SARPE Surgery

[s214111]

[quote="Vantwins"]Hi all! Sounds like everyones treatment is coming along well! John, how did it go getting the RPE in? That thing is no fun!

Kat - I don't know why the original surgeon and ortho didn't refer me to a perio. Just more reason that in hindsight, I think they were crappy doctors! If I need any more expansion after the botched SARPE, my new surgeon will deal with it during my next jaw surgery. I had my 2nd gum grafting on Friday, so I'm healing from that. Had my 2nd (new) ortho appt on Monday and got a stronger wire on my top teeth. It seems to be doing a good job of evening out my teeth. He said when I go back end of May he'll start working on closing the gaps, thank goodness! When I started all this, I never imagined I'd have a gap for 6+ months!!! I am sort of used to it by now though, but will be happy when it's gone!

Kat, I hope your bill gets sorted out! I got a very unexpected bill for 15k+ as well. The surgeon is appealing it. As he should - there's no way I'm paying him for the crappy job he did, so if he wants to get paid, he better work it out with insurance.

Insurance also denied my gum grafting, which I've already spend about 11k on. Argh. Thinking of the amazing vacation I could be taking instead of messing with my gums! Or the tummy tuck I'd much prefer!

Vanessa[/quote]

My RPE went in well. I found out today that it will need to be taken out on week 3, altered then reinserted. That is because the first expander only expands a total of 11 mm which will not do the job.

[Vantwins]

wow, you need a lot of expansion! Maybe Kat will weigh in, I think she expanded >11 as well. I think mine was around 8.
Vanessa

[katsface]

I did need 13mm of expansion total.

It was done with one expander which maxed out at 13mm (it's the largest one of that particular kind that they make). They make expanders that max out at bigger lengths than 13mm, but they use a little wrench instead of a key to activate the device.

The 13mm expander barely fit in my mouth with they installed it. They had to pace it very low in my mouth because I have a "high vaulted arch". In other words, my palate was too high and narrow to begin with to place the expander any closer to the roof of my mouth. I think if I had needed any more expansion they probably would have had to place one expander that would fit initially, max it out, then place another one with a bigger max expansion.

I kind of wish they had gone with using two expanders if that would mean having the RPE closer to the roof of my mouth. I've had this thing in for 3 months now, and I have another 4 or 5 to go, and my speech is still really garbled because there isn't much room for my tongue to move up and down without hitting the expander. I asked if he will change it out for a less intrusive TPA at some point but he won't He had very good reasons for this mind you, but I'm still sad about it. I know a lot of people get their expander taken out as early as a few months post surgery and I won't be able to have that done either. I have to have it in for around 7 months total. Again, he has very good reasons, but still a bummer. Anyway, my point is, you may be getting a good deal if having 2 expanders means they are less intrusively placed.

I read a blog, or watched someone's youtube videos who had the same thing done, so it seems like it's not completely unheard of.

[katsface]

Congrats on your surgery. Glad you are feeling better. It should be down hill from there.


An update on my gap, it has been closing freakishly fast. The ortho said it should close 1mm a month but it is closing 1mm every 1-2 weeks. I most now little less than 4.5mm from all high 9.5mm.


Cheers,
Goofy

Awesome! That's so exciting that the gap is closing so fast! It seems like more recent patients in the SARPE thread have had more aggressive orthodontists when it comes to post SARPE treatment. Maybe there is a trend of closing the gap sooner after expansion while the bone is still soft? One of the ortho assistants told me they don't want to let my gap close too fast because they have seen that it will close super fast initially and get down to the end and have the final few millimeters take forever. They seem to have better luck with a controlled closing. I don't know if the orthodontist would agree, though. Seems like the assistants have good intentions but don't always have 100% accurate information.

I'm so happy that you get the RPE taken out soon too! Although I'm also completely jealous. I think the wire that goes across your mouth to hold the arch is a TPA (trans palatal arch). I asked my ortho if I could have one and he said "no". I felt like a child being denied a trip to Disney. I have to have the RPE in for another 4 or 5 months and it's already been in for 3. He had good reasons. But I'm still bummed.

