Orthodontic Treatment as an Adjunct to Airway Management

The relationship between the dental and facial skeleton and the upper airway is well established. Narrow palates, retrognathic jaws, and certain skeletal patterns can contribute significantly to nasal obstruction, mouth breathing, and obstructive sleep apnoea (OSA). Orthodontic treatment — whether through palatal expansion, jaw advancement, or surgical orthodontic procedures — can play a meaningful role in addressing the skeletal components of upper airway dysfunction.

This practice works closely with ENT (ear, nose, and throat) consultants, sleep physicians, respiratory physicians, and oral and maxillofacial surgeons to provide coordinated, evidence-based care for patients whose breathing and sleep are affected by skeletal or dental factors.

The Orthodontist’s Role in Airway Management

Orthodontists are not primary airway physicians. However, there are specific skeletal and dental abnormalities — a narrow upper jaw, a deficient lower jaw, or a significant vertical skeletal pattern — where orthodontic or orthodontic-surgical intervention can directly improve upper airway dimensions and function.

Orthodontic involvement in airway management is adjunctive: it works alongside, and in coordination with, the assessments and recommendations of the patient’s sleep physician, ENT consultant, and surgical team. The aim is always to address the skeletal contribution to the airway problem as part of a broader, multidisciplinary management plan.

Conditions Where Orthodontics May Play a Role

Obstructive Sleep Apnoea (OSA)

OSA occurs when the upper airway collapses repeatedly during sleep, causing interrupted breathing, fragmented sleep, oxygen desaturation, and a range of cardiovascular and metabolic consequences. In patients where the airway anatomy is unfavourable due to skeletal factors, orthodontic and surgical interventions can produce meaningful and lasting airway improvements.

Relevant orthodontic interventions include:

• Palatal expansion (MARPE, BASME, DOME) — widening a narrow upper jaw increases nasal airway volume and reduces nasal resistance. There is growing published evidence supporting palatal expansion — particularly MARPE — as an effective adjunct in the management of OSA in adults, particularly in patients with documented nasal obstruction and a transversely deficient maxilla.
• Orthognathic surgery (mandibular and bimaxillary advancement) — maxillomandibular advancement (MMA) is one of the most effective surgical interventions for OSA, with high success rates across multiple studies. By advancing both the upper and lower jaws, MMA increases the retrolingual and retropalatal airway dimensions, reducing the tendency for the airway to collapse during sleep.
• Surgical facilitation for maxillary expansion — where nasal obstruction is a primary driver of mouth breathing and disturbed sleep, surgically facilitated palatal expansion in combination with the appropriate airway team can address the structural component of nasal resistance.

Nasal Obstruction and Mouth Breathing

Chronic nasal obstruction — whether from nasal septal deviation, turbinate hypertrophy, or a structurally narrow nasal passage — can drive habitual mouth breathing. In the context of orthodontic assessment, these patterns affect the dental and skeletal development of growing patients, and in adults, they may perpetuate or worsen existing malocclusions and skeletal patterns.

Where palatal expansion is planned as part of orthodontic treatment, any ENT pathology contributing to nasal obstruction is ideally assessed and, where appropriate, addressed concurrently. This practice works with ENT colleagues to ensure that the nasal airway is optimised alongside any skeletal expansion — maximising the functional benefit of treatment.

Sleep-Disordered Breathing in Patients Referred from Sleep Medicine

Some patients are referred directly from sleep physicians or respiratory physicians for an orthodontic assessment as part of the workup for sleep-disordered breathing. This may be because:

• CPAP is poorly tolerated and skeletal alternatives are being explored
• Imaging or clinical findings suggest a significant skeletal contribution to the airway problem
• The patient is a candidate for maxillomandibular advancement and requires orthodontic preparation
• A mandibular advancement device has been considered and an orthodontic opinion on dental suitability is needed

In these cases, a detailed skeletal and dental assessment is provided, imaging findings are reviewed, and a report and recommendation are sent back to the referring clinician with proposed next steps.

Working with Referring Clinicians

Patients referred from ENT consultants, sleep physicians, or surgeons are assessed with the same thoroughness as self-referred patients, but with particular attention to the aspects of the case relevant to the referring clinician’s questions.

Following assessment, a detailed letter is provided to the referring clinician including:

• Relevant clinical and radiographic findings
• The orthodontic diagnosis and its relationship to the reported airway concerns
• Options for orthodontic or combined orthodontic-surgical management
• Proposed sequencing and timeline
• Any additional specialist input required

Ongoing communication is maintained throughout treatment, with progress updates shared with the wider team at clinically relevant stages.

Myofunctional Therapy as Part of Airway-Focused Care

In selected patients, abnormal tongue posture or oral habits — such as a habitually low resting tongue position or a tongue thrust pattern — are identified during the orthodontic assessment. These patterns are often linked to mouth breathing and can contribute to the skeletal and dental features associated with upper airway dysfunction. They can also undermine the stability of orthodontic or expansion treatment if left unaddressed.

Where these habits are present, myofunctional therapy — which involves the retraining of the tongue, lip, and facial muscles to adopt a more functional resting position and movement pattern — can be an important component of the overall management plan. It works in conjunction with orthodontic treatment rather than as a standalone intervention, helping to reinforce the changes achieved and reduce the risk of relapse.

While myofunctional therapy is not offered at Lusk Orthodontics directly, we collaborate with experienced myofunctional therapists in Ireland and the UK, and coordinate referral and communication as part of the patient’s broader care plan where this is indicated.

Book an Airway-Focused Orthodontic Assessment

If you have been referred by a specialist or if you are concerned that your dental or jaw structure may be contributing to breathing or sleep problems, book a specialist orthodontic assessment.