A palate expander, often called a Rapid Palatal Expander (RPE), is an orthodontic appliance primarily used in growing children and adolescents. This device widens the upper jaw (maxilla) to correct discrepancies in the alignment and width of the dental arches. Since the treatment modifies underlying bone structure, patients and parents often ask about potential changes to overall facial appearance. The possibility of the nose changing is a common concern due to the upper jaw’s proximity to other facial features.
Understanding the Functional Goals of Palatal Expansion
The primary purpose of the RPE is to address functional and skeletal issues within the mouth and jaw structure. A major indication is correcting a posterior crossbite, where the upper back teeth bite inside the lower back teeth, causing uneven wear and jaw misalignment. Widening the maxilla establishes a harmonious relationship between the upper and lower dental arches.
Creating space for crowded permanent teeth is another goal of the treatment. When the upper jaw is too narrow, teeth may become twisted, overlapped, or impacted, often necessitating extractions. Palatal expansion provides the necessary arch width for permanent teeth to erupt naturally into their correct positions.
The expansion can also address certain functional breathing issues. A narrow upper jaw often restricts the nasal airway, which can lead to habitual mouth breathing. The mechanical widening of the palate helps open the airway, guiding the patient toward improved nasal breathing.
The Interconnected Anatomy of the Maxilla and Nasal Cavity
To understand the expander’s effects, one must examine the anatomical relationship between the upper jaw and the nasal structures. The maxilla is a large, paired bone that forms the roof of the mouth and the floor of the nasal cavity. The two halves of the maxilla are connected down the midline by the midpalatal suture, a fibrous joint.
The RPE applies gentle, continuous pressure to the teeth and palate, physically separating the two halves of the maxilla at the midpalatal suture. Since the palatal bone is integrated with the nasal floor, widening the maxilla increases the transverse dimension of the nasal cavity. This widening is a direct skeletal consequence of successful palatal expansion.
This structural change is most pronounced in the lower third of the nasal cavity, near the floor, increasing the overall airway space. Separation of the midpalatal suture is most effective in growing patients, as the suture fuses and becomes rigid in later adolescence and adulthood. This orthopedic effect is why the procedure is recommended during childhood.
Palatal Expansion and Nasal Appearance: The Aesthetic Outcome
While the internal skeletal change widens the base of the nasal cavity, the visible, external appearance of the nose is minimally affected. The soft tissues, including the skin and cartilage of the external nose, are highly adaptive and generally mask the subtle underlying bone movement. Any external change that occurs is usually a very slight broadening at the base of the nose.
The degree of change depends on factors like the patient’s age and the thickness of their soft tissues. In younger patients, whose tissues are more flexible, external changes are usually negligible and often go unnoticed. The primary effect is an increase in internal nasal volume, which is a functional result.
The widening focuses on the nasal base, while the nasal tip and bridge are structurally more distant and less influenced by expansion forces. Therefore, the fear of the nose becoming dramatically wider or distorted is unfounded with standard RPE procedures. Improved nasal breathing capacity is often considered a positive outcome.
Other Key Structural Changes Resulting from Maxillary Expansion
Successful maxillary expansion brings about other subtle structural changes to the midface besides the nasal cavity effects. Widening the maxilla can lead to a slight broadening of the overall midfacial region. This change is considered favorable, often resulting in a more balanced and proportionate facial structure.
Some patients treated during a growth spurt may observe a subtle enhancement of cheekbone prominence. As the upper jaw expands, the supporting bone structure in the zygomatic area may become slightly more defined. This enhancement is a secondary benefit of correcting the underlying skeletal deficiency.
The treatment also alters the appearance of the smile itself. Creating a wider dental arch allows more teeth to be visible when smiling, filling the space toward the corners of the mouth. This results in a broader, more aesthetically pleasing smile that harmonizes better with the rest of the face.