Abstract:
A mouth guard seated at least partially on an upper jaw of a user to reduce resistance of air flow in a nasal channel of the user comprises a flange positionable between the upper jaw and an associated upper lip such that the flange extends above a gum line of the upper jaw. A chamber within the flange includes a valve for adjusting the volume of the chamber so that pressure applied by the flange to the upper lip is adjustable to affect dilation of the nasal channel resulting from such pressure, thereby allowing the user to selectably reduce resistance of air flow in the nasal channel.

Description:
CLAIM OF PRIORITY 
     This Application is a Continuation of U.S. patent application Ser. No. 11/485,942, now U.S. Pat. No. 7,581,542, entitled “METHOD FOR TREATING SLEEP APNEA,” filed Jul. 13, 2006, which is a Divisional of application Ser. No. 10/386,063, now U.S. Pat. No. 7,328,705, entitled “DENTAL APPLIANCE FOR IMPROVING AIRFLOW THROUGH NASAL-PHARYNGEAL AIRWAY,” filed Mar. 10, 2003, both of which are hereby incorporated by reference herein. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of Invention 
     This invention relates to a nasal dilator, particularly to such a device which is designed to reduce airway resistance and therefore aid air flow through both the nasal and posterior pharyngeal regions of the upper airway. 
     2. Discussion of the Prior Art 
     Upper airway resistance to airflow is an affliction which affects millions of individuals and has very serious medical consequences with significant morbidity and mortality. The health effects are brought about by the disruption of normal sleep of those afflicted with snoring and sleep apnea (complete stoppage of breathing for a period of time). The effects of snoring and sleep apnea may also compromise the well being of those sleeping in proximity to the afflicted person by disrupting their ability to achieve healthy, restful sleep. 
     Sleep is impacted by both the increased effort needed to overcome increased resistance to airflow and by the fragmentation of sleep patterns brought about by awakenings that occur in both hyponia (reduced air flow) and apneic events (periods of stoppage of air flow). These conditions limit one&#39;s ability to go into the deeper stages of sleep that are necessary to refresh and restore and are damaging to many body systems. 
     The primary treatment for snoring and apnea is the use of a device, referred to as a CPAP (Continuous Positive Air Pressure) device. This device delivers pressurized air from a pumping component through a hose to a mask which is secured over the nose of the individual. This is successful at correcting the problem but is not well tolerated by a significant group of individuals due to the discomfort, lifestyle issues, and difficulty in the portability in traveling with the CPAP. Because of these factors a significant number of patients are forced to abandon the use of this therapy. 
     Surgical techniques have been available for many years; these attempt to permanently correct snoring problems encountered by individuals. However such surgical procedures are complicated and invasive and sometimes permanently change the appearance of the individual. In addition, numerous medical drawbacks, including cost, irreversibility, surgical risk, and long painful recovery periods, are inherent in surgical procedures. 
     Numerous devices are known which attempt to alleviate or eliminate snoring problem without invasive surgery. Some devices have focused on improving airflow through the nose. These devices are used both in awake periods, during increased demand such as athletic usage, and during sleep to improve airflow as an anti-snoring device. 
     There are two mechanisms: one attaches to the external skin of the nose on the right and left sides of by means of adhesives which act by pulling the skin outward to strengthen and expand the nasal passages. (Ruch, U.S. Pat. No. 6,375,667, Apr. 23, 2002) This device is disposable and can irritate the skin. Other such devices are designed to fit inside the nasal passageway and push the inner walls of the nose out, expanding the air passage. (Corsaro, U.S. Pat. No. 5,727,543, Mar. 17, 1998). This device can irritate the sensitive inner lining of the mucosa of the nasal passageway and is awkward. 
     There are also numerous devices known which attempt to alleviate or eliminate snoring problems without invasive surgery by repositioning the lower jaw (mandible) in an anterior (forward) direction. This pulls the base of the tongue forward and thereby increases the air passage in the posterior pharyngeal region (breathing passage behind the base of the tongue). 
     Devices which bring the mandible forward into a functional repositioning posture, and which hold the posterior airway open, fall into two general categories. The first is non-adjustable: the device fits in the mouth at a prescribed position. The disadvantage of this is that there are changes over time that occur and therefore may require changing the position of the lower jaw in relationship to the upper jaw over a period of time. 
     Devices which are adjustable have significant components inside the mouth behind the teeth. They take up space inside the mouth, restricting the space for the tongue and preventing it from coming forward. Some devices also have projections which extend from the mouth out between the lips. These affect the user&#39;s ability to close their lips, making the appliance less comfortable and inhibiting the ability of the user to turn to different positions during sleep. 
     Thus all known devices and techniques for improving airflow have one or more drawbacks or disadvantages. 
     OBJECTS AND ADVANTAGES 
     Accordingly several objects and advantages of the present invention are:
         (a) to provide an improved device for improving air flow through the nasal and pharyngeal air passage, preventing snoring and sleep apnea.   (b) To provide such a device that acts as a single unit and which works in a synergistic system   (c) to provide a nasal breathing aid which acts intraorally and can be fixed in place by attachment to a device,   (d) to provide an anti-snoring device which maintains maximum intraoral tongue space,   (e) to provide such a device which is entirely contained within the oral cavity and does not extend out between the lips       

