Does 3 piece lefort transverse widening give soft tissue support?

[april]

Some of us don't have that luxury, Kavan. Suffering from SA[not compliant with CPAP/APAP] or those who have unbearable TMJ pain will make it extremely difficult to keep alert on here let alone scrolling through various academic papers in order to better understand our condition and ways we can go about correcting such conditions & possible complication that may arise.

You might not have that luxury, but you also don't have much of a choice either.  If you want to know more about your condition and the ways to correct it, you have to do some research. There really isn't any way around it.

[kavan]

Some of us don't have that luxury, Kavan. Suffering from SA[not compliant with CPAP/APAP] or those who have unbearable TMJ pain will make it extremely difficult to keep alert on here let alone scrolling through various academic papers in order to better understand our condition and ways we can go about correcting such conditions & possible complication that may arise.

I also have sleep apnea and use the CPAP. Also have pain daily. Never stopped me from doing research and mind you on a lot of things I give info here about but it's too late to get myself.

I advocate people doing as much research as possible. Some people don't even have grammar school geometry background to understand some very BASIC things that are applicable to maxfax concepts.

Some of you don't have the 'luxury' to do research. MY ASS. Some of you got the $$$$$ to have and self pay for all this surgery and those appear to be the 'some of you' who don't have the 'luxury' to put in the time to research. IMO, it's ENTITLEMENT. Perhaps used to having stuff handed on silver platter.

[kavan]

You might not have that luxury, but you also don't have much of a choice either.  If you want to know more about your condition and the ways to correct it, you have to do some research. There really isn't any way around it.

I have noticed that people who don't have the 'luxury' of READING/research about the surgeries they are entertaining, have the $$$ to afford them and also the $$ to make a mistake if they do it wrong because they did not do the right research.  Have you noticed that?

[JourneyToSerenity]

You might not have that luxury, but you also don't have much of a choice either.  If you want to know more about your condition and the ways to correct it, you have to do some research. There really isn't any way around it.

Agreed. I'm not disputing anything, Kavan, mentioned in his former post, he was quite correct in that people need to do their own research. However, I just don't have that luxury, and I'm sure i can't be the only one. All I'm asking if for people to be more open minded and understanding.

I wish I could have the ability to look through various academic papers and process the information as it would enable me to take full advantage of the more knowledgable posters on here instead of being a passive learner, having to save their various links, articles and academic papers for when I feel more 'awake' which isn't a given throughout the week, in order for me to learn more about the various aspects to do with orthognathic surgery.

I also have sleep apnea and use the CPAP. Also have pain daily. Never stopped me from doing research and mind you on a lot of things I give info here about but it's too late to get myself.

I advocate people doing as much research as possible. Some people don't even have grammar school geometry background to understand some very BASIC things that are applicable to maxfax concepts.

Some of you don't have the 'luxury' to do research. MY ASS. Some of you got the $$$$$ to have and self pay for all this surgery and those appear to be the 'some of you' who don't have the 'luxury' to put in the time to research. IMO, it's ENTITLEMENT. Perhaps used to having stuff handed on silver platter.

What I said wasn't a slight on you, Kavan. You do a great job on answering peoples' queries on here and dedicating your time to help others, more often than not, you go the extra mile in that regard, it's much appreciated on my end. All i'm saying is that telling people to do their own research can be pointless for those who can't. Anyway, labelling people who's medical record and personal issues you are unaware off, that causes them cognitive issues and brushing it off as 'ENTITLEMENT' is extremely ignorant.

If you're still using CPAP for your apnea, we can assume that it's providing you with some relief for your symptons, then you're in a more fortunate position than me and others out there. There will be people like myself who have tried both CPAP + APAP and unfortunately had no relief, which may be the difference between us being able to conduct our own research.

I fail to see the correlation in being able to afford Jaw surgery and being able to analyse and throughly look at various academic papers enabling you to make more of an informed decision. I don't want to delve too much into my personal health issues, but when NHS doctors are at a loss at what to do, having exhausted all possible avenues, it's left me with only one alternative, the private route. This whole process is consuming my entire being, all of my savings and annual earnings, towards rectifying the issue, I would hardly call that having things handed to me on a 'silver platter', but to each their own.