My gap is closing pretty fast too. In fact they said they won't shave my fake tooth down any more frequently than every two weeks (even though the first time they shaved it by 1 or 2 mm and the gap was closed again by the next day!). They say they don't want it to close too fast. Anyway, it's been what? A month since I stopped expanding? And I'm down from a 12mm gap between my front teeth to 7mm as of today. Pretty sweet!

OK Picture time! I just set up a new flickr account just for my teeth/archwired photos. I took all of these photos today with my phone. Sorry they're not great quality. You can see my fake third central incisor in all of the photos.


The RPE, and you can kind of see my lingual brackets. You can also see how the RPE is bonded over my back teeth instead of being held in place with molar bands.


The lower 'expander' which isn't really an expander. In fact I've never seen a device like it, and they said it was custom made just for me. It's supposed to do a few things. One of which is help upright my lower back teeth because right now they tilt inwards. Somehow it is also supposed to anchor some of my teeth to they don't become extruded (?) as the front teeth are intruded (you'll see my fancy new intrusion arch next). I've also got cross bite elastics now that hook onto the lower expander on the inside, to the outside of the upper expander. The elastics are also supposed to help upright my molars on the bottom. You can see how narrow my lower arch is compared to my newly massive upper arch. Hence the need for so many 'expanding' devices on the bottom. He swears up and down that my lower jaw really is big enough to accommodate my new upper jaw... all I need is to get the lower teeth in the correct place. Keep your fingers crossed that that's true!

My fancy new intrusion arch! They cut off the front part of my original archwire and placed this crazy rectangular wire in. I still have the original wire in place from my canines to my molars on both sides. You can see the original wire above the intrusion wire in the back. The intrusion wire is next to my gums on the sides, and in the actual brackets in the front. The intrusion arch is supposed to pull all 4 incisors down into the bone. It's supposed to help alleviate my deep bite. We'll see. I'm not 100% convinced yet

I know it looks like I've got stuff stuck in my teeth, but I swear it's the powerchain! It's wrapped all the way around the front of my canines on both sides. Didn't have a chance to ask why. They also had to put invisalign style glue 'buttons' on the front of my canines to keep the powerchain from sliding off the tooth. Anyway, I ate curry without thinking on the same day they changed the powerchain to this configuration and it's been kind of yellow ever since. Sorry my teeth are still stained from the after surgery mouth wash. I wanted to wait to have a cleaning until my gap/fake tooth is gone.

I'm going to tell the ortho next time I go in that it's very nice if him to get me all of these accessories, but I like him just fine as it is. No need for more mouth jewelry to win my affections.

[MissMelissa]

I'm wondering how long everyone had their stitches in for? I had my sarpe surgery on feb 19th and I had some stitches out two weeks after and he said there were more that would dissolve. Its been 6 weeks since then. Last week I had a stitch hanging down, I don't know if it broke off or what but its gone. It still feels really tight above my gums and I can't make a face like a fish or to give a kiss because its so tight, is that normal? It almost looks like maybe there are still stitches but I don't know if that's just the way my gums healed. I'm worried my gums like grew over them or something. Did anyone ele have any issues with stitches and tight feeling above their gums?

[Vantwins]

Hi MissMelissa, call your surgeon's office - I remember they had to pull out/snip some of my stitches that weren't dissolving enough. I'm 5 months post SARPE and still feel tightness in my gums, still have numbness in my gums, and still have a spot on my top lip that is numb/tingly. I did have some complications with my SARPE but I think the prolonged numbness/tightness is normal for jaw surgery. Luckily, I've most gotten used to it and don't notice it often (besides when I brush my top front teeth, that feels weird!). When I had gum grafting on the top gums about 2 months ago, the periodontist shot novocaine into my gums, and I definitely felt that - ouch! - so at least I know it's not totally numb!
Vanessa

[Vantwins]

Kat - you've got a lot of metal in your mouth girl!! You've got a great attitude about it though! Thanks for sharing the pics.
Vanessa

[goofylook]

Thanks Kat for looking up the name.. yes it TPA but for some reason while I was writing that post I kept thinking RPE and I couldn't get passed that lol..

