---
title: "Orthodontics, Palate Expansion and the Sinuses UK | Guide (2026)"
url: https://virtualconsultant.online/guides/orthodontics-palate-expansion-sinuses-uk
description: "How palate expansion affects nasal breathing: the anatomy linking upper jaw and nasal cavity, when it lowers resistance, and who benefits."
updated: 2026-08-17T00:00:00Z
publisher: Virtual Consultant Online
---

Palate Expansion

Nasal Breathing

Sinuses

RME

# Orthodontics, Palate Expansion and the Sinuses: A UK Guide

The upper jaw (maxilla) and the nasal cavity share the same bony floor, which means that the width of the palate directly influences the width of the nasal passage. Patients with a narrow palate often have a constricted nasal cavity, increased airflow resistance, and a tendency towards mouth breathing. Rapid maxillary expansion (RME) — an orthodontic procedure to widen the upper jaw — can improve nasal breathing as a secondary benefit. This guide explains the anatomy, the evidence, what expansion can and cannot achieve for airway function, and how orthodontists and ENT surgeons collaborate in complex cases.

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## The anatomy linking the palate and the nasal cavity

The hard palate — the bony roof of the mouth — is also the floor of the nasal cavity. The two structures are separated by a thin layer of bone but are anatomically continuous. The maxillary sinuses, large air-filled spaces in the cheekbones on either side of the nose, also open into the nasal cavity via small drainage passages. When the upper jaw is narrow, the nasal floor is correspondingly narrow, reducing the cross-sectional area through which air must pass during nasal breathing. The midpalatal suture runs down the centre of the palate, separating the two halves of the maxilla. During childhood and adolescence this suture is cartilaginous and can be separated by orthodontic force — the principle behind rapid maxillary expansion. When it is separated, both halves of the maxilla move apart, widening not only the dental arch but also the nasal floor, with direct implications for nasal airway dimensions.

## How a narrow palate contributes to nasal obstruction

Nasal resistance — the force required to move air through the nasal passage — is exquisitely sensitive to small changes in airway dimensions. Resistance is proportional to the fourth power of the radius: halving the radius of a tube increases resistance sixteen-fold. A palate that is even a few millimetres narrower than average therefore significantly increases the work of breathing through the nose. In patients with a narrow palate and a high vaulted arch, the nasal turbinates — the scroll-shaped bones that project into the nasal cavity — often compensate for the narrower space by becoming enlarged (hypertrophied), further reducing airway area. The result is chronic nasal congestion that is structural rather than inflammatory in origin. These patients frequently become habitual mouth breathers, particularly during sleep. They may report that nasal decongestants provide only partial or temporary relief, because the obstruction has an anatomical basis that medication cannot address.

## What rapid maxillary expansion does to nasal dimensions

Rapid maxillary expansion (RME) widens the nasal floor by separating the midpalatal suture. Multiple studies using acoustic rhinometry, rhinomanometry (pressure-flow measurements), and CT imaging have confirmed that RME produces a measurable increase in nasal airway dimensions. Research consistently shows reductions in nasal airflow resistance of approximately 20 to 30 per cent following expansion. The increase is greatest in the posterior nasal cavity, where the floor widens most. Volume increases in the nasal cavity are also documented on CT. These anatomical changes are retained after the expander is removed and the suture ossifies — the expanded nasal dimensions are permanent, unlike the temporary effects of nasal decongestants or steroid sprays. It is important to note that expansion does not directly widen the sinuses themselves, but by improving nasal drainage pathways, it may reduce the frequency of sinus congestion and sinusitis in susceptible patients.

## Evidence on mouth breathing after palate expansion

Several prospective studies have examined whether palate expansion reduces mouth breathing in children with documented nasal obstruction. The evidence is consistently positive but requires careful interpretation. Studies using rhinomanometry show that nasal resistance falls significantly after expansion in children with narrow palates and concurrent nasal obstruction, and that nasal breathing volumes increase correspondingly. Polysomnography studies — overnight sleep studies — show reductions in the apnoea-hypopnoea index in children with sleep-disordered breathing who undergo expansion. A 2022 systematic review in the European Journal of Orthodontics confirmed that RME is associated with improvements in nasal breathing, reduced mouth breathing frequency, and improved sleep quality in paediatric populations. However, not all mouth breathing is structural. Many children mouth-breathe out of habit even after nasal obstruction is resolved, and breathing retraining or myofunctional therapy may be needed alongside expansion to achieve lasting change.

