Author Topic: Efficacy of MSE vs. multi segment lefort for nasal passage expansion  (Read 9954 times)

tyler93245

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I am very curious to know if there is any "tribal" knowledge on this site on the efficacy of a multisegment lefort 1 vs an MSE treatment in expanding the nasal passage.

Both surgeries apparently do provide an increase in the nasal passageway volume, but exactly how much is not necessarily well documented between the treatments.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5750828/#b4
https://escholarship.org/uc/item/2c05r669

Look at the attached image of a real MSE treatment. The change in nasal airway size seems drastic in comparison to what one would gain from a simple split of the maxilla at the lefort 1 level. I am left to wonder how MSEG lefort 1 surgery can even compete + if this may contribute to jaw surgery relapse if the nasal passage is not properly addressed.
« Last Edit: April 12, 2021, 09:58:34 PM by tyler93245 »

thedude

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Re: Efficacy of MSE vs. multi segment lefort for nasal passage expansion
« Reply #1 on: April 13, 2021, 01:55:33 PM »
Here is a good lecture on why MSE isn’t all it’s cracked up to be: https://m.youtube.com/watch?v=vsqs8KAqSzE&t=32s

kavan

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Re: Efficacy of MSE vs. multi segment lefort for nasal passage expansion
« Reply #2 on: April 13, 2021, 02:32:58 PM »
Although I don't have time to read and evaluate the articles you cited, the photo of the MSE looks like something someone would get for a significant expansion to the middle part of the bone structure. The piriform aperture has become incredibally WIDER. The holes visible in it could be the nasal passages. I'll assume they are if you're sure the photo is showing that is so.

The 3 piece Lefort 1 would certainly not expand the whole midface bone structure as you see in that photo. But I do think that people with very very WIDE piriform apertures (who would also have a very WIDE nose base with that) would have no problem breathing in air from their nose. However, the rest of the airway, the part that is expanded via the maxfax surgery towards that aim, IF that's the problem, might not get expanded with that.

Which surgery to pursue would depend on where the airway is narrow.
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tyler93245

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Re: Efficacy of MSE vs. multi segment lefort for nasal passage expansion
« Reply #3 on: April 14, 2021, 11:09:01 AM »
Although I don't have time to read and evaluate the articles you cited, the photo of the MSE looks like something someone would get for a significant expansion to the middle part of the bone structure. The piriform aperture has become incredibally WIDER. The holes visible in it could be the nasal passages. I'll assume they are if you're sure the photo is showing that is so.

The 3 piece Lefort 1 would certainly not expand the whole midface bone structure as you see in that photo. But I do think that people with very very WIDE piriform apertures (who would also have a very WIDE nose base with that) would have no problem breathing in air from their nose. However, the rest of the airway, the part that is expanded via the maxfax surgery towards that aim, IF that's the problem, might not get expanded with that.

Which surgery to pursue would depend on where the airway is narrow.
Yes, those holes are the entrance to the nasal passage.
I'm not sure about the width of my passages- but what I do know is my nose stuffs up at night, making it much more difficult for me to breath. Sometimes I'll wake up and air won't even be able to move through one of my nostrils, at all. I had a septoplasty which was supposed to fix this, however it did not do much. My ENT did not seem to think further treatment was possible, but it seems MSE helps alot. https://jawhacks.com/blog/mse-86-days-84-turns-expansion-complete

I'll be speaking to my maxfac about this. I have a MSEG lefort 1 planned, however I'm unwilling to take risks with my results so I'm now heavily considering delaying my surgery to go through a course of MSE (unless my maxfac can provide information that my nasal passage will be sufficiently expanded with a MSEG lefort 1) and then simply having a normal lefort 1 movement instead of a multi segment one.