     Further objects and advantages are: 
     Still further, to provide a device for improved nasal breathing and providing additional protection from traumatic injury which is incorporated into athletic mouth guards. 
     Still further, to provide a mandibular repositioning device that can be used in orthodontic therapy. 
     Yet further objects and advantages will become apparent from a reading of the ensuing descriptions and accompanying drawings. 
     SUMMARY 
     In accordance with this invention I provide a device for improving airflow for breathing by stretching the skin of upper lip region and the nose to maintain the free flow of air through the nasal air passage. The device comprises a base element that anteriorly repositions the lower jaw, thus repositioning the base of the tongue anteriorly. This reduces the resistance of airflow through the pharyngeal region by preventing the tongue from falling back during sleep and obstructing the pharyngeal airway located in back of the tongue region. 
    
    
     
       DRAWINGS—FIGURES 
         FIG. 1  shows a front view of a device for nasal dilation and anti-snoring according to my invention. 
         FIG. 2  shows a lateral view of the device in  FIG. 1 . 
         FIG. 3  shows a posterior view of the device in  FIG. 1 . 
         FIG. 4  shows a superior view of the device in  FIG. 1 . 
         FIGS. 5A-5D  show various aspects of an adjustable attachment of a lower base section of the device of  FIG. 1 . 
         FIG. 6  shows a midline cut view through the center of an upper anterior section of the device of  FIG. 1 . 
         FIG. 7A  shows a view looking down on upper dental splint. 
         FIG. 7B  shows a lateral view of upper dental splint in place on a dental cast. 
         FIG. 8  shows a lateral view of the device in  FIG. 1  on dental models. 
         FIG. 9A  shows a front view of the device in  FIG. 1  without nasal dilators for use as a mandibular repositioner. 
         FIG. 9B  shows the mandibular repositioner of  FIG. 9A  in its functional position shown on upper and lower dental models. 
         FIGS. 10A-10C  show several alternative embodiments for athletic mouth guards. 
         FIG. 10D  shows a cross-sectional cut view of fluid or air chamber. 
         FIG. 10E  shows an athletic mouth guard with nasal labial dilator buttons 
       DRAWINGS—REFERENCE NUMERALS 
       
         
           
                 
                 
               
             
                 
                     
                 
               
               
                 
