mandibular distraction + maxillary rotation?

[Wheatsnax]

I would ideally like to undergo mandible distraction (possible SARPE too), then proceed with rotation and advancement of the upper jaw.

It seems like I would have to visit two surgeons minimum for this - one who advocates and does a lot of rotation cases for the upper jaw, and one who does mandibular distraction.

Will there be any complications in regards to the planning? I would think that the amount of movement for the mandible would differ between both surgeon's individual plan and would cause a conflict.

Is there any surgeons out there who are familiar with both?

[Wheatsnax]

That will be ideal, but due to proximity issues (need to have frequent visits during the distraction process) it might be a little difficult. So far I have met a surgeon who does mandibular distraction but does not do or believe in CCW rotation.

Second best plan would be taking Surgeon A's CCW plans and getting Surgeon B to do the mandible part using distraction, then back to A for surgery. But that would mean 3 separate surgeries (install + remove distractor + upper jaw surgery) and huge hospital fees 

Need to shop around more I guess

[ditterbo]

In a past thread, it's been said that surgical expansion of the mandible seems to have a high failure rate, relapses, etc.. add in SAPRE and you risk relapse at different rates between the maxilla and mandible.

[ditterbo]

I actually read that surgeons shy away from doing CCW rotation because the history of the procedure was inherently unstable. Indeed, studies done in the 1970's and 80's showed a significant relapse, sometimes 100% full relapse. There was other studies that placed them somewhat stable, so there was a lot of conflicting theories and clinical study results.  They were even using wire fixation as well as rigid fixation back then. The problem was the material, if indigenous bone was used, there was high chance of relapse, simply because people would use there jaw muscles for tough foods. But after the Porous HA blocks were used by Larry Wolford, and using rigid fixation with soft diet for 4 months, none of his patients (23 patients evaluated) exhibited any relapse more than .5mm over a long term study. The ha blocks harden up after 4 months and the first four months are crucial, and bone actually starts integrating into the pores, further stabilizing the material. I've called up many surgeons office and they all told me that any surgeon should know how to perform the procedure, but some don't do as much.

I haven't read anything too different from this with regards to HA blocks and relapse, but it seems the jury is still out on the long term viability of using an HA block for posterior downgrafts, given the bone remodeling that occurs over ones lifetime. 

[Wheatsnax]

I actually read that surgeons shy away from doing CCW rotation because the history of the procedure was inherently unstable. Indeed, studies done in the 1970's and 80's showed a significant relapse, sometimes 100% full relapse. There was other studies that placed them somewhat stable, so there was a lot of conflicting theories and clinical study results.  They were even using wire fixation as well as rigid fixation back then. The problem was the material, if indigenous bone was used, there was high chance of relapse, simply because people would use there jaw muscles for tough foods. But after the Porous HA blocks were used by Larry Wolford, and using rigid fixation with soft diet for 4 months, none of his patients (23 patients evaluated) exhibited any relapse more than .5mm over a long term study. The ha blocks harden up after 4 months and the first four months are crucial, and bone actually starts integrating into the pores, further stabilizing the material. I've called up many surgeons office and they all told me that any surgeon should know how to perform the procedure, but some don't do as much.

I guess surgeons who advocate distraction over osteonomies would champion the issue of stability and would hence shy away from CCW/downgrafting.