DOME is a procedure to manage patients with sleep apnea and high arched narrow palate. This helps widen the narrow nasal floor, improving nasal breathing and give room for the tongue to fit in the concavity of the palate. It can be done separately or in conjunction with other procedures.

First, a maxillary expander is placed along the midline suture of the upper jaw (into the hard palate) under local anesthesia by orthodontist, preoperatively. 

Second step is bilateral surgical osteotomies with splitting the midline suture by the surgeon. All incisions are done transorally. Bucogingival incision and consequent bilateral LeFort I osteotomies are performed.

Next, the primordial groove of the mid palatal suture is deepened using piezoelectric saw and wedge opened with straight osteotomes. The gap between the maxillary incisors is visible as the suture opens. Then, the expander is turned to ensure separation of the midpalatal suture bilaterally, until the gap is 1 mm. Third step is expansion of maxilla by patient. Postoperatively, patients turn the maxillary expander by 0.25 mm daily. Eight to ten mm of nasal floor expansion can be attained within a month.

In the final step, orthodontist close the gap between maxillary incisor after completion of maxillary expansion.

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