                    10 thermoplastic base unit 
                    12 right posterior section 
                 
                 
                    14 left posterior section 
                    16 right lateral wall 
                 
                 
                    18 left lateral wall 
                    20 left occlusal wall 
                 
                 
                    22 right occlusal wall 
                    24 right lingual wall 
                 
                 
                    26 left lingual wall 
                    27 anterior lingual flange 
                 
                 
                    28 right occlusal laminate 
                    29 left occlusal laminate 
                 
                 
                    30 right attachment tube 
                    31 right outer tube 
                 
                 
                    32 left attachment tube 
                    34 left outer tube 
                 
                 
                    36 right retention plate 
                    37 left retention plate 
                 
                 
                    38 right orthodontic adjustment screw 
                    40 left orthodontic adjustment screw 
                 
                 
                    42 right acrylic head wall 
                    44 left acrylic head wall 
                 
                 
                    46 acrylic material joining screw to base 
                    50 right connecting/adjustment wire 
                 
                 
                    52 left connecting/adjustment wire 
                    54 right adjustment section 
                 
                 
                    56 left adjustment section 
                    58 right upper-horizontal wire 
                 
                 
                    60 left upper-horizontal wire 
                    62 right distal-vertical wire 
                 
                 
                    64 left distal-vertical wire 
                    66 right lower-horizontal wire 
                 
                 
                    68 left lower-horizontal wire 
                    70 right anterior-vertical wire 
                 
                 
                    72 left anterior-vertical wire 
                    74 right body of connecting wire 
                 
                 
                    76 left body of connecting wire 
                    78 right vertical rise of connecting wire 
                 
                 
                    80 left vertical rise of connecting wire 
                    82 right anterior face of connecting wire 
                 
                 
                    84 left anterior face of connecting wire 
                    86 maxillary flange 
                 
                 
                    88 right nasio-labial dilator buttons 
                    90 left nasio-labial dilator buttons 
                 
                 
                    92 nasio-labial dilator body wire 
                    94 right button retention loop 
                 
                 
                    96 left button retention loop 
                    98 right free wire segment 
                 
                 
                   100 left free wire segment 
                   102 attachment segment 
                 
                 
                   104 maxillary dental splint 
                   110 acrylic bonding material 
                 
                 
                   112 maxillary repositioning flange 
                   114 anterior segment of expansion screw 
                 
                 
                   116 adjustment segment of expansion screw 
                   118 posterior segment of expansion screw 
                 
                 
                   120 acrylic attachment of expansion screw 
                   122 moveable wall of expansion screw 
                 
                 
                   124 adjustment nut 
                   126 mouth guard nasal extension 
                 
                 
                   128 injection valve 
                   130 fluid/air chamber 
                 
                 
                   132 mouth guard 
                 
                 
                     
                 
               
            
           
         
       
     
    
