Remember palatal expanders or splitters? For those of you who didn’t have the warm and fuzzy experience of an expander, allow me to paint a picture. Imagine lying on your couch at home while your mom or dad hovered over your open mouth with a “key” that was inserted into a crank cemented to your upper teeth. Every day for several weeks you would have your crank turned with this key.
Often, during this experience, you would have the distinct pleasure of hearing an audible pop, which was the sound of your palate splitting down the middle. It didn’t stop at your palate, though; the bone-splitting actually went all the way up to your nasal bones and the bones of your face, separating them from each other. Don’t get me wrong: nothing dangerous was happening. In fact, you were doing what the orthodontist wanted: you were splitting your upper jaw in half in an attempt to either get you out of a corset, gain room for crowded teeth, or both. Now, if this were the only way to accomplish these goals, then I would have to say “OK, let’s do it.” It’s not, however, and I haven’t used an expander to gain space for teeth since I was in my orthodontic graduate residency program.
That being said, I do think that there is a place for rapid palatal expanders, and that is in young patients who have been diagnosed with airway obstruction. In these children, palatal expansion really can provide quick relief to breathing difficulties, especially if combined with the removal of large adenoids. We have good evidence to demonstrate that palatal expansion increases the volume of the nasal airway and consequently decreases the resistance to air flow.