[GJ]

I haven't read the entire thread, so maybe this was covered, but in general the 3 piece is only done if the traverse of the upper doesn't match the lower. So they widen the upper so that when the bite comes together it overlaps the lower properly and forms a good bite.

The lower can't really be widened or narrowed due to the limiting factor of the TMJ's width. Some attempt it, but it has terrible side effects on the TMJ. Since the upper doesn't have those restrictions, you can widen it. Now, there are some major complications with 3 piece. The biggest is the bone dies. This happens due to lack of blood flow while segmented. A cutting edge/excellent surgeon might have a way to mitigate that risk, though I don't know what it is. But Gunson, for example, has fewer complications performing it compared to most surgeons. There must be some trick or skill that others don't know.

With regard to support...you'd think bone widening would support tissue, and it seems to do that in cases where people have naturally good structure. But with jaw surgery I was told over and over the soft tissue does not always follow the bone. This has to do with "how your tissue responds" (whatever that means), thickness of the tissue, muscles, etc.

[PloskoPlus]

Pretty much what GJ said - the lower arch dictates. Although some surgeons can widen the lower with subapical osteotomies, which won't stress the condyles,  the risk of nerve damage is too high.

[GJ]

Pretty much what GJ said - the lower arch dictates. Although some surgeons can widen the lower with subapical osteotomies, which won't stress the condyles,  the risk of nerve damage is too high.

Yes, the nerves are the other limiting factor on the lower. Forgot about that.

[kavan]

I haven't read the entire thread, so maybe this was covered, but in general the 3 piece is only done if the traverse of the upper doesn't match the lower. So they widen the upper so that when the bite comes together it overlaps the lower properly and forms a good bite.

The lower can't really be widened or narrowed due to the limiting factor of the TMJ's width. Some attempt it, but it has terrible side effects on the TMJ. Since the upper doesn't have those restrictions, you can widen it. Now, there are some major complications with 3 piece. The biggest is the bone dies. This happens due to lack of blood flow while segmented. A cutting edge/excellent surgeon might have a way to mitigate that risk, though I don't know what it is. But Gunson, for example, has fewer complications performing it compared to most surgeons. There must be some trick or skill that others don't know.

With regard to support...you'd think bone widening would support tissue, and it seems to do that in cases where people have naturally good structure. But with jaw surgery I was told over and over the soft tissue does not always follow the bone. This has to do with "how your tissue responds" (whatever that means), thickness of the tissue, muscles, etc.

EXCELLENT explanation and covers what Plosko said where basically, the muscles might 'want' to push the bone back or put some force on the bone and yes, there is blood loss from the lefort and when cut into segments, more loss and that's part of reason blood supply could be lost to some of the teeth.

[kavan]

Agreed. I'm not disputing anything, Kavan, mentioned in his former post, he was quite correct in that people need to do their own research. However, I just don't have that luxury, and I'm sure i can't be the only one. All I'm asking if for people to be more open minded and understanding.

I wish I could have the ability to look through various academic papers and process the information as it would enable me to take full advantage of the more knowledgable posters on here instead of being a passive learner, having to save their various links, articles and academic papers for when I feel more 'awake' which isn't a given throughout the week, in order for me to learn more about the various aspects to do with orthognathic surgery.

What I said wasn't a slight on you, Kavan. You do a great job on answering peoples' queries on here and dedicating your time to help others, more often than not, you go the extra mile in that regard, it's much appreciated on my end. All i'm saying is that telling people to do their own research can be pointless for those who can't. Anyway, labelling people who's medical record and personal issues you are unaware off, that causes them cognitive issues and brushing it off as 'ENTITLEMENT' is extremely ignorant.

If you're still using CPAP for your apnea, we can assume that it's providing you with some relief for your symptons, then you're in a more fortunate position than me and others out there. There will be people like myself who have tried both CPAP + APAP and unfortunately had no relief, which may be the difference between us being able to conduct our own research.