    
     DETAILED DESCRIPTION 
     
       FIGS. 1-4 
     
     A preferred embodiment of a nasal dilator and anti-snoring device according to the invention is illustrated and  FIG. 1  (anterior view),  FIG. 2  (lateral view),  FIG. 3  (posterior view), and  FIG. 4  (top view). The device has a base unit  10 , which fits over the lower teeth. It is constructed of thermoplastic material, which is heat molded over a dental model of the patient&#39;s teeth. In the preferred embodiment, the thermoplastic material used is 3 mm thick biocryl, available from Great Lakes Orthodontics of Tonawanda, N.Y. The biocryl is pressure molded over the dental casts of the lower teeth using a Biostar thermoplastic molding unit, available through Great Lakes Orthodontics. 
     The resultant molded form is cut in the inner side (lingual/tongue) of the dental arch approximately 3-5 mm below the upper margin of the gum line from the back of the posterior-most tooth on the right completely around the dental arch to the posterior-most tooth on the left. The molded material is then cut around the outer gingival margin of the molar and bicuspid teeth so that the material forms a right posterior section  12  with a right lateral wall  16 , a right occlusal wall  22 , and right lingual wall  24 , all of which encase the posterior teeth. 
     The device has a left posterior section  14 , which is cut in a similar fashion providing a left lateral wall  18 , a left occlusal wall  20 , and a left lingual wall  26 , which provide encasement of the left posterior teeth. 
     The posterior sections provide coverage of the teeth and a means of securing base unit  10  to the dental arch. The molded biocryl material is next cut to remove the material on the facial or outer surface of the anterior teeth from the right canine tooth to the left canine tooth, leaving an anterior lingual flange  27  which extends from the inside upper edges of the anterior teeth to 3-5 mm below the gum-tooth margin. This completes base unit  10 . 
     Base unit  10  can also be made of any other material which can be used to secure the lower dental arch, such as processed acrylics, hard-molded outer shell material with a soft inner lining, boil-and-bite materials, preformed arch forms, or other commercially available materials. 
     Orthodontic headgear tubes, available from Posse Dental Supply of Oxnard, Calif., are used as right and left attachment tubes  30  and  32 . Tubes  30  and  32  consists of outer tubes  31  and  34  and right and left retention plates  36  and  37 . Tubes  30  and  32  are placed over occlusal walls  20  and  22  so that retention plates  36  and  37  lie across the top of occlusal walls  20  and  22  at the area of the first molar tooth. This creates right and left tubes  30  and  32  which are oriented so that retention plates  36  and  37  lie over the occlusal walls and outer tubes  31  and  34  are cantilevered out laterally. Other means of attachment may be used, such as snap mechanisms and bonding of the joining mechanisms. 
     FIGS.  5 A- 5 D—Posterior Lower Base With Adjustment Components 
       FIGS. 5A-5D  show various views of posterior sections  12  and  13 . Occlusal laminates for right and left sides  28  and  29  are made by cutting a piece of 1 mm biocryl to fit over right and left occlusal walls  20  and  22 , respectively. Each layer of occlusal laminates  28  and  29  is bonded to respective occlusal walls  20  and  22  by a layer of cold-cure acrylic. Plates  36  and  37  are bonded into their positions over the first molar region lying between occlusal laminates  28  and  29  and occlusal walls  20  and  22 , respectively. Multiple layers or greater thicknesses of material can be used to increase the height of base unit  10 . 
     An orthodontic adjusting screw—in the preferred embodiment a 3 mm Forestadent Standard Expansion Screw, available from Great Lakes Orthodontics—is used. Orthodontic acrylic is applied to cover the posterior segment of the expansion screw  118  to form a posterior acrylic adjustment wall  122 . The screw is positioned on lateral wall  16  below outer tube  31  so that adjustment wall  122  butts up against anterior-vertical wire  70 . Orthodontic acrylic is applied to the anterior segment of the expansion screw  114 , bonding it to lateral wall  16 . The adjustment segment of expansion screw  116  and the posterior segment of expansion screw  118  remain unattached and free to move. 
     Adjustment segment of expansion screw  116  can be adjusted by a key (not shown). The key is a straight wire which can be inserted into a hole in adjustment nut  124  and used as a lever to rotate nut  124 . As nut  124  turns it expands the adjustment section  116 , moving the free posterior segment of the expansion screw  118  in a posterior direction. This pushes adjustment wire  50  moving it in a posterior direction through outer tube  31 , carrying the repositioning flange  112  in a posterior direction. This adjustment is used to reposition the lower jaw forward relative to the upper jaw to increase the repositioning effect of the device. 