I imagine a DJS would be fairly useless if I still have these nasal breathing issues so I'm concerned about the lack of information there seems to be on this. It seems that using MSE as a means to expand the nasal passageway is very novel, however MSE is a very tested/safe treatment and it's not hard to realize why it would be so effective for nasal breathing. I'll take the "safe" route regardless.


kavan

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Re: Efficacy of MSE vs. multi segment lefort for nasal passage expansion
« Reply #4 on: April 14, 2021, 12:25:04 PM »
Yes, those holes are the entrance to the nasal passage.
I'm not sure about the width of my passages- but what I do know is my nose stuffs up at night, making it much more difficult for me to breath. Sometimes I'll wake up and air won't even be able to move through one of my nostrils, at all. I had a septoplasty which was supposed to fix this, however it did not do much. My ENT did not seem to think further treatment was possible, but it seems MSE helps alot. https://jawhacks.com/blog/mse-86-days-84-turns-expansion-complete

I'll be speaking to my maxfac about this. I have a MSEG lefort 1 planned, however I'm unwilling to take risks with my results so I'm now heavily considering delaying my surgery to go through a course of MSE (unless my maxfac can provide information that my nasal passage will be sufficiently expanded with a MSEG lefort 1) and then simply having a normal lefort 1 movement instead of a multi segment one.

I imagine a DJS would be fairly useless if I still have these nasal breathing issues so I'm concerned about the lack of information there seems to be on this. It seems that using MSE as a means to expand the nasal passageway is very novel, however MSE is a very tested/safe treatment and it's not hard to realize why it would be so effective for nasal breathing. I'll take the "safe" route regardless.

I looked at the link you gave and it was kind of weird because I recognized, word for word, something I said on this board prior which was: "Since the roof of the mouth is the floor of the nose"... It's like I never heard a surgeon say it that way and when I said it exactly that way on JSF years back, I said it in the absence of hearing it said that way anywhere else. I digress.

TBH, I don't know a whole lot about the MSE but clearly, the photo you showed was something that expanded the whole middle 1/3rd of the face. So, from my perspective, the MSE expansion device looks very much like something that can be used when the AESTHETICS it could/would kick up are on target with what the person wants to achieve and most likely does have a very favorable 'side effect' of better nasal breathing for someone who might not even be getting it for that specifically.

 But prior I just wanted to point out the parts of the airway/s that are opened up with the multi segment bimax would be to different parts of the airway and which parts are the issue to your particular situation are indeed best explored with the doctor.

I took a quick look at the video 'the dude' linked to and the doctor on there was saying the MSE opened in a cone shape way as to not reach all the way to the PNS. But of course, one interested in having the MSE would be more inclined to watch the whole thing than my quick look.

Not that I can argue in favor or against on the above statements I made. But I do agree you should discuss with the surgeon to see if the surgery (already planned for you?) can be adapted to include the device, called off if no adaptation OR maybe establish if it's something you could have afterwards.
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LeFort 3000

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Re: Efficacy of MSE vs. multi segment lefort for nasal passage expansion
« Reply #5 on: April 14, 2021, 04:05:01 PM »
why would you ever want to expand your nose that much? it will look horrible horrible horrible. it will not be worth the widened arch or increased breathing capability.

thedude

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Re: Efficacy of MSE vs. multi segment lefort for nasal passage expansion
« Reply #6 on: April 14, 2021, 04:07:04 PM »
Take a look at this device:
https://facialsculptureclinic.com/en/surgery/orthognathic-classification/upper-jaw-too-narrow-smile-distrator/

This is what you want. With this device you get at least 2mm of bone expansion for every 1mm at the level of the teeth. The spidery looking "hyrax" expander used in MSE supposedly isn't even half of that. So just by using this device you will get twice the expansion you otherwise would have because eventually the upper arch becomes wider than the lower arch and your bite will be too compromised to expand anymore. Even better is that because this doesn't touch the teeth you can leave this device in while you are doing braces which saves time and prevents relapse from wanting to remove it too soon. It probably hurts less too because moving teeth is always painful. The "hyrax" device seems completely obsolete to me. I can't see any reason to use it when this is available. If you want more tooth movement, use this device instead and give yourself a better nasal airway and a broader more attractive midface as a bonus.

Here are a couple of examples to show what this does for the face. You can just imagine how much better these people breath through there nose with an extra 10mm of space in there. If you look close at the first case you can see the base of the nose is wider just from this even before the second jaw surgery.
https://facialsculptureclinic.com/en/case/jaw-surgery/too-narrow-upper-jaw-smile-distractor/168/
https://facialsculptureclinic.com/en/case/jaw-surgery/too-narrow-upper-jaw-smile-distractor/227/

Now notice in the first link at the top of the post they traditionally make three cuts in the adult jaw when they do palate expansion: one on each side of the upper jaw like with the Lefort surgery and one down the suture in the middle. The cuts on the side aren't required. There are sutures elsewhere on the skull that will absorb the stress from the expansion. Do it this way and it's a much less invasive surgery. Probably expands the face elsewhere too a little that way. You can even just do so called micropunctures along the suture and a little bit of "bone scoring" elsewhere making it a remarkably noninvasive surgery.

