Should I get SARPE as well?

[sean89]

Hi everyone,

I'm beginning to have regrets over my surgery. I had chin-wing two months ago to camouflage my class 2 jaws, and though I am happy with the external aesthetic outcome, I regret not fixing the internal/intraoral problems (overjet, overbite and narrow palate) that made me look into jaw surgery in the first place. 

I was a borderline candidate for SARPE, BSSO (6mm overjet but with only 4mm mandibular retrognathia) and maxillary impaction (maximum 2mm). I regret not fixing my narrow palate and overjet at the same time as my surgery, but a BSSO is now off the table because my mandible would project too much because of the chin wing (unless I had chin wing revision plus BSSO but I don't want that) so I am left with the dilemma of whether to get SARPE.

Hopefully, SARPE would:

1. Widen smile and eliminate buccal corridors with a stable end result (unlike fixed braces treatment)

2. Slightly reduce overjet (by 1 maybe 1.5mm) as the upper teeth supposedly tip in as the arch is widened and so reduce need for BSSO if combined with fixed braces on lower arch (which might reduce overjet by another 2.5, 3mm).

3. Controversial but I have heard it might get rid of my nasally speaking voice (which I hate) because nasal breathing gets better or something.

Number 3 is something that is extremely important to me, and I feel is something that would help me enormously in my professional life as speaking is my work. So I guess I'm asking whether the people that have undergone SARPE noticed any changes in speaking?

I've attached a photo of my arch (the picture is too small so you might not be able to see), but I am a borderline surgical case because when I first saw my surgeon (in person) he told me that I didn't need it, but when I later sent him a DVT scan, he told me it was an option. I know that Kizarq had palatal expansion and my arch is a similar width (maybe very slightly wider) to what his arch was.

So I'm wondering whether the recovery/risks are worth it? From what Kizarq wrote, it was a difficult recovery and maybe not worth it if I can get a similar result with braces.

And if I got SARPE, would I be able to avoid braces on the upper arch (because my teeth are straight, my arch is just narrow) and just have braces on the lower?

And how easy is it to cope with the expander in your mouth? Does that come with speech problems?

Sorry if there's not much structure to this, I'm tired and about to go to bed but all information about SARPE would be greatly received because I don't know much but wonder/hope that it might be a better alternative to getting fixed braces on upper arch with the possible benefit of reducing my nasally sounding voice.

*Also, I've found some pre-op photos of myself and will post them privately (along with redacted post-op photos) of my chin-wing if some established posters are interested in them. Message me if you are interested and I will get round to it tomorrow evening.

Thanks.

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[sean89]

Thanks Kizarq, I vaguely recall your before/after photos and I don't remember you wearing braces in the after. Were you not required to wear them?

[LoveofScotch]

kizarq,

Sorry, if this is a dumb question, but why did you pick SARPE instead of just getting a multi-segment LeFort when you have surgery?

Cheers!

[Lazlo]

could we see a before and after of your chin wing? that would help me advise you better as well.

[Lazlo]

Don't bother with multi-segment. Yes sarpe is a good idea for you. It's the only way to expand, but see an ortho about it.

[PloskoPlus]

Don't bother with multi-segment. Yes sarpe is a good idea for you. It's the only way to expand, but see an ortho about it.

Why do A&G do multi-segment and not SAPRE then?

[pekay]

Why do A&G do multi-segment and not SAPRE then?

They do it in conjunction with upper jaw surgery, it's still unreliable. The relapse rate is ridiculously high.

[PloskoPlus]

They do it in conjunction with upper jaw surgery, it's still unreliable. The relapse rate is ridiculously high.

Really?  Where does this information come from?  Because A&G have a god-like rep.

[sean89]

I will get them in August 13 up until double jaw surgery. (preparation phase). SARPE was just prior.

Thanks for your response Kizarq.

Are you glad you went through with SARPE, and would you have got it done if it wasn't paid by insurance or would you have just tried to achieve a similar width with braces?

[Optimistic]

I PM'd OP this however am posting it here too just to get everyone's opinion.

Why couldn't he get

- DO of the mandible to widen the lower arch
- SARPE to widen the upper arch/palate
- Follow with braces (or wilckodontics to speed it up)
- Then if need be, get a le fort I to advance the maxilla, reduce overjet, and possibly a bit of ccw rotation to get a better bite and occlusal plane. He said he needed a BSSO and didn't get one, so by doing this he'd get auto-rotation and auto-advancement of the mandible as well

It seems this could fix all his concerns without the need for a chin wing revision. Moreover, the time needed to do this wouldn't be nearly as great. DO and SARPE would take what, eight months to fully heal? After which he could probably just follow up with a surgery-first lefort and then get braces to put the teeth where they should be.