     This process is repeated on the left side of the device. 
     A length of orthodontic wire is used as a right connecting and adjustment wire  50 . In the preferred embodiment, Leone orthodontic wire, which is 1.1 mm in diameter, available from Posse Dental Supply, is used. 
     Wire  50  is bent 3 to 4 mm from its end at a 90-degree angle using orthodontic pliers to form right anterior-vertical wire  70 . Another bend is made 3 to 4 mm from the initial bend in a 90-degree angle around parallel axis from the first bend so as to form a right lower-horizontal wire  66 . A third 90-degree bend is made 3 to 4 mm from the second and around a parallel axis to the first two bends to form a right distal-vertical wire  62 . This configuration forms right adjustment section  54 . 
     Another length of orthodontic wire is cut and bent in the same manner as wire  50  to form a left connecting-adjustment wire  52  and corresponding left adjustment section  56  with its corresponding left upper-horizontal wire  60 , left distal-vertical wire  64 , left lower-horizontal wire  68  and left anterior-vertical wire  72 . However the number of bends in right connecting-adjustment wire  50  and  52  can be reduced so that there is a 90-degree bend 8 mm from the end of the wire. A 180-degree foldback bend is made 4 mm in from the end of the wire to create right adjustment section  54  with a right anterior-vertical wire  70  and a right distal-vertical wire  62 . 
     Right wire  50  is inserted into the back of right outer tube  31  so that adjustment section  54  is distal to outer tube  31  and right body of connecting wire  74  passes through the tube and extends anteriorly. At the junction of the first premolar and the canine tooth, a 90-degree bend is made parallel to the axis of the bands of adjustment section  54 , forming right vertical rise of connecting wire  78 . Another 90-degree bend is made so that the portion of wire anterior to right vertical rise of connecting wire  78  is directed towards the curve of the anterior dental arch, forming a right anterior face of connecting wire  82 . Face  82  is bent to form a curve around the anterior dental arch. 
     Left connecting-adjustment wire  52  is inserted into left outer tube  34  and corresponding bends are made to form left body of connecting wire  76  of the left vertical rise of connecting wire  80  and the left anterior face of connecting wire  84 . Left and right anterior faces of connecting wires  82  in  84  meet at the midline. 
     FIG.  6 —Midline Cut View Upper Segment 
       FIG. 6  shows a midline cut view of maxillary repositioning flange  112 . 
     A sheet of thermoplastic material is molded over the cast of the upper dental arch of the patient. In the preferred embodiment a 1 mm sheet of biocryl is used. However, other materials may be used, as discussed 
     A separating media sheet is molded over splint  104  and a sheet of 3 mm biocryl is heat molded over the facial surface of the anterior of the splint  104  and the separating media. This molded material is removed and cut so that it extends from the junction of the first bicuspid tooth and the canine tooth on one side to the junction of the first bicuspid tooth and canine tooth on the opposite side and form the edges of the anterior teeth up to the uppermost vestibular extension to form a maxillary flange  86 . 
     FIGS.  7 A- 7 B—Upper Splint 
       FIG. 7A  shows the maxillary dental splint  104  as seen looking down into the inner surface of splint and  FIG. 7B  shows the dental splint placed on a dental cast. 
     The sheet of biocryl, which has been molded over the upper dental cast, is cut so that it extends over the dentition up to the gingival margins to form maxillary dental splint  104 . Splint  104  is placed in position over the occlusal side of base unit  10  and positioned so that the midline of the teeth lines up and the dental arch is oriented so that the lower anterior teeth provide 1 to 3 mm forward of the upper anterior teeth. It can be positioned by using a dental cast mounted on an articulator using a bite registration taken on the patient in the desired position to orient the dental casts on an articulator alternatively it can be estimated and then adjusted on delivery. 
     Flange  86  is placed in position anterior to maxillary splint  104  so that it fits between splint  104  and wires  82  and  84 . Orthodontic acrylic is applied over wires  82  and  84 , joining them to flange  86 . The bulk of orthodontic acrylic material used to attach wires  82  and  84  that extend out from flange  86  to form an acrylic bumper  110 . This unit forms maxillary repositioning flange  112 . 