Kasey Li does this and I'm sure some other things too and calls the whole thing "EASE:" https://www.sleepapneasurgery.com/surgical-solutions-for-adults-ease/ Dr. Li by the way is an absolutely incredible surgeon and just all around good person.

Gadwins

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Re: Efficacy of MSE vs. multi segment lefort for nasal passage expansion
« Reply #7 on: April 14, 2021, 10:28:28 PM »
Take a look at this device:
https://facialsculptureclinic.com/en/surgery/orthognathic-classification/upper-jaw-too-narrow-smile-distrator/
[...]

One orthodontist told me, that there were cases, such this device just drilled itself further into the jaw sideways. I don't know, if there are any real studies about this scenario.

tyler93245

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Re: Efficacy of MSE vs. multi segment lefort for nasal passage expansion
« Reply #8 on: April 16, 2021, 12:03:55 PM »
This is what you want. With this device you get at least 2mm of bone expansion for every 1mm at the level of the teeth. The spidery looking "hyrax" expander used in MSE supposedly isn't even half of that. So just by using this device you will get twice the expansion you otherwise would have because eventually the upper arch becomes wider than the lower arch and your bite will be too compromised to expand anymore. Even better is that because this doesn't touch the teeth you can leave this device in while you are doing braces which saves time and prevents relapse from wanting to remove it too soon. It probably hurts less too because moving teeth is always painful. The "hyrax" device seems completely obsolete to me. I can't see any reason to use it when this is available. If you want more tooth movement, use this device instead and give yourself a better nasal airway and a broader more attractive midface as a bonus.

Here are a couple of examples to show what this does for the face. You can just imagine how much better these people breath through there nose with an extra 10mm of space in there. If you look close at the first case you can see the base of the nose is wider just from this even before the second jaw surgery.
https://facialsculptureclinic.com/en/case/jaw-surgery/too-narrow-upper-jaw-smile-distractor/168/
https://facialsculptureclinic.com/en/case/jaw-surgery/too-narrow-upper-jaw-smile-distractor/227/

Now notice in the first link at the top of the post they traditionally make three cuts in the adult jaw when they do palate expansion: one on each side of the upper jaw like with the Lefort surgery and one down the suture in the middle. The cuts on the side aren't required. There are sutures elsewhere on the skull that will absorb the stress from the expansion. Do it this way and it's a much less invasive surgery. Probably expands the face elsewhere too a little that way. You can even just do so called micropunctures along the suture and a little bit of "bone scoring" elsewhere making it a remarkably noninvasive surgery.

Very interesting and insightful. Thank you for this response.

I never noticed the differences between MSE types, I'll queue myself in now.

The fact that this type of expansion can be done with braces on is very convenient since I've already had my braces placed a month ago.

My understanding is that the horizontal Lefort style cuts used in SARPE prevent the whole maxilla from expanding because those cuts absorb the expansion rather than letting the whole maxilla split, so they are to be avoided.

Do you have personal experience with MSE?

kavan

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Re: Efficacy of MSE vs. multi segment lefort for nasal passage expansion
« Reply #9 on: April 16, 2021, 02:50:25 PM »
Very interesting and insightful. Thank you for this response.

I never noticed the differences between MSE types, I'll queue myself in now.

The fact that this type of expansion can be done with braces on is very convenient since I've already had my braces placed a month ago.

My understanding is that the horizontal Lefort style cuts used in SARPE prevent the whole maxilla from expanding because those cuts absorb the expansion rather than letting the whole maxilla split, so they are to be avoided.

Do you have personal experience with MSE?


From the link 'the dude' gave https://facialsculptureclinic.com/en/surgery/orthognathic-classification/upper-jaw-too-narrow-smile-distrator/  it shows that particular doctor uses a cut for that SARPE device as you say such that the whole maxilla does not get expanded in the process. But from the diagram shown, the cut looks to be at the level where the expansion would be also be to the base of the nose which seems to be where you want the expansion.

