New to Board: SARPE Surgery Questions

[spayurpets]

Hi everybody! My name is Ali and I am so glad to have found this board! I have a few questions as I just decided to have SARPE. Any help woudl be greatly appreciated! I have a Class III malocclusion on one side of my mouth adn Class I on the other (Grrrr!) I jsut decided against a LeFort (upper jaw surgery) though I hate the length of my face...The RPE will have to do

1. Is RPE ever covered as a medically necessary procedure and do you need a Class III bite classification to get medical necessity?
2. Do you go under general anesthesia and get an ng tube up your nose, etc. ?
3. Are there different kinds of/styles of exapnder appliances?
4. What is recovery typically like in terms of length, etc.?
5. What is the typical/ballpark price for the expander appliance?
6. Do you have to wait til the gap is at it's widest point before your orthodontist will start to close the gap or can he start to close it as it is opening?
7. Has anyone had expansion just on one side of the bite and if so did it affect the symmetry of your face?


Ali

[Brandyleigh35]

Hey Ali,
Check out my blog (March archive) I had SARPE last year and documented the whole procedure from beginning til end with lots of pics.

To answer your questions

1. Is RPE ever covered as a medically necessary procedure and do you need a Class III bite classification to get medical necessity?

I don't believe this is covered unless you have orthodontic coverage. The RPE is considered an orthodontic appliance. Mine was not covered at all, I had to pay for full orthodontics which included the RPE.

2. Do you go under general anesthesia and get an ng tube up your nose, etc. ?
Mine was done with I.V sedation right in my OS office. Took 50 minutes total for him to do the SARPE, remove a wisdom tooth, and a lower molar. I didn't feel a thing and was good to go walking out of the OS office. It really depends on your OS though, many do it as on out patient surgery, some do it as an overnight in the hospital. You need to ask you OS.

3. Are there different kinds of/styles of exapnder appliances?
Yes there are a few, some have acrylic over the expanded device some do not. I have a pic on my blog of a standard RPE. Most orthos use a certain type. YOu will need to ask your orthodontist this question, he will probably have a dental model with the appliance in place so you can see exactly what yours will look like.

4. What is recovery typically like in terms of length, etc.?
Recovery is not that bad. I could've gone back to work after 10 days but took 3 weeks off anyway. Expansion was the worst part as I had a slight headache the whole time during it, but energy wise I was fine after the first week. I have seen a few who have gone back to work after just one week. It is very individual but by 2 weeks you should be fine.

5. What is the typical/ballpark price for the expander appliance?
I have know idea, it was written up in a complete treatment package for me, as it was a part of the orthodontic procedure. For all of it, braces, appointments, RPE and all I paid about $7200.00

6. Do you have to wait til the gap is at it's widest point before your orthodontist will start to close the gap or can he start to close it as it is opening?
Ok...this sorta varies, but the most widely held thought on this is that closure does not take place until expansion is complete. There has been some studies done on using powerchains to hold the teeth together, and from what I have found it has not been shown to drastically affect the end results. With that being said.....my ortho tried this! I lasted 3 days, in excruciating pain before I finally took the bloody chain off! As soon as it was removed I instantly felt relieve. I did not have him mess with it again until expansion was complete. So.....your front teeth will be sensitive, unless your into pain, your doctor will most likely not be comfortable doing this and you should plan to have the diastema closed upon the finish of expansion. In other words...you will need to lear to love your gap for awhile. We all had to do it, and it really is the best course of treatment.

My gap only got about 3mm wide an took about 7 weeks to completely close. We gained 9mm of space in my mouth. 6-12 weeks is about average for full closure depending on the amount you expand.

7. Has anyone had expansion just on one side of the bite and if so did it affect the symmetry of your face?

Never had this done, or heard of it. SARPE in and of itself will change your appearance some. It will widen your maxilla a bit in the area under your nose, and may make your nose appear a tiny bit wider. Not noticible to others at all, but slightly noticible to you.

May I ask why you have decided against the Lefort? Personally if it was me, I would skip the SARPE and do the Lefort. SARPE is nothing more then a modified Lefort anyway, and I would think given the fact that Lefort was suggested that you would get faster, more complete results with it. SARPE, is a lot slower then just a straight up Lefort. I will be going in May 24th for upper, lower, and genio. If I could've avoided the SARPE all together I would've done it and just got everything fixed in one fail swoop with the Lefort. Also....if your doctor deems it medically necessary your insurance may very well cover it, and then you wouldn't have to pay for the RPE. Anyway....that is just my two cents worth.

Hope this helps answer some of your questions.

[science teacher]

I can help too.

1. THe RPE is part of orthodontics my SARPE was covered by the medical insurance.

2. My surgery was done in the hospital with an overnight stay. I had the ng tube. The surgery was about an hour. I entered the hospital at 11am and left at 8:30 the next morning.

3. I have a standard bihelix expander all metal. It doesn't bother me much. I would wait as long as possible to have it put in. Mine went in 24 hours before surgery. Sometimes people get them as much as a month early.

4. I'm one of the quick ones. I had my surgery on a Wednesday and went back to work on Monday. I teach so I talk a lot. I did ok. I never got a headache with the expansion. It seems to be best to expand at night though.

5. My ortho is abou $5200. Surgery cost me about $1200.

6. Brandy was lucky. My gap got to 8.5mm, about 3/8 of an inch. I still have some gap and I"m 4 months out of expansion. my ortho will put a powerchain on to start closing the gap in April.

7. It is not possible to only expand 1 side of your mouth with this procedure. The physics of how the device works makes both sides expand at the same time.

I agree with Brandy. If the Lefort I was recommended I wouldn't do just a SARPE. Surgery is surgery, I'd go for the whole enchilada.

