**Table 1.**

*Reported effects of rapid maxillary expansion.*

*<sup>\*</sup> Clinical experience (not published).*

*<sup>\*\*</sup>Caregivers' testimony.*

*<sup>\*\*\*</sup>All treatments improve esthetics.*

#### *Upper Airway Expansion in Disabled Children DOI: http://dx.doi.org/10.5772/intechopen.102830*

of the ligaments and muscles, including the vascular and nervous components of the organs in which it is integrated.

Some severe cases of respiratory disease may include the obligatory use of noninvasive ventilation during a high period of time and sometimes beginning in the first months of life. This required helpful device may have different consequences, depending on the time of use, the direction of the forces, type of appliance, place where the force takes effect, and hardness of the structure.

As we have seen, the absence of treatment for this situation can have serious consequences, and there are multiple treatment approaches. Among the different possibilities, the doctor must not forget the devices we are talking about, among many others with beneficial effects.

When we opt for any orthodontic techniques, we have to consider that the child may not be able to collaborate in the placement or use of the device, which is a limitation.

Furthermore, when expansion is achieved in children who are used to mouth ventilation, the collaboration of a myofunctional therapist may be imperative to teach and encourage nasal ventilation, meaning space is not enough. We have to train muscles to the desired function.

Usually, in children, we use tonsillectomy and adenoidectomy to free up some space so that the child breaths better. RME is an alternative treatment to AT because it reduces nasal resistance and makes air passage through the nose easier. Besides enhancing the quality of nasal breathing, RME benefits the growth of the maxillary dental arch and thus enhances the tongue position, allowing proper sealing of the lips [13, 37, 73–76].

Children submitted to RME revealed an augment in the total nasal volume from the initial symptoms to after treatment that persisted over time. Besides, RME substantially increases nasal volume, P < 0.05, compared to the control group; these outcomes are constant through the retention period [3].

OSA children with maxillary constriction had no clinical complaint after treatment with RME. Also, clinical evaluations (orthodontic and otolaryngological) remain normal at the 12-year follow-up period. There was a substantial reduction of the AHI and its duration and a significant increase of SpO2 [31, 59]. Children with OSA, with dental malocclusion and treated with RME, improved AHI significantly, respiratory symptoms and nasal resistance diminished, and nasal breathing returned in almost 80% of the children [59].

It remains crucial to understand if RME alone is sufficient for treating mild OSA if significant adenotonsillar hypertrophy is present or if surgery is necessary. When combined with the two techniques, it will not be relevant which treatment is started first as both will be necessary. Still, in some circumstances, there will be the possibility that one treatment performed first solves the problem [74].

The long-term evolution of RME treatment suggests that a reappearance of elderly symptoms is possible, so follow-up is recommended to avoid recurrence [75].

Remember that relapse is always possible and a retention period, sometimes forever (fixed contention), is necessary.

Beckwith-Wiedemann, Marfan's, Crouzon, or Down Syndrome are characterized by a specific phenotype and OSA prevalence [9–11, 40, 76–80].

Applying these techniques always requires a prior individualized study, holistically considering the patient, evaluating their ability to collaborate and the child's different family, social, cognitive, and developmental aspects. And some pathologies do not get better with ERM, like Solitary Median Maxillary Central Incisor Syndrome [81] that does not benefit from RME despite the typical nasal and maxilla anomalies.

The different conditions may present with their specifications or integrate with other pathologies, making it difficult to differentiate the treated problem. So, we need to get better definitions of each condition, which may appear as technology gets better.

If we want an increase in the oronasal and pharyngeal space, we depend on the children's occlusion before and after treatment.

The generality of studies are about mechanical effects of fixed appliances and do not aim at general health, not approaching themes such as cardiovascular risk, neurocognitive impairment or quality of life and the consequences to child's development.

The importance of the intervention of the pediatric dentist and the techniques used are poorly known among physicians and pediatricians, so its dissemination to family doctors and other specialties is essential, and hospital teams that include the different professionals should be rapidly implemented.
