SARPE vs LeFort I

[goofylook]

There seem to be a lot of confusion about the difference between SARPE and LeFort I Osteotomy surgeries. I was confused myself initially when I heard about these two surgeries and after lots of research I finally figured out the difference. I wish there was a clear post that explained the difference, hence this post.

First of all, a LeFort is a type of facial fracture involving the maxilla. There are 3 types of LeFort; LeFort 1, 2 and 3. Please refer to this article for more information about LeFort fractures:
http://en.wikipedia.org/wiki/Le_Fort_fracture_of_skull

So basically a LeFort 1 is a fracture made in the maxilla above the teeth, refer to the images in the link above. Now both surgeries (SARPE and LeFort 1 osteotomy) include fracturing the maxilla on the LeFort 1 line. This is kinda confusing because one surgery is commonly refer to as LeFort 1 and the other as SARPE even though both follow the LeFort 1 fracture line. To add to the confusion I think there was another way of performing the SARPE (probably still used) which I don't really know much about.

SAPRE is more than just a surgery; it is the combination of installing an RPE (rapid palatal expander), the surgery to diconnect the bones, and then the actual expansion of the palate by crancking the RPE using the key. I believe SARPE is not commonly refered to as LeFort 1 because the surgery is just a step in the SARPE process. However, when looking at the insurance paperwork, it shows that the surgery you are getting is a "LeFort 1" because the surgeon is fracturing the skull on the LeFort 1 line and not because you are getting a "LeFort 1 Osteotomey" surgery.

LeFort 1 Osteotomy is a more invasive and complex surgery because the surgeon does not only fracture the skull but also moves the bones to the new location. Here, all of the expansion happens durring the surgery, no expander involved. The jaw can also be altered in other ways such as the jaw can be moved forward or backward. Or excess bone from the top of the jaw can be removed to reduce a gummy smile. After everything is done and in position, the jaw is fixed to the skull again with plates and screws.

I hope this post help those who are seeking information and getting ready to go through this journey.

Cheers,
Goofy

[katsface]

VERY well explained. Thanks for making this post!

I think the most important point you made is that SARPE (Surgically Assisted Rapid Palatal Expansion) is a process that involves having your expander installed, having a surgery to allow for expansion, activating the device, stabilizing the jaw, and having the device removed. The whole process takes months. It involves many steps, and specialized equipment (the expander). "SARPE" refers to more than just a surgery.

On the flip side, LeFort 1 is just a surgery. There's no expander, and no process (aside from normal healing).

So, saying you're having a LeFort 1 isn't the same as saying you're having SARPE done, because that doesn't include the rest of the SARPE process. Saying you're having SARPE done may imply that you're having a Lefort 1, because it seems to be a popular choice for the surgical part of SARPE. But having a SARPE doesn't necessarily mean you're having a Lefort 1, because apparently there is at least one other surgical method that can be used.

Since a Lefort 1 can be used as the surgical part of the SARPE process your insurance company may call your procedure a Lefort 1. It won't concern itself with the rest of the SARPE process, because your health insurance probably doesn't cover the orthodontic portion of the process (like having the expander installed, having your ortho monitor the process, aligning the teeth etc.)

I know I just re-explained pretty much what you wrote above, but I was just working it out in my head and it's helpful for me to write these things out.

Thanks again, Goofy!

[LyraM45]

I'm really glad to see this post! Thanks for writing all of this out!

I don't have my surgical consult until April 17th, but one of my questions was if I need to expand my arch (ortho says I do.... all of my ortho consults said this, actually), then how will that be done? Ortho guessed it would all be done through Lefort 1 (I also have gummy smile and overjet/overbite/open bite they are correcting), but obviously he doesn't have the only say in that and is waiting to hear what the surgeon says. But, I got to wondering why not SARPE? And then with my research it seemed like they both accomplished the same thing and I got confused. Your post cleared a bit of that up for me!

[goofylook]

Hi LayraM45, I m glad to help in any way possible. I know it is a hard decision to make - the whole what to do and how to do it? Here are my 2 cents in the matter. The ortho should know if you need an expansion and it seems like there is an agreement that you do. The ortho should be the one telling you what you need to do surgery-wise as well (SARPE vs LeFort 1 or any other procedure). He should know based on his plan whether you need a LeFort 1 or SARPE because he is the one that is architecting your new smile. Personally, I would not recommend an ortho who is pushing this responsibility onto the surgeon. The surgeon should achieve "surgically" what the ortho has designed for him, period! (and make sure no complications arise from the surgery). I would also recommend going (at least consult) the surgeon recommended by your ortho unless you already know and trust a surgeon in that area. The reason for this is that the ortho and that surgeon most likely have dealt with each other quite often and have got to a point where they can understand each other pretty easily. Another thing is ask your ortho questions like "how many cases similar to mine have you done? " etc. These type of questions boost your trust in your ortho which is a good thing because he is the quarterback of your smile reconstruction team.

I hope this help. Good luck..

Goofy

[LyraM45]

Thanks for your reply!

I think it's not that he doesn't know which one, but he wants to go for Lefort1 and I guess doesn't want to say for sure until he meets with the surgeon and discusses his opinion and they come to an agreement what's best for my case. My ortho and surgeons office are in the same plaza, and my ortho always goes over and meets face to face with whomever I am consulting with. Last week it as the perio for an implant, and I was surprised to hear that my ortho walked over to his office and sat down with him and talked over my case file that morning before I had my appointment later in the day. I thought that was great!

