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Maxillary Skeletal Expanders


A Maxillary Skeletal Expander (also known as MSE), is a class of devices that use at least 4 screws also known as Temporary Anchorage Devices / TADs to attach to the upper palate. While it’s not considered a “surgery,” the screws generally need to be inserted by a surgeon under anesthesia. It works by separating the mid-facial bones that were previously two separate bones, but fused together at the mid-palatal suture. The MSE is a newer version of  Miniscrew-Assisted Rapid Palatal Expansion (MARPE), which is a type of Rapid Palatal Expansion (RPE).

Rapid palatal expansion historically used teeth-based forces and only worked in teens. Trying to do tooth-borne-only appliances in adults would likely only damage teeth. An MSE generally uses only bone-based forces and can work in adults. There are MSE variants such as MANE which uses both screws and teeth attachments to exert forces. The last one is what I had done and my experience has been fairly positive.

Generally, an MSE can have issues, such as insufficient grip of the bone with the screw and the suture being too strong to split. In this case it’s very possible to either get “screw drag” where the screws cut through the soft tissue with no expansion or a partial expansion either on only front or back or skewed to one side. Some undesirable teeth “tipping” can occur as well, where the angle of the teeth changes from being straight down due to pressure. In case one’s issue is only a partial expansion, a second MSE or one with more than 4 screws might finish the expansion.

However, if successful, and MSE and similar devices can improve the airway and create a great improvement in sleep apnea outcomes.

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