     A length of orthodontic wire, in the preferred embodiment a 10 cm length of 1.2 mm diameter Leone wire is used. A right button retention loop  94  is bent at one end and a left button retention loop  96  is bent on a parallel axis so that the final length of wire is equal to the circumference of the dental arch from the lateral of the canine root area on the right side to the lateral to canine root area on left side. This is usually approximately 8 cm in length. 
     Two nasio-labial dilator buttons  88  are made by placing liquid orthodontic acrylic into previously made molds, which have a smooth spherical facial surface and a flat back surface. Buttons  88  are placed on a counter with the spherical surface facing down in a pre-made rubber mold. A nasio-label dilator body wire  92  is placed on top of the flat surfaces of buttons  88  so that their loops  94  and  96  are centered over the flat surface of buttons  88 . Buttons  88  are bonded to loops  94  and  96  by means of orthodontic acrylic, which is applied over the buttons, embedding the wire and bonding it to buttons  88 . This forms a nasal dilator apparatus  87 . 
     Nasal dilator apparatus  87  is made to fit over maxillary flange  86  by creating a band in body wire  92 , which forms to the facial surface of flange  86 . Nasal dilator apparatus  87  is centered on the upper facial surface of maxillary flange  86 . Orthodontic acrylic is applied over the center portion of the wire laterally to the lateral incisor area to join nasal dilator apparatus  87  to maxillary flange  86 . Nasal dilator apparatus  87  has right and left free wire segments  98  and  100 , which allow adjustment of buttons  88  and  90  to position them in the vestibule at the correct height and distance from the maxilla. This creates the appropriate stretching of the upper lip and lateral nasal walls to maintain and stretch, therefore increase the nasal canal to allow freer flow of air. 
     Operation—FIG.  8 —Device In Place On Dental Models 
       FIG. 8  shows the device in position on a dental cast as it sits over the teeth in the mouth. It positions and holds the lower jaw forward. This forward posturing of the mandible prevents the jaw and tongue from moving posteriorly, thus preventing the patient&#39;s airway from being compromised. 
     The user wears this device by placing it in their mouth as they are going to sleep. Maxillary dental splint  104  sits over the upper teeth to support the teeth and distribute the forces of the mandible throughout the dental arch. Splint  104  is then snapped in over the teeth and is held secure by the frictional force of the material around the teeth. 
     Specifically, the device is placed in the mouth with lower dental arch secured in place by means of base unit  10  over the lower dental arch and engaging it by snapping it over the teeth. Maxillary repositioning flange  112  is positioned anterior to the maxillary dental arch with the maxillary splint. It is necessary for the patient to reposition their mandible forward as the lower jaw is closed in order to position maxillary repositioning flange  112  in its proper functional position in front of the upper anterior teeth. The device then holds the mandible in a more forward position and helps maintain the airway patent while allowing a degree of mobility of the jaw. 
     Nasal dilator apparatus  87  is positioned inside the upper lips and stretches the lips to maintain the nasal air channel patent. 
     Gross adjustments of the mandibular repositioning can be made by bending right and left adjustment sections  54  and  56  in a manner which pushes anterior vertical wires  70  and  72  anterior or posterior to their original position. More sensitive adjustments can be made by adjusting expansion screw assembly  116  and expanding the screw, thereby pushing adjustment wire sections  54  and  56 . Both of these methods of adjustment act by moving adjustment wires  50  and  52  and maxillary repositioning flange  112  in a posterior direction, therefore moving the mandible in a more anterior direction. 
     Nasal dilator apparatus  87  can be adjusted by bending free wire segments  98  and  100  to alter the position of buttons  88  so that they cause stretching of the nasal labial tissue. This stretch increases the tension of the lateral walls of the nose, increasing the strength of these walls against the collapsing forces of inspiration. This allows air to move through the nasal passage with greater ease, resulting in greater airflow and a lessening of the negative pressure created in inspiration. Decreasing the negative pressure in the nasal region decreases it in the entire respiratory channel and works with the mandibular repositioning to improve the function of the device. 
     FIGS.  9 A- 9 B—Additional Embodiments 
