Is SARPE a 2-Piece LeFort 1?

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#1 Post by **chicago29** » Fri Sep 05, 2008 7:37 am

OK, so I know this topic has come up and I spent an hour last night going through posts...but I'm still confused

In my OS consult, he said step 1 for me is probably surgical rapid palatal expansion. I said, "Oh, a SARPE". He said "Yes, or a 2 piece LeFort...same thing".

I didn't hound on this because I'm going back in 3 weeks for a computer analysis and a formal treatment plan, and I'll get the gory details at that time.

However, once and for all, is a SARPE the same as a "2 piece LeFort"?

Again I apologize for this as I know its been answered, but navigating that SARPE thread is next to impossible!!!

Best Regards
Chicago29

#2 Post by **suetemi** » Fri Sep 05, 2008 8:15 am

I believe so. A Lefort is just the method of fracture used to disattach the maxilla from the skull, and I assume that the maxilla needs to be disattached in order to cut the palate in half and allow for expansion. I think a SARPE is a type of 2-piece Lefort that uses the palate expander. A 2-piece Lefort without the use a palate expander would not be a SARPE. That's my thinking...of course there's a lot of assumptions going on so please correct me if wrong.

#3 Post by **badbite** » Fri Sep 05, 2008 11:30 am

suetemi wrote:I believe so. A Lefort is just the method of fracture used to disattach the maxilla from the skull, and I assume that the maxilla needs to be disattached in order to cut the palate in half and allow for expansion. I think a SARPE is a type of 2-piece Lefort that uses the palate expander.

That sound right to me. My OS called my SARPE a Lefort something or other (I forget the details now). It is very confusing because different OSs call te same thing by different names.

#4 Post by **Brandyleigh35** » Mon Sep 08, 2008 10:24 pm

They are not the same. Some doctors when they do the SARPE perform a Lefort 1 (2 piece) what this means is that they completely release the bone connections on each side. When just a SARPE is done, the bones are down fractured on each side but not completely broken/released. It is basically a modified Lefort.

Hope this answers your question

Brandy

#5 Post by **chicago29** » Tue Sep 09, 2008 6:49 am

OK, now I am even more confused

It is probably my lack of understanding with anatomy that is causing this.

My perception (which is probably incorrect) is that with SARPE they basically split the roof of your mouth in half...or at least the hard palate portion of it. If that is the case, I don't see how there is a difference between the SARPE and the "modified LeFort".

I thought that if there was to be any movement for adults, the upper jaw suture needs to be fully released.

Is one of these procedures "preferred", or is one worse to recover from? Or is this all just the preference of the OS?

Many Thanks
Chicago29

#6 Post by **Brandyleigh35** » Sun Sep 14, 2008 9:46 pm

Maybe I didn't explain this very well. With the SARPE it is not so much about the palatal suture being separated (I mean obviously that has to be fractured in order for there to be expansion.) The difference with the Lefort 1 , 2 piece verses the SARPE is that with the Lefort the outside connections are completely released. With the SARPE they are down fractured (not completely separated but fractured) so still somewhat attached. What this means is that the upper maxilla is completely mobile and loose with Lefort. With Sarpe, it is not...it is still slightly attached.

Does that make sense?

#7 Post by **chicago29** » Wed Sep 24, 2008 3:16 pm

Thanks Brandyleigh...I think I understand now.

I talked to the OS today and his plan is definitely a 2-piece LeFort. He said the upper jaw would be completely detached and held together by soft tissue after the procedure. This sure as heck sounds like a MAJOR surgery to me and is no different than any upper jaw surgery. What worries me is what makes this so "routine" and an "outpatient" procedure as opposed to the LeFort I that there are so many examples of on these message boards.

One thing that made me somewhat more at ease...I asked him point blank: "Is this always the way you do a SARPE, or is it different in my case due to the complexity". He stated this is how he does all maxillary expansions.

Is there anybody on here that had a SARPE and they know it was consistent with the 2 piece LeFort I as outlined in this post? Are the complications and/or recovery period worse?

I know that nobody can compare and contrast directly since I would hope nobody had to have it done one way one time, and then have it done another time the other way

#8 Post by **badbite** » Thu Sep 25, 2008 8:02 am

I honestly couldn't tell you what I had. It is so confusing. My OS said they are interchangable. He called mine a 2 piece Leforte 1 with some ohter technical names after that.

He did say they Chisel (?) the bone along both sides. I really don't remember now. That may not have been his words. He also told me the surgery sould feel no worse than having wisdom teeth out. SO I thought "easy." I didn't take any time off work (a very demanding job with small children for ten hours or more a day). Big mistake!

However, now I see my last post. I have never heard of the cutting the palate in half!?!

I did have a palate expander. I would say it was not rapid, I had to turn for over 3 weeks. So, chicago29, you are not alone in your confusion.

#9 Post by **phil** » Thu Sep 25, 2008 9:47 am

badbite,

"Rapid" is a relative term, isn't it? I look back on my expansion period (24 days) and I thought it would never end!

In the span of a life, though, what is it...or in the span of ALL life, how much time do we live through?

Only a moment...at a time...isn't that right?

Now, if all will allow me to wax philosophical (instead of orthodontical)...

...what is going on in this moment?

Be well, and at peace,

Phil

#10 Post by **Esoteric** » Fri Sep 26, 2008 10:57 am

Chicago,

My doc also said he had my whole upper jaw mobile and it was going to be held by soft tissue. It was funny when he told me about it because he seemed so enthusiastic about it and positive that the result would be great. We've talked before and you know about my recovery so far and I would expect yours to be about the same.

Badbite,

My doc also told me it shouldn't be much worse than having my wisdom teeth out =). The thing that you have to remember is that having your wisdom teeth out is a cinch for some ( i.e. me) and really hard for others. I would equate SARPE surgery just a bit above the wisdom teeth teeth surgery as far as pain but mostly because I had a lot more swelling with SARPE. As far as the rapid part goes mine went from no gap to about an 8mm gap in 7 days. It was fast but seemed like it would never end.

Phil,

So true. I used to fret over the big 2 year plan of attack but in reality it's not much time at all when compared to your lifespan. Plus, I would say 99.8% of the people who go through this stuff come out happier in the end.