Rapid maxillary expansion in therapy-resistant enuretic children: An orthodontic perspective.
OBJECTIVE
To evaluate whether rapid maxillary expansion (RME) could reduce the frequency of nocturnal enuresis (NE) in children and whether a placebo effect could be ruled out.


METHODS
Thirty-four subjects, 29 boys and five girls with mean age of 10.7 ± 1.8 years suffering from primary NE, were recruited. All subjects were nonresponders to the first-line antienuretic treatment and therefore were classified as "therapy resistant." To rule out a placebo effect of the RME appliance, all children were first treated with a passive appliance for 4 weeks. Rhinomanometry (RM), acoustic rhinometry (AR), polysomnographic registration, and study casts were made at different time points.


RESULTS
One child experienced severe discomfort from the RME appliance and immediately withdrew from the study. Following RME, the long-term cure rate after 1 year was 60%. The RM and AR measurements at baseline and directly after RME showed a significant increase in nasal volume and nasal airflow, and there was a statistically significant correlation between reduction in enuresis and increase in nasal volume. Six months postretention, a 100% relapse of the dental overexpansion could be noted.


CONCLUSIONS
RME has a curative effect in some children with NE, which could be connected to the positive influence of RME on the sleep architecture. Normal transverse occlusion does not seem to be a contraindication for moderate maxillary expansion in attempts to cure NE in children.
a  Senior Consultant, Postgraduate Dental Education Center, Department of Orthodontics, Örebro, Sweden.
Farhan
F
Bazargani
b  Senior Consultant, Public Dental Service, Uppsala County Council, Department of Orthodontics, Uppsala, Sweden.
Ingrid
I
Jönson-Ring
c  Associate Professor, Senior Consultant in Paediatric Nephrology, Department of Women's and Children's Health, Uppsala University, Uppsala University Children's Hospital, Uppsala, Sweden.
Tryggve
T
Nevéus
D002508:Cephalometry; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008437:Maxilla; D009296:Nasal Cavity; D053206:Nocturnal Enuresis; D009666:Nose; D009967:Orthodontic Appliances; D010155:Palatal Expansion Technique; D025363:Rhinomanometry
Nocturnal enuresis; Rapid maxillary expansion