Growing a Better Airway: Rapid Maxillary Expansion, Nasal Breathing, and the Open Question of Aerobic Development in the Child and Adolescent Athlete

Abstract

Background. Rapid maxillary expansion (RME) involves the widening of the maxilla and midpalatal suture. Transverse maxillary deficiency has been identified as a factor that can increase nasal airway resistance and contribute to sleep-disordered breathing (SDB) in children. However, there has been no investigation into whether fixing this issue can enhance aerobic development in young athletes. 

Objective. This study aims to combine the existing research on RME and airway issues with pediatric exercise physiology to create testable hypotheses regarding nasal breathing efficiency, recovery and aerobic training capacity in young athletes. 

Methods. A thorough structured narrative review was conducted, utilizing a systematic approach to evaluate literature from PubMed, Scopus, Web of Science, and Embase. The AMSTAR-2 and GRADE frameworks were applied to assess secondary syntheses.

Results. RME consistently decreases nasal airway resistance (with moderate certainty in the short to medium term). The impact on pediatric obstructive sleep apnea (OSA) is towards improvement but remains of low to moderate significance — RME does not significantly affect the apnoea–hypopnoea index by itself, with enhancements mainly found in oxygenation and in combination treatments. This positions RME as a secondary or adjunct option. Connections to exercise efficiency and performance are weak, indirect, and somewhat null; there are currently no trials linking RME to aerobic outcomes in athletes. 

Conclusion. While RME could facilitate nasal breathing and support better recovery through improved sleep, there is no substantiated evidence indicating a direct improvement in athletic performance; this highlights the need for further research within pediatric exercise physiology.