EASE (modified SARPE) with Kasey Li

[ian33]

Hi all,

I'm a sleep apnea patient, also suffering from TMJ and malocclusion (left crossbite and anterior open bite). After failure with CPAP, an oral device, and nasal surgery, still sleeping terribly with daily headaches, I've decided to go ahead with jaw surgery.

I saw the renowned surgeon Kasey Li, who recommended Endoscopically-assisted surgical expansion (EASE) followed by the MMA (after maybe 6-9 months of orthodontics). The EASE would aim to open my nasal airway (which was not significantly improved by my septoplasty and turbinate reduction). EASE is essentially a less invasive version of the SARPE, which Dr Li developed himself...

https://www.sleepapneasurgery.com/ease.html

Has anyone else had the EASE for sleep apnea, or heard of anyone else who has? I'd be interested to hear your experiences! (I'm going to have the surgery in September.)

Thanks!

[Lazlo]

Sounds good!

Wish I had been offered this or even SARPE.

I wonder if my teeth could tolerate something like this even now.

How different things might have been had I not been f**ked over by my ortho.

[RedFountain]

I underwent SARPE (not EASE) surgery with Dr Joel Defrancq (Antwerp) in March of this year, to help with my sleep apnea. The distractor used was very similar to the one in your link. https://www.facialsculptureclinic.com/en/surgery/jaw-surgery/widening-of-the-jaws/

I wonder about the actual surgical differences between SARPE and EASE, and if it isn't just a marketing thing. The name certainly makes it seem that way.

The smaller gap between the front teeth sounds nice, but when I look at the bottom two images, it seems to me the tooth gap is only ~2-3 mm because the expansion was only ~2 -3 mm (which would hardly be enough to solve sleep apnea problems). The two halves are completely parallel, meaning the expansion at the anterior part (the gap between the teeth) is the same as the posterior expansion. The case shown here had a pretty wide palate to begin with (around 40mm I'd say?). Would very much like to see more extreme cases (low 30's, or even high 20's)

Good luck!

[RedFountain]

I wonder if my teeth could tolerate something like this even now.

What do you mean, tolerate this even now? Due to age, or what?

I was 33 when I underwent surgery. Everything went fine. Surgery had a much larger (positive) impact on my facial aesthetics than I had anticipated. The forces from the appliance pushed my entire midface outwards (all the way up to the zygos), not just the palate (which is what I was expecting)

[JourneyToSerenity]

2-3mm expansion is hardly ideal if you suffer from a narrow palate, like mentioned above, the case illustrated seems to show a palate that only needs minor adjustments as their palate seems to have a fairly wide palate to begin with. I was told that maximum expansion that doesn't compromise the maloclussion is ideal in order to maximise the width of the nasal cavity, along with MMA.

I have a V-shaped palate so 2-3mm expansion from EASE wouldn't be ideal. I would definitely consult with several other prominent maxfax surgeons, show them your CBCT and CEPHS, see what they say.

[kavan]

To Red Fountan and JourneyToSerenity:

Tell me why you both think that a 2-3mm measured DIRECTLY FROM the PHOTO means that's the actual 'real life' amount? Or is is just JTS who thinks this. Please clarify.

[ian33]

Thanks for the thoughts everyone. Yes, I'm going to ask Dr Li to explain the EASE to me more fully next time I'm in contact with him, especially 1) How it sufficiently widens the nasal airway and palate while only leaving a small gap between the front teeth and 2) What the advantage of doing the EASE followed by MMA is over doing the MMA with a segmental Lefort which could also, I understand, widen the jaw.

I'm inclined to trust Dr Li's judgement on this, as he seems like an excellent surgeon, with a huge amount of expertise in expanding the airway. He is also exceptionally contactable - he gives patients his personal email address, and often replies to emails within minutes or a couple of hours. The main problem I'm encountering is finding an orthodontist where I'm based (near Dallas, Texas) who is happy to work with a surgeon out of state. Has anyone else worked with an out-of-state surgeon and a local orthodontist?

[JourneyToSerenity]

To Red Fountan and JourneyToSerenity:

Tell me why you both think that a 2-3mm measured DIRECTLY FROM the PHOTO means that's the actual 'real life' amount? Or is is just JTS who thinks this. Please clarify.

I've purely assumed that since he's stated on his website that one of the advantages of EASE, is small gaps, as a result time spent under an orthodontic appliance is shortened. If it was able to make a much larger gap, surely he wouldn't have mentioned the 'unsightly gap' and the fact that orthodontic work would be shorter as an advantage. I've taken it from here:

EASE results in a small gap between the front teeth (usually 2-3 mm) that can be eliminated easily using orthodontics (possibly with Invisalign). Other widening procedures result in a very large (8-10 mm) and unsightly gap. Such a large gap leads to prolonged orthodontics and can compromise the health of front teeth due to the distance of teeth movement needed to close the gap.

[kavan]

I've purely assumed that since he's stated on his website that one of the advantages of EASE, is small gaps, as a result time spent under an orthodontic appliance is shortened. If it was able to make a much larger gap, surely he wouldn't have mentioned the 'unsightly gap' and the fact that orthodontic work would be shorter as an advantage. I've taken it from here:

EASE results in a small gap between the front teeth (usually 2-3 mm) that can be eliminated easily using orthodontics (possibly with Invisalign). Other widening procedures result in a very large (8-10 mm) and unsightly gap. Such a large gap leads to prolonged orthodontics and can compromise the health of front teeth due to the distance of teeth movement needed to close the gap.

