated by orthodontics very quickly.
  2. TPD achieves much greater airway expansion compared to that by dental expanders because the expansion by TPD is entirely skeletal and does not involve shifting teeth.
  3. TPD achieves opening of the entire nasal airway, especially the back of the nose and palate, and thus results in greater improvement in breathing and OSA. This is the only method that consistently opens up the entire nasal airway.

  4. TPD before and after

 

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References:

Guilleminault C, Li KK.  Maxillomandibular Expansion by Distraction Osteogenesis for the Treatment of Sleep-Disordered Breathing: Preliminary Results.  Laryngoscope; 114:893-896, 2004.

Li KK.  Surgical Therapy for Obstructive Sleep Apnea Syndrome.  Seminars in Respiratory and Critical Care Medicine; 26:80-88, 2005.

 

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