Can you have palate expansion after jaw surgery?

[thedude]

It seems like everyone recommends doing palate expansion before jaw surgery, but is there any reason you could not do it after? Would you have to remove the hardware leftover from the jaw surgery first? Are there any other reasons you couldn't do it after? Does it risk re-fracturing the jaw where it was broken for the jaw surgery?

[ArtVandelay]

I believe SARPE does the lefort I cut without the down fracture, so yes you would need to remove any hardware or cut through it but removal sounds more appropriate. I imagine there is extra concern about making sure your bone healed and can withstand the procedure.

If you really want to know this just email some surgeons and ask, it's a straightforward question.

[kavan]

Let me re-phrase how your question sounds to me:

'Can I get a jaw surgery FIRST where all the plans revolve around the PRESENT width of my palate so that my upper jaw teeth mesh/fit properly with my lower jaw teeth after my surgery. But THEN get my palate expanded afterwards so that my teeth don't mesh correctly anymore?'

[thedude]

Let me re-phrase how your question sounds to me:

'Can I get a jaw surgery FIRST where all the plans revolve around the PRESENT width of my palate so that my upper jaw teeth mesh/fit properly with my lower jaw teeth after my surgery. But THEN get my palate expanded afterwards so that my teeth don't mesh correctly anymore?'

I'm not sure I see the difference. My occlusion is fine right now so I could just go and get jaw surgery without any orthodontic work. That would be the fastest and easiest fix.

Or I could do palate expansion first and have 18 months of orthodontic work to make that fit. That would assure a better outcome by having better nasal breathing but maybe jaw surgery would be enough. There is no way to predict whether it will be. If I could just get a traditional jaw surgery and hope for the best but have palate expansion as a last resort if it doesn't work that would be the ideal situation for me.

[GJ]

In general you want to follow order of operations. Less risky procedures first, then see if something more extreme is needed. But beyond that, Kavan is right, in that the bite wouldn't fit after expansion. Since the lower jaw can't be expanded in any real sense (just flaring teeth), you could have a serious bite problem in that situation.

You can probably find a surgeon willing to do anything, though. It wouldn't surprise me if someone would do this. But ask a reputable surgeon and get the answer, and if it's different than what we're saying, let us know.

[Sergio-OMS]

Since the lower jaw can't be expanded in any real sense (just flaring teeth), you could have a serious bite problem in that situation.

Surgery can expand the lower jaw, in fact.

[kavan]

I'm not sure I see the difference. My occlusion is fine right now so I could just go and get jaw surgery without any orthodontic work. That would be the fastest and easiest fix.

Or I could do palate expansion first and have 18 months of orthodontic work to make that fit. That would assure a better outcome by having better nasal breathing but maybe jaw surgery would be enough. There is no way to predict whether it will be. If I could just get a traditional jaw surgery and hope for the best but have palate expansion as a last resort if it doesn't work that would be the ideal situation for me.

TBH, when people ask things that sound to me like dumb or illogical questions, I like to determine if it's because the person asking lacked a piece of information when asking it OR lacks a logical thinking process. So, here, I rephrased the question and introduced a piece of information you could have been lacking when you asked the question. So, yes, I asked the SAME thing you asked but in a different way. I was wanting to determine if you could gain any insight as to how ass backwards your thinking process was. But you just continued on with the same thinking process. So, I've determined it isn't one I can help with and will leave you to your own devices in what ever decisions you make.

[GJ]

Surgery can expand the lower jaw, in fact.

Isn't that just for rare genetic cases due to the risk to the condyles?

[thedude]

TBH, when people ask things that sound to me like dumb or illogical questions, I like to determine if it's because the person asking lacked a piece of information when asking it OR lacks a logical thinking process. So, here, I rephrased the question and introduced a piece of information you could have been lacking when you asked the question. So, yes, I asked the SAME thing you asked but in a different way. I was wanting to determine if you could gain any insight as to how ass backwards your thinking process was. But you just continued on with the same thinking process. So, I've determined it isn't one I can help with and will leave you to your own devices in what ever decisions you make.

Don't come here and act like a bully. My question was an honest and legitimate one and regardless of how stupid you think it is has every right to be heard and considered as much as any other question.

[DRIVVEN]

It seems like everyone recommends doing palate expansion before jaw surgery, but is there any reason you could not do it after? Would you have to remove the hardware leftover from the jaw surgery first? Are there any other reasons you couldn't do it after? Does it risk re-fracturing the jaw where it was broken for the jaw surgery?

