title: Orthodontic widening of the palate may provide a cure for selected children with therapy-resistant enuresis.
abstract: OBJECTIVE
  According to a number of small case series, orthodontic treatment may have anti-enuretic effects. Thus, we evaluated whether widening of the palate can alleviate enuresis and whether prognostic information can be gained from examining children's nocturnal respiration and nasal airway dimensions.
  
  
  METHODS
  Children with therapy-resistant enuresis underwent polysomnography, focusing on nocturnal respiration, and had their nasal airways examined. Rapid maxillary expansion was performed, widening the maxilla by approximately 0.5 cm. The dental appliance was removed after 6 months. Enuresis frequency was evaluated four times: at baseline, with the orthodontic apparatus in situ, after completed maxillary expansion and 1 year post-treatment.
  
  
  RESULTS
  Of the 34 children recruited, one dropped out due to oral discomfort. The numbers of wet nights per week on the four assessment occasions were 5.48 ± 1.48, 5.12 ± 1.73, 3.09 ± 2.49 and 2.63 ± 2.81; p < 0.001. The proportions of responders, intermediate responders and non-responders during treatment were 21.2%, 27.3% and 51.5%, respectively. Responders were found to have a lower enuresis frequency at baseline (p = 0.001) and to have larger nasal airway dimensions (p = 0.01).
  
  
  CONCLUSIONS
  Orthodontic widening of the palate may be curative in a subgroup of children with therapy-resistant enuresis.
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: Tryggve
authors.initials: T
authors.lastname: Nevéus
authors.affiliation: University Hospital Örebro, Örebro, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Leissner
authors.affiliation: University Hospital Örebro, Örebro, Sweden.
authors.forename: Stig
authors.initials: S
authors.lastname: Rudblad
authors.affiliation: Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
authors.forename: Farhan
authors.initials: F
authors.lastname: Bazargani
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D053206:Nocturnal Enuresis / Q000628:therapy*; D010155:Palatal Expansion Technique; D011379:Prognosis; D011446:Prospective Studies; D012119:Respiration; D014554:Urination
keywords: Enuresis; Polysomnography; Rapid maxillary expansion; Respiration; Rhinometry