Kim

[Brandyleigh35]

OH, yeah, I forgot to mention that my SARPE was covered by insurance also. I only had to pay for my orthodontics and the RPE expander. My doctor wrote a note to insurance stating medical necessity and so far everything has been pretty much covered.

I will have to pay about $3500 in May for all my other work, but other than that amount all three of my surgeries will be covered 100%.

Yes, I agree with Kim, the RPE puts equal pressure on both sides of our mouth so you would not be able to expand on one side. The only time this happens is if for some reason they didn't get full seperation during the SARPE and you weren't expanding properly. They of course would have to go in again and fix this. I'm telling you.....go for the Lefort. I think you would be much happier with the results and frankly it is less drama. Everything all at once but they would be able to address all the issues (including the sides that are different)

[Delag]

....but you can be expanded unevenly. This is one of the reasons my ortho is wanting the Lefort for me. I am sure it could all be fixed with orthodontics, but it is extra time etc...

[kristiano8]

The RPE appliance- I had to pay for. I had a lefort 1 done and after being given the run around, The covered the surgery.

I had an outpatient surgery with general anesthesia with an ng tube.

I have to same type of expander that Brandy had

I just went back to work yesterday, two weeks after my surgery and I started the gym again yesterday--my OS said I could have gone back to work after one week -I think I would have been okay to go back about nine days post op but I had the time and I was a little nervous because since the surgery sometimes I get dizzy when I bend over and I wanted to make sure I wasn't in any pain after I started turning ( 1 week post op)

My pallatal expander and 2 years est. in braces comes to a grand total of $5025. I had to put 25% down and now I pay $157 a month

my ortho said they are going to wait and see how fast the gap closes (at full expansion) on its own then if its slow they'll but the braces on to help it along

I don't think they expand one side or the other- the lefort 1 procedure they moved my upper jaw to the right a little bit-- I had a midline deviation

I hope I answered some of your questions and Good Luck.

[jonni]

I haven't had my surgery yet, but my oral surgeon did tell me that for every turn I make he is going to make it 3/4 on one side and 1/4 on the other. This will supposedly help get my midline and crossbite better. So, I am expanding on both sides but not evenly.

Make sense?

[spayurpets]

Thank you to all of you for your replies! I am beyond grateful for you all and am SO glad I found this board. How cool is the internet? Anyways, I thought I would say a little more to explain my situation (especially in regards to my rejecting the Lefort)...

I was given two options by my OS: the Lefort/Genioplasty OR SARPE/Genioplasty. Both my OS and Orthodontist have been discouraging me from the Lefort for a couple of reasons. I wanted the Lefort mostly to shorten the length of my face (thought we could address the bite issues at the same time); because I only have a Class I skeletally and a Class I on dental xrays on one side of my mouth and a class III on the other side, my surgery and hospital would be ALL out of pocket; I live in Orange County CA and if you haven't seen the TV shows....it's a moeny eating county LOL...

For example, my 2 years of braces are $7640 (all out of pocket), my SARPE surgery is $3000 (90% likely it will be all out of pocket) and my genioplasty is $2640: TOTAL: $13, 280! If I did the Lefort ($7800) (not including hospital for 2 days which would be approximately $14,000), I would be broke (TOTAL: $24,440 not including loss of work), they both there will be significant changes to my nose (which I hate and want to fix too! ) and well, it would only be for cosmetic, face-shortening reasons so....I'm hoping you now understand my dilemna.

On to other topics...I should probably post pics of my bite so I can explain this better but my cross bite is only on one side of my mouth. Only on the right side of my midline do I have bottom teeth in front of top and bottom molars are about 5 mm out to the side (slide your jaw to the right and forward and that is what my bite is like). I'm concerned as my OS said in my SARPE he was going to split the palate in the middle and also in my right cheek to move that side of my bite over more. I know I need to talk to him more about this because I don't want my face to become asymmetrical.

I love you guys!

On a random note, where can I get an avatar to add to my profile I tried to jsut add a photo from my computer but no luck. I checked out the directions and tehy weren't very helpful.

Also, BRANDY....my employer probably should try to take down your site LOL ...I spent 3 hours yesterday while at work and supposed to be working reading your SARPE experiece! LOL! WHich BTW has me very depressed. I am hestiating at the gate now becuase you were so miserable Any thoughts?

Ali

[Brandyleigh35]

Hey Ali,
I'm sorry you were depressed, that was not my intention at all. Honestly the whole thing was really a piece of cake. I had a hard time with the appliance mostly, however that is really not the norm. People have issues with the appliance because it is annoying, but my issues were a bit different. I have a very sensitive mouth. It does not like oral intrusions of any kind, especially things on the inside of my mouth. My tongue never would adapt to it so it made my whole experience a bit more challenging. Overall though the procedure was really no where near what I expected. I had no pain hardly at all....nothing that couldn't be managed with advil. I only took the pain meds they gave me one night, just so I could sleep, but I wasn't really in pain. AS for the issues I did have, they were entirely due to the powerchain that the ortho put on immediately after my surgery. AS soon as I took it off things were fine.

I would do the SARPE again in a heartbeat! We have achieved amazing results with it, in a very short amount of time. It really was no big deal. If you doctor is recommending it, I would say "JUST DO IT" you will be happy with the results in the end.

Brandy

[spayurpets]

Thanks so much for your encouragment Brandy! I really appreciate it and it really helped me a lot. Your blog is awesome though so I hope you don't feel bad that I got depressed ...I'm also pretty bummed about getting braces again so some of my bummed out-ness is due tot hat and not the SARPE stuff. It will be my third time with braces...UGH! I/m going to stock up on the bandaids just in case my mouth hates the appliance, too! Thanks again for all teh support everybody

[spayurpets]

Yay! Thanks Meryaten! I love my new avatar. I am so glad I found this board