     Additional embodiments are shown in  FIGS. 9A and 9B ;  FIG. 9A  shows the front view of the device for mandibular reposition which has uses for orthodontic care.  FIG. 9B  shows device in place repositioning the mandible forward. This embodiment functions as a mandibular repositioning device which can be used for snoring and sleep apnea therapy or in orthodontics as the device to reposition the mandible and stimulate the growth of the mandible in orthodontic treatment. It differs from the preferred embodiment utilizes the device without nasal dilator apparatus  87 . 
     FIGS.  10 A- 10 E—Alternative Embodiments 
       FIGS. 10A and 10B . show frontal and lateral views of an athletic mouth guard  132  which is constructed of molded commercially available materials shaped to extend up into the space between the upper jaw and the upper lip and stretch the nasal-labial soft tissue to function as a nasal dilator. 
       FIG. 10C  shows an additional alternative embodiment of an athletic mouth guard  132  of similar form to that of  FIGS. 10A and 10B . This contains a chamber in the flange  126  which extends into the space under the upper lip. This space can be filled with substance which allows control of the pressure in the chamber. This chamber  130  can be pressurized by substances such as liquid or air and allows adjustment of the volume of the flange  126  thereby adjusting the control of effect of tissue stretch and also providing a cushioning and protecting effect of the mouth guard  130 . 
       FIG. 10D  shows a cross-section through the device in  FIG. 10C . The device fits over the teeth as a mouth guard  132  and extends between the upper jaw and the upper lip. This cross-section shows the chamber  130  with a valve  128  in which an injection syringe (not shown) can be used to pressurize the chamber  130 . 
       FIG. 10E  shows an additional embodiment. Nasal dilator apparatus  87  is attached to a mouth guard which can be used in non-contact activities. 
     CONCLUSION, RAMIFICATIONS, AND SCOPE 
     Thus the reader will see that this device creates improved airflow through the nasal and pharyngeal regions. It is used at night during sleep in the treatment of snoring and sleep apnea, which are medical conditions which carry significant medical morbidity and mortality. It can also be used to enhance breathing in times of needed maximal nasal pharyngeal respiration during waking activities such as during athletic activities. 
     Resistance to air flow through the nasal and posterior pharyngeal airway lead to snoring and sleep apnea. This health condition has a significant impact on millions of people. This device functions to prevent the closure of the breathing passageways in both the nose and throat regions. 
     These goals are accomplished because the device maintains maximum intraoral volume and eliminates the need for components which extend through the lips, outside of the mouth. It provides adjustability and significant degree of motion, which reduces strain on the dentition. 
     The advantages of this appliance are the synergistic effect of maintaining the airway in two different areas of resistance at the same time with one device. It accomplishes this with a device that is easy to use, has a minimal of material interfering with the tongue, has no components which extend out through lips, and which minimizes discomfort and forces on the teeth. 
     While my above description contains many specificities, they should not be construed as limitations to the scope of the invention, but rather as an exemplification of one preferred embodiment. Many other variations are possible. For example the nasal dilator apparatus can be constructed in a way so that it can be incorporated into sports mouth guards which can function both as a means maintaining maximum airflow through the nose while providing a cushion to protect the face during contact sport. This embodiment can use chambers, which contain air or liquid, which create a volume of material under the upper lip in the vestibule, which stretch as the nasal labial tissue and provides a cushion for impacts on the facial region. 
     The apparatus can also consist of molded acrylic material, plastics, or molded material forming a chamber, which contains air under pressure or water that creates hydraulic pressure. The pressure of this chamber can be constructed to allow adjustability of the size and pressure of the nasal dilator apparatus by means of a valve, which allows addition or subtraction of air or liquid. 
     Other uses of this device are for treatment of mouth breathers, who have developed a short upper lip. The device can be used to stretch the upper lip. The device can also be used in orthodontics as a lower jaw repositioner to correct malocclusions. 
     Accordingly, the scope of the invention should be determined, not by the embodiments illustrated, but by the appended claims and their legal equivalents.