Does a Segmental Lefort 1 increase Intra-Nasal Space? (Breathing)

[Luis_McLovin]

Im getting jaw surgery soon, and am in consultation w/ the doctor, but they aren’t willing to expand my upper jaw to help treat my complaints re: breathing problems which are in my sinuses and their current plan is only to advance the maxilla, which will help my throat airway, but not my intra-nasal.

So I want to propose to my doctor a different movement which should help the intra-nasal space.  So my question is, does a Lefort 1 segmented (split right down the middle) increase intra-nasal space? My thinking is that its similar to SARPE because itll increase the palate width, which is connected to base of the septum, hence increasing intra-nasal space. However, because SARPE is not a cut, and it is appliance driven expansion, im unsure if this would also be true for a Lefort 1 segmented; ie, because it is a cut, would expanding the palate of the mouth also mean an increase in the size of the septum floor and intranasal space?

[coldconduit]

I plan to get an MSE to guarantee nasal airway expansion.

You might find this thread useful: https://jawsurgeryforums.com/index.php?topic=8296.0

[GJ]

Did they give a reason why they wouldn't do that procedure?

It does carry some massive risk like death of the entire maxilla due to a loss of blood flow, which I have seen in one case of someone who posted here (I'm not positive, but I think she might have passed away). So it's not something I'd request haphazardly.

[Dex1816]

Did they give a reason why they wouldn't do that procedure?

It does carry some massive risk like death of the entire maxilla due to a loss of blood flow, which I have seen in one case of someone who posted here (I'm not positive, but I think she might have passed away). So it's not something I'd request haphazardly.

With a segmental LeFort?! That’s horrendous, never heard of that happening. Will be looking into this as that’s certainly put me off.

[GJ]

With a segmental LeFort?! That’s horrendous, never heard of that happening. Will be looking into this as that’s certainly put me off.

It's rare, and usually happens with inexperienced surgeons, but I've seen at least one case where it happened with an experienced surgeon. Given that it's rare, I wouldn't completely rule it out of it's truly what you need, but definitely make sure you need it. And get second and third opinions on it. I think the risk is that while the maxilla is segmented during that time period blood flow can be lost, and if it is lost for too long, the maxilla actually "dies"...really gnarly. At least that's my understanding of what happens.

[Dex1816]

It's rare, and usually happens with inexperienced surgeons, but I've seen at least one case where it happened with an experienced surgeon. Given that it's rare, I wouldn't completely rule it out of it's truly what you need, but definitely make sure you need it. And get second and third opinions on it. I think the risk is that while the maxilla is segmented during that time period blood flow can be lost, and if it is lost for too long, the maxilla actually "dies"...really gnarly. At least that's my understanding of what happens.

Interesting, thanks. Will definitely think thrice about this.

[thedude]

Did they give a reason why they wouldn't do that procedure?

It does carry some massive risk like death of the entire maxilla due to a loss of blood flow, which I have seen in one case of someone who posted here (I'm not positive, but I think she might have passed away). So it's not something I'd request haphazardly.

Holy cow. Did she die as a direct result of the procedure? Is the risk from splitting down the middle or any multisegmental lefort?

[kavan]

Im getting jaw surgery soon, and am in consultation w/ the doctor, but they aren’t willing to expand my upper jaw to help treat my complaints re: breathing problems which are in my sinuses and their current plan is only to advance the maxilla, which will help my throat airway, but not my intra-nasal.

So I want to propose to my doctor a different movement which should help the intra-nasal space.  So my question is, does a Lefort 1 segmented (split right down the middle) increase intra-nasal space? My thinking is that its similar to SARPE because itll increase the palate width, which is connected to base of the septum, hence increasing intra-nasal space. However, because SARPE is not a cut, and it is appliance driven expansion, im unsure if this would also be true for a Lefort 1 segmented; ie, because it is a cut, would expanding the palate of the mouth also mean an increase in the size of the septum floor and intranasal space?

My response is limited to the statement of 'because SARPE is not a cut'... SARPE is a cut. It's a cut they make before they put in the expander. The 'surgically assisted' part of SA in SARPE is the cut. To the best of my knowledge it's a type of distraction osteogenisis where your own bone fills in during process of expansion. In that way there is no risk of a graft not taking if you just split down the middle during a surgery. If you just split down the middle and leave a big GAP, there is no bone contact at all and all would be dependent on a graft taking. For palate expansion (which expands the nasal base), SARPE is the safer bet but usually planned ahead of the actual Lefort 1 procedure.

[GJ]

Holy cow. Did she die as a direct result of the procedure? Is the risk from splitting down the middle or any multisegmental lefort?

From memory, she had an underlying condition that made it more of a risk, and the surgeon somewhat disregarded that risk. It was a combination of the underlying condition and the surgical result that was expected to drastically cut her life short (I didn't follow her case, but that's what she wrote was the expected outcome - an early death).

My first orthodontist also had a patient without any underlying condition who died from a segmented lefort. My understanding is what I wrote above, that while it's segmented blood flow can't get to the entire maxilla, so the bone actually dies. I think this might be a risk of a standard lefort, too, though I'm not sure. But that's probably a quicker procedure. I think time might be a major variable here. If you're concerned, ask your surgeon for specifics on it. I'm talking from vague memories of these cases.