## ENT and orthodontic collaboration in complex airway cases

Children with significant nasal obstruction benefit from assessment by both an orthodontist and an ear, nose and throat (ENT) surgeon before treatment is planned. In UK hospitals this often happens through a combined craniofacial or sleep clinic where both specialties contribute to a shared treatment plan. The ENT assessment typically includes nasal endoscopy, acoustic rhinometry, and review of adenoid and tonsil size — both adenoidal hypertrophy and tonsillar enlargement can co-exist with a narrow palate and compound the nasal obstruction. In some cases, adenotonsillectomy is recommended before or alongside orthodontic expansion to maximise the airway improvement. The orthodontist contributes information about the dental and skeletal anatomy, the appropriateness of expansion, and the planned treatment sequence. Effective collaboration avoids the situation where surgical removal of adenoids alone fails to resolve obstruction because the structural narrowness is not addressed, or where expansion proceeds without recognising that the primary obstruction is adenoidal.

## Palate expansion in children versus adults (SARPE)

Rapid maxillary expansion works most reliably in children and younger adolescents because the midpalatal suture has not yet ossified. In girls, the suture typically begins to fuse from around age 14 to 16; in boys from 16 to 18, though there is significant individual variation. Before fusion, orthodontic forces alone can separate the suture using a removable or fixed expander appliance. The optimum age for RME for airway benefit is 8 to 14 years — early enough to achieve reliable separation but after the permanent teeth have erupted sufficiently to anchor the appliance. In adults whose suture has fully ossified, conventional expansion with an expander appliance produces tooth tipping rather than true skeletal expansion, and the airway benefit is negligible. Adults who require skeletal expansion for functional reasons undergo surgically assisted rapid palatal expansion (SARPE) — a procedure performed under general anaesthetic by a maxillofacial surgeon who surgically releases the fused suture before the orthodontic expander is activated. SARPE is available on the NHS in adults where there is clear clinical indication, usually involving a significant crossbite as well as airway considerations.

## Does palate expansion help snoring or sleep apnoea?

Palate expansion is not a primary treatment for obstructive sleep apnoea (OSA) or snoring in adults, and it should not be presented as such. However, in children with OSA associated with adenotonsillar hypertrophy and a narrow palate, expansion is an important part of a combined treatment approach. Paediatric OSA guidelines — including those from the British Thoracic Society — recognise expansion as an adjunctive intervention when skeletal narrowing is a contributing factor. In adults, the evidence for expansion as a standalone treatment for OSA is limited to small case series and the effects are modest compared to CPAP therapy or mandibular advancement devices. Some adults with mild positional snoring and a confirmed narrow arch may notice improvement after SARPE, but this is a secondary benefit rather than a primary treatment goal. Patients with OSA should have a formal sleep medicine assessment and should not rely on orthodontic treatment alone.

## Which patients benefit most from expansion for nasal breathing?

The patients most likely to benefit from palate expansion for nasal breathing are those who have all three of the following: a confirmed narrow maxillary arch (usually with a posterior crossbite), objective evidence of nasal obstruction (raised nasal resistance on rhinomanometry or reduced nasal volume on acoustic rhinometry), and an age within the window for effective skeletal expansion (typically under 16 for girls, under 18 for boys). Patients who mouth-breathe habitually without confirmed structural narrowing are unlikely to achieve significant benefit from expansion alone. Similarly, patients whose nasal obstruction is primarily due to allergic rhinitis, polyps, or adenoidal hypertrophy will not achieve adequate relief from expansion unless the primary cause is also addressed. A thorough assessment by both an orthodontist and an ENT surgeon is essential before attributing nasal symptoms to a narrow palate and committing to expansion treatment.

