Distraction Osteogenesis Maxillary Expansion Surgery (DOME)

Understanding the Anatomy

The upper jawbone is composed of two bones (maxillae) that are fused at the center. Together, they form the hard palate (roof of the mouth), the nasal floor and a portion of the eye socket.

In infants and children, the upper jaw bones and the area where they join are soft and pliable. During childhood and early adolescence, maxillary expansion can often be achieved non-surgically by using orthodontic appliances to gradually expand the upper palate. This type of treatment may be used in children with a high, narrow palate to correct a cross-bite, improve nasal breathing, or make more room for the tongue and teeth.

By adulthood, however, the maxillae are hardened and nonsurgical expansion is not as successful. Before the DOME procedure was perfected, there were limited surgical treatment options for adults with obstructive sleep apnea caused by a high, narrow upper palate.

Who Is a Candidate for DOME?

The DOME procedure may be a surgical treatment option for obstructive sleep apnea in adults with:

• Narrow and highly arched upper palate
• Little or no tolerance for CPAP treatment or traditional oral appliances
• Narrow nasal floor

Preparing for Maxillary Expansion Surgery

Before scheduling this procedure, you will be evaluated by both an oral surgeon and an orthodontist. Multiple imaging studies may be ordered to fully understand the anatomy of your jaw, nasal floor and upper palate.

Your surgeon will advise any medications that should be stopped prior to surgery. As with all major surgeries, you should fast for at least 12 hours before your procedure. For your safety, all of your doctor’s pre-surgery instructions must be followed exactly.

How the Procedures Are Performed

Maxillary expansion in adults is a multi-step process that can take a year or more to complete.

Step One: Placement of Orthodontic Expander Device
A customized maxillary expander device and 4-6 mini-implants are installed in the roof of the mouth. This step can be performed at an orthodontist’s office under local anesthesia or before the maxillary osteotomy under general anesthesia.

Step Two: Maxillary Osteotomy
This is a minimally invasive surgery performed in a hospital or outpatient surgery center. The surgeon makes an incision between the two halves of the upper palate to create a tiny gap that will allow for the desired expansion. The surgery itself usually takes less than 60 minutes and patients are usually discharged within the same day.

Patients are advised to avoid strenuous physical activity for 3-4 weeks after discharge. A soft diet is recommended for the first week, after which a normal diet can be resumed with the doctor’s approval.

Step Three: Gradual Expansion
This phase of treatment is performed by the patient at home. Starting approximately five days after surgery, the patient will use a key to turn the expander every day for about a month. This is usually enough time to achieve the optimal expansion of 8-10 mm. This step may create a small gap between the front teeth which will be corrected in step four.

Step Four: Braces or Invisalign
In the final phase, braces or Invisalign are fitted by an orthodontist to restore normal tooth spacing, alignment and bite. Braces are typically left in place for a year to achieve optimal results.

Possible Risks & Side Effects of DOME

The DOME procedure is overall safe and effective procedure. Risks and side effects may include:

• A slight tingling sensation in the roof of the mouth. This is caused by stretching the nerves in the upper palate and typically goes away as the incision heals and new tissue grows.
• Minimal bleeding.
• Temporary darkening of the front teeth.
• Tooth loss (rare).