What is Palate Expansion?

What is Palate Expansion?

For children with cleft palate, their teeth often sit in the wrong place in their mouth. Sometimes an orthodontist can slowly move a child’s teeth into a more correct position. But if your child’s bone is in the wrong position, moving your child’s teeth will not help. Palate expansion is a treatment doctors use to slowly expand your child's jaw and palate.

Alveolar Ridges & Palate Expansion Devices


Children who have cleft lip and palate have differences in the way their alveolar ridges line up. Alveolar ridges are the arches that hold your child's teeth.

If these ridges are too narrow, or if the roof of your child’s mouth is too narrow, your child may need something called a palatal expansion device. Your child won't need surgery for this type of treatment. Instead, your child's orthodontist will place this device inside your child's mouth and use it to slowly open up your child's collapsed upper jaw line.

SARPE Surgery

If children are over a certain age or if their palate is extremely narrow, the palate expansion device may not work well. In these cases, your surgeon may need to perform surgery to move the gum lines into their proper location.

This is called surgically assisted rapid palate expansion or SARPE.

During SARPE, your surgeon will carefully make cuts into the jaw bone. These cuts allow the bones in your child's palate to move. After a surgeon cuts into the bone, a palate expansion device can then carefully and quickly move your child's upper jaw bone and upper teeth into their correct position.

During SARPE procedures, surgeons use a similar device to the devices that orthodontists use inside children's mouths.

My Child Has a Narrow Palate—Does That Affect Her Nasal Passages?

When a child has a narrow upper jaw that is collapsed in, their nasal passage is usually very narrow too. This is because the roof of the mouth shares tissue with the floor of the nose.

Sometimes the bones inside a child's nasal passage are larger than normal. These bones can also be pushed in towards the center of the nose. These bones inside your child’s nasal passage are called inferior turbinates.

Depending on the shape of your child's face, surgeons can move your child's teeth and palate into their correct position and also open their narrow nose during the same surgery. Surgeons can do both of these things at once by adjusting where they cut the bones before they move the palate.

In other situations, surgeons may need to remove extra bone at the front of the inferior turbinate. This extra bone can cause swelling just inside the nostril.

Your surgeon may also recommend shrinking or removing some of the soft tissue inside the turbinate to help your child breathe through their nose more easily. 

Our understanding of the face and nose helps us choose the best surgery for your child's long-term health and quality of life. If your child has nasal congestion problems, your pediatric facial plastic & ENT surgeon can assess how best to help your child breathe through their nose.

Why Do Surgeons Need to Operate On the Bones in My Child’s Face?

As pediatric facial plastic & ENT surgeons, we operate on the bones inside the face for many reasons. For example, we use these types of surgeries to:

  • remove tumors from deep inside the nose;
  • repair broken facial bones;
  • treat teeth, nose, or facial infections;
  • change the position of facial bones to improve the airway in children who have sleep apnea;
  • and more.

Operating on the bones inside your child's face gives us a deep understanding of bones' anatomy and function.

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Does My Child Have a Narrow Lower Jaw?

Sometimes children have a narrow lower jaw that is shaped more like a V than a U. Usually, children with a narrow lower jaw also have very crowded teeth.

Some of these children don't have enough bone in the center of their jaw bone (also called the mandible). An orthodontist can sometimes use a device to help widen your child's jaw. But older children may need surgery to help create enough room.

Symphaseal Mandible Distraction: Fixing a Narrow Lower Jaw

To make enough room for your child's teeth, a surgeon may recommend a type of surgery called symphaseal mandible distraction.

In this procedure, surgeons use an incision (cut) inside your child's lip just below their middle teeth. Your surgeon will carefully cut the bone in the center of your child's jaw. Your surgeon will then place a device on the lower jaw that will be used to create new bone in the center of the lower jaw.

Cutting into the bone spurs your child's jaw to create bone scar. Stretching (or distracting) this bone scar creates new bone growth over time.

Surgeons leave this device in place for several months while your child's new bone hardens.

What To Expect

  • Your child will probably stay in the hospital overnight. This is so that we can make sure your child isn’t in too much pain after their surgery. Occasionally children need to stay in the hospital for a few days. Older children can usually go home after a palate expansion surgery.
  • The sutures (or stitches) above your child’s gum line will dissolve on their own. They do not need to be removed.
  • Your child will use an antiseptic mouth wash for a week. This will help your child prevent infection.
  • We will give your child pain medication. Our staff will closely monitor and adjust the amount of pain medication to make sure they are not in too much pain.
  • We will closely monitor your child to make sure they can breathe easily. We will also watch how much they are eating and drinking.
  • Some children have a small nose bleed after surgery. This is usually because a breathing tube is placed in your child’s nose to allow full access to the mouth and jaws. Usually a nasal decongestant spray will stop any nose bleeds. We are experts at managing nose bleeds if this spray does not fix the problem.

Our nursing staff cares for many children who have cleft palate surgeries. Our staff will provide you with tips as well as compassionate care after your child’s surgery. 

Common Questions

Are there restrictions on how my child can eat and drink?

We don’t put restrictions on how your child eats or drinks after surgery. Most children heal well. Restricting how your child eats or drinks will not make them heal faster.

Will my child be able to eat and drink after their surgery?

Most children do well eating and drinking after jaw surgery. Your child’s jaw will be sore, so be sure your child does not eat hard foods.

Will my child have breathing problems after palate surgery?

We will closely monitor your child for breathing problems. But your child probably will not have any breathing problems. 

Will my child's teeth be numb after surgery?

Some children will have temporary numbness in their upper teeth after surgery. But any numbness should not last long.

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