So, I'll trust him that he just wants to work it out with the surgeon and collaborate on whats the best route to go. But, I'll definitely be on my toes to make sure there's no funny business and he's the one driving the case!

[someguy]

Thank you goofylook for this post. I've been trying to get a grasp on what all the names refer to and this lays it out well. I'm not sure what type of surgery I'll be needing yet, but I know that my upper palate is too narrow, so I am assuming I will need SARPE. However I also have a skeletal underbite, so I assume I need one of the Lefort surgeries as well. Does anyone know if the SARPE alone can be used to correct underbites, or in general, is further bone movement always needed? Thanks.

[katsface]

Thank you goofylook for this post. I've been trying to get a grasp on what all the names refer to and this lays it out well. I'm not sure what type of surgery I'll be needing yet, but I know that my upper palate is too narrow, so I am assuming I will need SARPE. However I also have a skeletal underbite, so I assume I need one of the Lefort surgeries as well. Does anyone know if the SARPE alone can be used to correct underbites, or in general, is further bone movement always needed? Thanks.

I think with an underbite either the upper jaw needs to be moved forward, or the lower jaw needs to be set back, or both, right?

SARPE won't address either of those. SARPE really only widens the palate. To move the upper jaw forward, you would need a lefort that advances the jaw. Now, I don't know if the two procedures can be done at the same time, or if you would need SARPE first, then maybe a double jaw surgery.

[goofylook]

Generally I don't think a SARPE can be used to fix an underbite. However, in my case and I have read other people say that, SARPE do bring the upper teeth/jaw forward a little bit. I m not sure how this would translate in your case but you can definitely consult with an Ortho. Also, try to find a specialized ortho in cases like yours, orthos (especially dentists who do braces) do the simple things (teeth alignment) and when they take on more complicated cases they break them down into multiple steps, example widen the jaw, align teeth, then push upper jaw forward or lower jaw backward, and align again. On the other hand, there are Orthos that do the more complicated cases that involve osteotomies and jaw movement rather than just teeth alignment. Try to locate one of those Orthos in your area. They might be able to save time and money by combining some steps, example align the teeth then widen the jaw and move it forward in one surgery, then align teeth again. They will be familiar with advanced surgical approaches than a regular ortho.

Again, golden rule is don't try to diagnose yourself, consult as many orthos (usually free of charge) and compare notes and ask tons of questions.

Good Luck,
Goofy

[rosesrred1026]

Thank you so much for the explanations! This board great. is I probably should have looked at this thread earlier; it would have saved me from looking like a fool in front of my oral surgeon's office manager!

I got my SARPE surgery done three days ago (Thursday the 16th - more information on that to come in the SARPE thread), and in the couple days before that I was looking over and signing the payment forms and such. I saw that the SARPE itself was coded as 'Lefort 1' for $14K. My insurance covered the bulk of it, but my initial paranoid thought was that the oral surgeon's office was trying to extort me and my insurance company by coding it as a more expensive procedure! I demanded to know why my SARPE was not listed as such, since the way I understood it, LeFort was the procedure where my jaw would be wired shut and take 6 weeks to recover.

The office manager explained (probably thinking that I was an idiot the whole time) that this was just how SARPE was denoted on insurance billing forms, and I would in fact be having that procedure and not the Lefort. She told me to contact my insurance company if I needed further confirmation. I reluctantly took her word for it, and now I see that she was correct.

Anywho, thanks again! I'm just beginning the process, so I will no doubt be back!

[rosesrred1026]

*is great. Ugh, pardon the typo. Still getting the hang of using this forum.

[goofylook]

rosesrred1026, congrats on your surgery!! Hope you are feeling better everyday.
I do totally understand what you went through with the surgeon office and insurance because I did the exact same things as you LOL.. so you are not alone there! That's the reason I decided to write this post and take all what I learned from my research and interactions with the Ortho and Surgeon as well as other people input into one post. My hope is this one stop shop will help educate new patients about the differences between the two surgeries and guide them to ask their doctors the right questions.

Again, thank you for stopping by and I m looking forward to hearing about your progress in the SRAPE thread.

Cheers,
Goofy

[DivaDeuce007]

Hi all!

I actually have now had both SARPE and Lefort done. My SARPE was done in 2011 and my Lefort (and lower jaw surgery) was done this past June 14th). I had to have the Lefort done because of a 3mm over expansion of my upper jaw. My teeth essentially were not lining up with the middle of my face, so my surgeon wanted to correct it. While I cant tell much now. I think the explanation of the two procedures were dead on! I could not have had just the Lefort done two years ago... my jaw was just two narrow. So the SARPE was a much better option. We will see how the Lefort and lower jaw looks in the coming weeks.

[mia137]

Hello!

I am tentatively scheduled for a Lefort1, and possibly moving the lower jaw back a little, on July 25th. I have an appointment to discuss the procedure next week and I'm trying to compile all the questions I need to ask before then. I'd love suggestions. The surgeon and ortho are both big names so I'm not concerned about expertise, but I would like to know about risks, recovery, complications, preparation, etc.

The short notice is because I just found out I need the surgery last Thursday, was planning on doing it late Feb or early March, but realized that might not work because I'm going to be trying to get pregnant. The best option seems to be moving it up.

Thanks!