## What patients feel during and after palate expansion

Most patients undergoing palate expansion report a pressure sensation across the roof of the mouth after each turn of the expansion screw, extending into the nose, cheeks, and sometimes the area between the eyes. This pressure is a direct result of the suture being distracted and is reassuring evidence that expansion is occurring. It typically lasts two to four hours after each turn and is managed with ibuprofen or paracetamol. A gap opening between the upper front teeth — a midline diastema — appears during active expansion as the two halves of the maxilla separate; this closes naturally once turning stops. Some patients notice an improvement in nasal breathing quite quickly — within the first few weeks of expansion — as the nasal floor widens. Others experience initial congestion as the turbinates adapt. Discharge, minor bleeding from the nose, and a sensation of stuffiness are common in the first week or two and resolve spontaneously.

## Useful related pages

[Palatal Expander UK](https://virtualconsultant.online/guides/palatal-expander-uk)

[Mouth Breathing and Orthodontics UK](https://virtualconsultant.online/guides/mouth-breathing-orthodontics-uk)

[Children's Orthodontics UK](https://virtualconsultant.online/guides/childrens-orthodontics-uk)

[Functional Appliances UK](https://virtualconsultant.online/guides/functional-appliances-uk)

[Malocclusion UK](https://virtualconsultant.online/guides/malocclusion-uk)

This guide is for general information only. It is not a diagnosis, treatment plan, or substitute for advice from a registered dentist or orthodontist.

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### Frequently Asked Questions

Can palate expansion improve nasal breathing?

Yes — in patients with a confirmed narrow upper arch and objective nasal obstruction, palate expansion can reduce nasal resistance by 20 to 30 per cent by widening the nasal floor. The improvement is greatest in children treated before the midpalatal suture fuses, typically before age 14 to 16. An assessment by an orthodontist and ENT surgeon is recommended to confirm that a narrow palate is contributing to the nasal obstruction.

At what age should palate expansion be done for airway benefit?

The optimal age is 8 to 14 years — after the first permanent molars have erupted to anchor the appliance, and while the midpalatal suture is still open and can be separated without surgery. Treatment in this window achieves true skeletal expansion and lasting improvement in nasal dimensions. Expansion in adults requires surgical assistance (SARPE).

Does expanding the palate affect the sinuses directly?

Palate expansion widens the nasal floor and may improve the drainage pathways from the maxillary sinuses into the nasal cavity, which can reduce the frequency of sinusitis in some patients. However, it does not directly enlarge the sinuses themselves. Patients with chronic sinusitis due to polyps, allergy, or anatomical sinus pathology will need ENT assessment and may require separate treatment.

Can palate expansion cure sleep apnoea in children?

In children with obstructive sleep apnoea associated with both adenotonsillar hypertrophy and a narrow palate, expansion is part of a combined treatment approach that also typically includes adenotonsillectomy. Studies show significant reductions in the apnoea-hypopnoea index after this combined approach. In adults, expansion alone has modest effects on OSA and is not a substitute for CPAP therapy or specialist sleep medicine review.

How long do the nasal breathing improvements last?

The improvements are permanent. Once the midpalatal suture has ossified after the retention phase, the expanded nasal dimensions are stable. Long-term follow-up studies confirm that the increase in nasal airway volume and reduction in nasal resistance persist into adulthood. A small amount of dental relapse is possible if retention is not maintained, but the skeletal nasal floor change is not reversible.

Can upper back teeth be moved into the sinus?

Not into it in the way the phrase suggests. The floor of the maxillary sinus often dips between the roots of the upper molars, and orthodontic movement can carry a root against or apparently through that thin cortical plate on a radiograph. What actually happens is that the sinus lining is displaced ahead of the tooth rather than perforated, and movement typically slows because the cortical bone resists it. It is a recognised reason why moving upper molars backwards or bodily across the arch is slower and less predictable than the same movement lower down.

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Citation details

Title Orthodontics, Palate Expansion and the Sinuses UK | Guide (2026)

Publisher Virtual Consultant Online

Published 2024-06-01

Updated 2026-08-17

URL [https://staging.virtualconsultant.online/guides/orthodontics-palate-expansion-sinuses-uk](https://staging.virtualconsultant.online/guides/orthodontics-palate-expansion-sinuses-uk)