I am not a medical professional, but the very LAST thing i would do is do is palate expansion after Upper jaw surgery, mostly because as an adult, you dont get expansion of the bone at all, you get tooth movement. If you need ortho to widen the arch, that is one thing.  I dont think that everyone recommends palate expansion before surgery. Even SARPE is a very unstable procedure but works well for some. By unstable i mean the way it splits is often uncontrolled and many surgeons believe that a three piece leforte (already not the most stable of procedures) is compromised if you split it with sarpe prior to surgery.  If you do SARPE after sugery,. You might create a really unstable bite. If you had upper jaw surgery, IMO if you use anything other than gentle forces, you risk irreparable harm to your bite. For these reasons, I dont think there is a single OMFS that would recommend upper jaw surgery (a very controlled  placement) followed by palate expansion. Make sure you get several professional opinions.

[kavan]

Don't come here and act like a bully. My question was an honest and legitimate one and regardless of how stupid you think it is has every right to be heard and considered as much as any other question.

Your question WAS heard. No one deprived you of your right to use what ever thinking process you used to ask your question. I'm just telling you it isn't one I personally can help with. When I said I will leave you to your own devices in what ever decisions you make.... as 'bullying' as that may have sounded, it was my way of conveying the HINT that I, personally am electing  to skip or de-prioritize time and focus to your further questions. So, you should be pleased to know any further questions you ask will be totally FREE from responses from the Kavan bully pulpit.

[Breakingbad]

In general you want to follow order of operations. Less risky procedures first, then see if something more extreme is needed. But beyond that, Kavan is right, in that the bite wouldn't fit after expansion. Since the lower jaw can't be expanded in any real sense (just flaring teeth), you could have a serious bite problem in that situation.

You can probably find a surgeon willing to do anything, though. It wouldn't surprise me if someone would do this. But ask a reputable surgeon and get the answer their, and if it's different than what we're saying, let us know.

I just had a consultation with a well known US surgeon, and he said that I could do MSE to expand the maxilla as an alternative to extractions to make room for decompensation. In my case, I don't have a discrepancy between my upper and lower arches, so expanding the maxilla would make the top arch wider than the bottom. To fix this, he suggested doing the MSE as part of a plan where the lower teeth are flared outward to match the new width of the upper arch. I asked about expanding the lower jaw to match the upper, but he said he didn't recommend it and that flaring the lower teeth outward was the only option.

The surgeon did say that this would all have to be done with a particular orthodontist who he said "sets everything up well" and does "a good job" with it,  but I think what you're saying is that this is a bad idea in general. Am I understanding this correctly?

[GJ]

I just had a consultation with a well known US surgeon, and he said that I could do MSE to expand the maxilla as an alternative to extractions to make room for decompensation. In my case, I don't have a discrepancy between my upper and lower arches, so expanding the maxilla would make the top arch wider than the bottom. To fix this, he suggested doing the MSE as part of a plan where the lower teeth are flared outward to match the new width of the upper arch. I asked about expanding the lower jaw to match the upper, but he said he didn't recommend it and that flaring the lower teeth outward was the only option.

The surgeon did say that this would all have to be done with a particular orthodontist who he said "sets everything up well" and does "a good job" with it,  but I think what you're saying is that this is a bad idea in general. Am I understanding this correctly?

My feeling is if you flair the lower teeth to match the MSE in the upper arch, then you run a high probability of the lower teeth relapsing. Basically that it wouldn't be stable. This opinion is based off many consults and discussions. I'm not saying what I write is 100% fact, but it's an educated opinion.

My understanding on expanding the lower jaw is that it can torque the condyles, so it's only done in deformity/syndrome type cases.

[kavan]

My feeling is if you flair the lower teeth to match the MSE in the upper arch, then you run a high probability of the lower teeth relapsing. Basically that it wouldn't be stable. This opinion is based off many consults and discussions. I'm not saying what I write is 100% fact, but it's an educated opinion.

My understanding on expanding the lower jaw is that it can torque the condyles, so it's only done in deformity/syndrome type cases.

I've included a journal article about that topic in the educational section. https://jawsurgeryforums.com/index.php/topic,8362.msg77536.html#msg77536

'Midsymphyseal distraction Osteogenesis' (MSDO) which is sometimes called; 'Midline Mandible Distraction Osteogenesis' (MMDO).

 Since questions about expanding the lower jaw do pop up and mods here can't be expected to know all the ins and outs of them given this is in venue of an esoteric procedure, they can refer to the article for more info or use the name of the procedure to research more about it.

[Lazlo]

Surgery can expand the lower jaw, in fact.

tell us more please. i had bimax advancement for class two. But I also had premolars taken out before. Can i get lower and upper expansion done during surgery? And is this safe, low risk and no further potential for nerve damage (my lower right lip is numb for years after double jaw surgery).