Same doctor has another case on there ('the dude' gave link to that). It's of a woman that had the 'smile expander' device (the SARPE device that particular doctor uses) and her midface area is noticeably wider. Yet he also has her down for cheek augmentation via HA. But how much one can augment the cheek area with HA is kind of limited and her midface expansion looks to be more than what would arise from HA alone. So, I'm WONDERING if the doctor didn't make the same cut shown in one of his diagrams to limit the expansion in her case such that the SARPE expansion could extend to also expand her midface area. Like, clearly, I can see why the L1 cut would be used to PREVENT the forces of expansion to extend upward to the rest of the anterior midface. But I don't see why it couldn't be used without the L1 scoring to EXTEND the forces of expansion HIGHER to the midface.

In any event, there looks to be quite an assortment of devices to expand the palate. Here's a link I found: https://en.wikipedia.org/wiki/List_of_palatal_expanders. There are probably even more than that.
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Gadwins

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Re: Efficacy of MSE vs. multi segment lefort for nasal passage expansion
« Reply #10 on: April 16, 2021, 11:40:47 PM »
[...]

Same doctor has another case on there ('the dude' gave link to that). It's of a woman that had the 'smile expander' device (the SARPE device that particular doctor uses) and her midface area is noticeably wider. Yet he also has her down for cheek augmentation via HA. [...]

If you mean this woman https://facialsculptureclinic.com/en/case/jaw-surgery/too-narrow-upper-jaw-smile-distractor/227/ , then it is just bad photo presentation. Even her forehead is noticable wider and her ear to ear distance is also larger. I don't think, that you can widen the forehead.

She also looks a bit more up in the after pictures (right one). I am comparing the first pictures, where she is not smiling and is looking directly into the camera.

At least, what I saw in some painting programs, when I tried to compare the distances.
« Last Edit: April 16, 2021, 11:58:05 PM by Gadwins »

kavan

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Re: Efficacy of MSE vs. multi segment lefort for nasal passage expansion
« Reply #11 on: April 17, 2021, 12:26:24 AM »
If you mean this woman https://facialsculptureclinic.com/en/case/jaw-surgery/too-narrow-upper-jaw-smile-distractor/227/ , then it is just bad photo presentation. Even her forehead is noticable wider and her ear to ear distance is also larger. I don't think, that you can widen the forehead.

She also looks a bit more up in the after pictures (right one). I am comparing the first pictures, where she is not smiling and is looking directly into the camera.

At least, what I saw in some painting programs, when I tried to compare the distances.

Says you (who measures 'ear to ear distance when the after photo HIDES the ears) whom I didn't post to and don't wish to hear from. Kindly stop trolling my posts.
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Gadwins

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Re: Efficacy of MSE vs. multi segment lefort for nasal passage expansion
« Reply #12 on: April 17, 2021, 12:35:41 AM »
You can see her accesoires, what is part of her ears, and I gave two references, just to be sure.

I just outline a statement of you, which could be wrong and everybody can make their own oppinion and you don't have to react to it.

tyler93245

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Re: Efficacy of MSE vs. multi segment lefort for nasal passage expansion
« Reply #13 on: May 06, 2021, 02:35:37 PM »
I spoke to Dr. Gunson about this recently.

"Some ENTs claim that more nasal airway expansion is possible with MSE vs jaw surgery, but there is no research to prove this". (Not his exact words)

He pointed out that since a MSEG lefort 1 cut (or atleast the one he performs) is made slightly above the nasal base, the airway is indeed expanded.

Up to this point, though, I've found no opinions on which procedure is better at expanding the nasal base.

It seems there is not much knowledge on which procedure provides the best outcome in expanding the nasal passageway. This seems to be a novel field of ENT research that not many have looked into.

Geometrically, atleast, MSE does seem like a clear winner in this aspect.

It's very unlikely I'll skip out on some sort of MSE treatment at this point. MSE is not possible after surgery and I am unwilling to jeopardize my airway results. Regardless of what the research may say at this point, MSE seems like a "no risk" proceedure (in the fact that jaw surgery can be performed after it). I'll likely put my planned jaw surgery date on hold after I consult/ plan with a few specialized ENTs. It seems like the foolproof "safe" route to take.

thedude

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Re: Efficacy of MSE vs. multi segment lefort for nasal passage expansion
« Reply #14 on: May 06, 2021, 03:06:26 PM »
MSE is not possible after surgery.
Absolutely no reason you cannot do MSE after jaw surgery.