jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: thedude on September 17, 2020, 11:35:36 AM
-
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 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.
-
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?'
-
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.
-
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.
-
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.
-
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.
-
Surgery can expand the lower jaw, in fact.
Isn't that just for rare genetic cases due to the risk to the condyles?
-
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.
-
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.
-
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.
-
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?
-
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.
-
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.
-
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).
-
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).
See the link provided in reply #13 if you want to know more about mandible expansion.
-
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.
Thank you very much for explaining. It’s quite interesting and slightly alarming to hear that, since the surgeon who suggested this is very well known. It makes me wonder whether this treatment with MSE done on the upper arch and the lower teeth flared outwards might only be stable when done by certain doctors who know the right way to do it, or perhaps only on patients who meet certain criteria. I realize this is a bit of an obscure topic, but I’m wondering if to you that sounds like a likely, or even possible explanation for this?
About torqueing the condyles: According to some videos from his YouTube channel, it seems that Dr. Paul Coceancig routinely rotates the ramus laterally outward at the condylar to increase the bigonial width. I’ve attached a picture showing how he does it—note that it was originally posted on this forum by Louis_Mclovin. Wouldn’t this torque the condyles in much the same way as a mandibular expansion would?
-
What is the surgeon in the US known for and how familiar is he to the mods of JSF? We don't know because he isn't mentioned by name. However, there is a doctor in Australia we are familiar with who's marketing procedures resolve to a type of subterfuge. But we shan't name him here.
Also the 'explanation' the doctor gave you doesn't resolve to the NAME or TERM the procedure/modality suggested to you is called or much info at all. So, little way to research it further. It sounds a little like 'teeth tipping' to the BUCCAL side. But it might not be that or if it is, teeth tipping to the buccal side might not be a bad thing if your lower teeth are presently tipped toward the lingual. You should find out from the doctor, what the ortho procedure is called and if it's something requiring a permanent retainer. You have already established from the doctor that it's NOT mandibular expansion.
-
What is the surgeon in the US known for and how familiar is he to the mods of JSF? We don't know because he isn't mentioned by name. However, there is a doctor in Australia we are familiar with who's marketing procedures resolve to a type of subterfuge. But we shan't name him here.
Also the 'explanation' the doctor gave you doesn't resolve to the NAME or TERM the procedure/modality suggested to you is called or much info at all. So, little way to research it further. It sounds a little like 'teeth tipping' to the BUCCAL side. But it might not be that or if it is, teeth tipping to the buccal side might not be a bad thing if your lower teeth are presently tipped toward the lingual. You should find out from the doctor, what the ortho procedure is called and if it's something requiring a permanent retainer. You have already established from the doctor that it's NOT mandibular expansion.
I believe the surgeon is known for being a good alternative to Dr. Gunson in the Los Angeles area. That's the general impression I got from searching this forum and others. People in the LA area seem to often go to him because he's a big name, but works with insurance while Gunson doesn't. I am certain that you know of him and at least one other doctor who works out of the same practice. I hope that makes things clearer.
I think I see your point now about the lack of information. You're right that he was suggesting teeth tipping to the buccal side in the lower arch, in order to match the width of the upper arch. My understanding was that this would be done using braces, but I may have misunderstood. I do remember that he wanted 2 lower pre-molars extracted so that the lower anterior teeth could be pushed back with braces to achieve decompensation, so I assume that he meant that using the braces, the lower teeth could be tipped to the buccal side simultaneously.
I have an appointment in 2 days with the orthodontist that he said would do the MSE and all the orthodontic work, so I'll have more information soon. That orthodontist is an expert in MSE located in Southern California.
When I get more information, would you suggest that I post it here along with more specifics about my case, or in a new thread focussed on my specific case? I don’t want to derail the thread by talking too much about my specific case. For example, you just mentioned that if my lower teeth are presently tipped toward the lingual, tipping them outward could be okay, and I could reply with more information about this, and even include x-rays, but like I said, I don’t want to derail the thread. Your advice would be greatly appreciated.
-
.......
I think I see your point now about the lack of information. You're right that he was suggesting teeth tipping to the buccal side in the lower arch, in order to match the width of the upper arch. My understanding was that this would be done using braces, but I may have misunderstood. I do remember that he wanted 2 lower pre-molars extracted so that the lower anterior teeth could be pushed back with braces to achieve decompensation, so I assume that he meant that using the braces, the lower teeth could be tipped to the buccal side simultaneously.