I fail to see the correlation in being able to afford Jaw surgery and being able to analyse and throughly look at various academic papers enabling you to make more of an informed decision. I don't want to delve too much into my personal health issues, but when NHS doctors are at a loss at what to do, having exhausted all possible avenues, it's left me with only one alternative, the private route. This whole process is consuming my entire being, all of my savings and annual earnings, towards rectifying the issue, I would hardly call that having things handed to me on a 'silver platter', but to each their own.

Well, what I said wasn't meant to be a slight on you either or anyone on this thread. But I do find in general--and not to personalize this--a correlation with those who have a lot of finances for these surgeries AND who 'expect' others to inform them in total about them BUT who don't want to do a lot of their own research, as having some entitlement issues. I've been on boards long enough to see a correlation.

I do my best to explain things so they can be understood. But still, that requires the other person to have a level of education, logic or basic capacity to understand as a BASIS for me to explain. Explanations and subsequent understanding of them can only go as far as what ever the base line knowledge level someone has and I'm most certainly not going to fill in many GAPS or give remedial tutorials if that seems to be the problem.

Well, for those who can't do their own research and who BALK at the suggestion of doing their own research, no matter what their reasons, as long as they don't expect someone else should do it FOR them and spoon feed it to them. We can all pitch in somewhat to help fill in some gaps. But if a person truly wants to learn (who is NOT a fast learner), it will take them longer and they will need to put in the effort.

ETA: What is this all about anyway. I told Dogmatix to do some of his own research. I even found a research paper FOR him and told him he can't expect a doctor to sit down and tutor him because a doc can turn down a patient if they need excessive question time and much more so than others. That's all true. Besides, he got a lot of good advice on here as to WHY he should be happy he doesn't need a multi-segment lefort and why it's done and not done. So, he got ample info on here. BUt if he wants to 'understand' stuff like exactly how they do the surgery, he will have to do his OWN research. That is VERY TRUE.

This was going fine until you got on defining the act of doing what one can do to educate one's SELF, ie. one's own research as a LUXURY or something that was too much of a BURDEN to do for some. Luxury or burden-- what ever--IF someone wants to know something on a more advanced level, then they've gotta do what they need to do to UN-CONFUSE themselves and advance their present level of understanding which is usually RESEARCH.

I wasn't referring to you or him when I mentioned 'entitelment' issues. But there are people on this board who don't do any of their own research, have tons of money to pursue a lot of these surgeries JUST for COSMETICS and who BALK when told to do their own research. So, not everyone has entitlement issues but I do see enough of that here. Not on this string. But I do see it around.

It's very TRUE that if one wants to increase their level of understanding and raise it to a higher level, one does have to hunker down to some self study and not all what is true is palatable to all people for what ever reason.

[forwardgrowth]

You should look into MSE+Facemask can solve this issue for you dogmaxtix

[Dogmatix]

I haven't read the entire thread, so maybe this was covered, but in general the 3 piece is only done if the traverse of the upper doesn't match the lower. So they widen the upper so that when the bite comes together it overlaps the lower properly and forms a good bite.

The lower can't really be widened or narrowed due to the limiting factor of the TMJ's width. Some attempt it, but it has terrible side effects on the TMJ. Since the upper doesn't have those restrictions, you can widen it. Now, there are some major complications with 3 piece. The biggest is the bone dies. This happens due to lack of blood flow while segmented. A cutting edge/excellent surgeon might have a way to mitigate that risk, though I don't know what it is. But Gunson, for example, has fewer complications performing it compared to most surgeons. There must be some trick or skill that others don't know.

With regard to support...you'd think bone widening would support tissue, and it seems to do that in cases where people have naturally good structure. But with jaw surgery I was told over and over the soft tissue does not always follow the bone. This has to do with "how your tissue responds" (whatever that means), thickness of the tissue, muscles, etc.

Thanks. With your, and the other responses I feel confident that I have explored this and that it's not something I wish to pursue if not needed.

To some externt, I'm sure soft tissue follow bone movement, but as you say, maybe not in the predicted way, which was one of the reasons for the thread as well. But then again, in this context I think some of the aesthetics actually is in a sharp bone structure.