OK, thanx. So your mentioning the 2-3mm gap was independent of RedFountain said and only in reference to the text.

....The smaller gap between the front teeth sounds nice, but when I look at the bottom two images, it seems to me the tooth gap is only ~2-3 mm because the expansion was only ~2 -3 mm ...

[RedFountain]

To Red Fountan and JourneyToSerenity:

Tell me why you both think that a 2-3mm measured DIRECTLY FROM the PHOTO means that's the actual 'real life' amount? Or is is just JTS who thinks this. Please clarify.

Because the text says so. Tell me why you think I measured from the photo?

EDIT: My original post above might have been worded vaguely. Here's what I tried to convey:
The reason Dr Li can claim this surgery only results in 2-3mm teeth gap might be because the lateral expansion itself is perhaps only 2-3mm, which seems hardly enough to be effective.

Once again, I would urge you Ian33, to ask him about more extreme cases (lateral expansion of ~10mm), or, if he doesn't have those, why small EASE movements are as effective as larger SARPE movements.

[kavan]

Because the text says so. Tell me why you think I measured from the photo?

EDIT: My original post above might have been worded vaguely. Here's what I tried to convey:
The reason Dr Li can claim this surgery only results in 2-3mm teeth gap might be because the lateral expansion itself is perhaps only 2-3mm, which seems hardly enough to be effective.

Once again, I would urge you Ian33, to ask him about more extreme cases (lateral expansion of ~10mm), or, if he doesn't have those, why small EASE movements are as effective as larger SARPE movements.

I asked because the 2-3mm you referenced was worded with direct reference to the PHOTOS and not the text and that amount could be measured directly from the photos.

As per your EDIT, looks like you realize your post might have been worded vaguely enough for me to ask.

[JourneyToSerenity]

OK, thanx. So your mentioning the 2-3mm gap was independent of RedFountain said and only in reference to the text.

No problem. Yeah, my reference to the 2-3mm was strictly taken from the website. Where I stated 'as mentioned above' it was related to RF's comment on the width of the palate to begin with, which stuck out to me upon looking at the photos, which was stated here:

The case shown here had a pretty wide palate to begin with (around 40mm I'd say?)

Thanks for the thoughts everyone. Yes, I'm going to ask Dr Li to explain the EASE to me more fully next time I'm in contact with him, especially 1) How it sufficiently widens the nasal airway and palate while only leaving a small gap between the front teeth and 2) What the advantage of doing the EASE followed by MMA is over doing the MMA with a segmental Lefort which could also, I understand, widen the jaw.

I'm inclined to trust Dr Li's judgement on this, as he seems like an excellent surgeon, with a huge amount of expertise in expanding the airway. He is also exceptionally contactable - he gives patients his personal email address, and often replies to emails within minutes or a couple of hours. The main problem I'm encountering is finding an orthodontist where I'm based (near Dallas, Texas) who is happy to work with a surgeon out of state. Has anyone else worked with an out-of-state surgeon and a local orthodontist?

I'm sure, Dr.Li, is well respected in his field, but all the most prominent surgeons in this field are all well informed with regards to sleep apnea. At the end of the day, it's up to you, I hope you do consult with other maxfax surgeons for your own sake and then make an informed decision on what would be the best possible way to treat your problems. That way at least you wont have any regrets in case things do go wrong.

Also, ask him about the possibility of the jaw relapsing? SARPE also isn't a foolproof method and your jaws can[in extreme circumstances] relapse to pre-surgery state. From my consultation, my surgeon mentioned that even after SARPE, the jaw may very well narrow over-time with age, I was told that I may see even a 1mm-2mm narrowing and so he'll widen the arch taking that into account.

With all due respect, doctor's giving out their e-mail or replying quick to them is normal procedure especially if you're a private patient. I can't speak about the US, in the U.K, many surgeons have their own orthodontist they like to select, just make sure that the orthodontist you choose has a vast history in dealing with orthognathic cases.

[kavan]

From the text:
[EASE results in a small gap between the front teeth (usually 2-3 mm) that can be eliminated easily using orthodontics (possibly with Invisalign). Other widening procedures result in a very large (8-10 mm) and unsightly gap. Such a large gap leads to prolonged orthodontics and can compromise the health of front teeth due to the distance of teeth movement needed to close the gap.]

Actually, I'm not sure whether or not other SARPE procedures kick up a large 8-10mm gap as his text reads. Here is an article that says it is a misconception http://www.toportho.org/think-pieces

Scroll down till you get to the part about SARPE, then look for an illustration that reads:

[SARPE: Frequent Misconceptions
3, With the surgical cuts, the 2 halves of the maxilla move apart almost in parallel.

NOT TRUE: The hemi maxillae tilt outward as they move, separating more above than below.]

So, even though the text of Li's article refers to a 2-3mm gap, it doesn't preclude someone getting more than that. Nor does it necessarily preclude someone getting MORE expansion  where it's actually needed just because the gap between the front teeth is less than the area they actually need to expand via the SARPE.