Well, then the lack of information was from your not relaying what I guessed he may have been relaying, in particular, teeth tipping to the buccal side which is fine if they are tipped towards lingual and tipping towards buccal will match up with what's done to the maxillary arch.
I have an appointment in 2 days with the orthodontist that he said would do the MSE and all the orthodontic work, so I'll have more information soon. That orthodontist is an expert in MSE located in Southern California.
When I get more information, would you suggest that I post it here along with more specifics about my case, or in a new thread focussed on my specific case? I don’t want to derail the thread by talking too much about my specific case. For example, you just mentioned that if my lower teeth are presently tipped toward the lingual, tipping them outward could be okay, and I could reply with more information about this, and even include x-rays, but like I said, I don’t want to derail the thread. Your advice would be greatly appreciated.
You can post the info in this thread. X-rays are not required and most certainly Paul C's stuff is not needed. If you're concerned about relapse, what he told you about that possibility would be needed or if he told you a perm retainer would be needed.
-
Well, then the lack of information was from your not relaying what I guessed he may have been relaying, in particular, teeth tipping to the buccal side which is fine if they are tipped towards lingual and tipping towards buccal will match up with what's done to the maxillary arch.
You can post the info in this thread. X-rays are not required and most certainly Paul C's stuff is not needed. If you're concerned about relapse, what he told you about that possibility would be needed or if he told you a perm retainer would be needed.
Sorry, I thought that “teeth tipping” and “teeth flaring” were synonymous. Apparently not.
Anyway, your assumption about my lower teeth being tipped toward the lingual side was correct. The orthodontist that specializes in MSE confirmed that in my case, tipping the lower teeth outward would be an appropriate solution, since my lower teeth are presently tipped toward the lingual side, meaning that they could be tipped outward to account for the increase in upper arch width from MSE. He stated that doing this would result in them being in an upright position over the bone, which would be healthier than the lingually tipped position that they are in currently.
-
Sorry, I thought that “teeth tipping” and “teeth flaring” were synonymous. Apparently not.
Anyway, your assumption about my lower teeth being tipped toward the lingual side was correct. The orthodontist that specializes in MSE confirmed that in my case, tipping the lower teeth outward would be an appropriate solution, since my lower teeth are presently tipped toward the lingual side, meaning that they could be tipped outward to account for the increase in upper arch width from MSE. He stated that doing this would result in them being in an upright position over the bone, which would be healthier than the lingually tipped position that they are in currently.
OK. That's a good reason and glad to hear it is what it sounded like it could be.
-
See the link provided in reply #13 if you want to know more about mandible expansion.
wow that cuck surgeon didn't even respond to my question.
-
I believe the surgeon is known for being a good alternative to Dr. Gunson in the Los Angeles area. That's the general impression I got from searching this forum and others. People in the LA area seem to often go to him because he's a big name, but works with insurance while Gunson doesn't. I am certain that you know of him and at least one other doctor who works out of the same practice. I hope that makes things clearer.
I think I see your point now about the lack of information. You're right that he was suggesting teeth tipping to the buccal side in the lower arch, in order to match the width of the upper arch. My understanding was that this would be done using braces, but I may have misunderstood. I do remember that he wanted 2 lower pre-molars extracted so that the lower anterior teeth could be pushed back with braces to achieve decompensation, so I assume that he meant that using the braces, the lower teeth could be tipped to the buccal side simultaneously.
I have an appointment in 2 days with the orthodontist that he said would do the MSE and all the orthodontic work, so I'll have more information soon. That orthodontist is an expert in MSE located in Southern California.
When I get more information, would you suggest that I post it here along with more specifics about my case, or in a new thread focussed on my specific case? I don’t want to derail the thread by talking too much about my specific case. For example, you just mentioned that if my lower teeth are presently tipped toward the lingual, tipping them outward could be okay, and I could reply with more information about this, and even include x-rays, but like I said, I don’t want to derail the thread. Your advice would be greatly appreciated.
Hi Breakingbad,
When you say 2 premolars removed, do you mean one on either side or two on both sides?
-
Hi Breakingbad,
When you say 2 premolars removed, do you mean one on either side or two on both sides?
I meant one on each side, so 2 lower teeth in total.