Anyways, I finally had my ortho appointment on Tuesday 4/23 and it went pretty good. The great news is my RPE is OUT!!! finally! The TPA is not as bad but I still rather not having anything across my palate. The 3 and half months with RPE kinda passed in no time. I didn't feel like I had it for that long!

The gap is still closing fast. As soon as I got home from the othro I noticed that it closed even more after they put in a new chain between the incisors. Now it is at less than 3mm from the bottom and about 4mm from the top vs 2 weeks ago 4mm bottom and 5mm top. Hopefully it keeps closing consistently at this rate and it won't get stuck at the last push like some people have indicated.

All and all things seems to be improving pretty well. Hope everyone's treatment is going well.

Cheers,
Goofy

[Chadly]

New guy here.
I am about 9 hours away from my Surgery, being done as an outpatient. Starting to get the butterflies.

Anyway, the expander has been in since April 16th. I am a little concerned about the reports of vommitting blood and bloody noses, since I have High Blood Pressure which is control with daily meds.

One topic I didnt see much about in the post, how is your speech after the surgery? I am a 9-1-1 Dispatcher, and have taken 9 days off work for recovery. I did have a speech impediment when i first got the expander installed, but my speech has gotten much better. If your speech was affected, how long did it take to return to "normal"?

Here's a facebook page I created to document most of my progress.....

[john123]

Effing got denied coverage for SARPE surgery. So now I sit with braces and an RPE in my mouth for no good reason. Our only option now is to send in a re-worded request in to the insurance agency and hope for the best. Unfortunately, we just don't have the money to spend $25k on 'aesthetic' surgery. I've never been so bummed in my life. It's extremely hard going from "my teeth are going to be perfect in 18 months" to "shiiit looks like I'm stuck with shiitty teeth."

I'm going to the ortho on monday to talk about my options moving forward if surgery doesn't work out. I guess I could try and expand my palate without jaw surgery...even tho I'm 19 and my jaw has probably stopped growing. Another thing I could do is just straighten them out, add in my missing lateral incisor, bond my peg lateral incisor, without fixing my bite. Buuuut, I don't even know if I have enough room for all that because my bite is so edge-to-edge.

Sorry all for venting, but none of my friends would want to hear this and I just had to get it off my chest. I'm just extremely disappointed in this and my ortho as well. I mean, of course my ortho didn't tell me this was a possibility before I fished over the full $8k for my braces....why would he....

Sigghhhh I'm just tired of feeling like the only one without perfect damn teeth mayne

[goofylook]

Chadly, how did your surgery go? Hope everything went well for you! There shouldn't be much speech impediment from the surgery. The expander is what causes the speech impediment, so if you are used to speaking with the RPE then you won't have any further speech issues from the surgery itself.

john123, insurance companies seem to dislike maxillofacial surgeries in general. My insurance didn't have any maxillofacial surgeon in network within 200 miles radius!!! I had to file tons of paperwork, phone calls, and arguments to get them to cover the bulk of the surgery and they still didnt cover the whole cost. However, in my case the insurance did cover the aesthetic part of the surgery, the problem was the surgeon fee. Try again with your insurance company and be a hard-a*s as much as possible with them.
Another possibility is to do this surgery in the surgeon office. I know there is a way to do this surgery without full aesthetic, however I didn't research it further!
Another way is go ahead and get another insurance coverage because whatever you will end up paying for this new insurance in premiums and deductibles for a year or two will never be even close to 25K.
Anyways, this is my 2cents.. Best of luck to you..


Cheers,
Goofy

[Chadly]

Goofy-- Surgery went fine, lasted about 2 hours. Surprisingly no pain at all, and I had the bloody noses stopped later in the afternoon.

Turning the expander 2x in the am and 2x in the pm. Speech is a little mumbled...

[Hyrules]

Wow 4 times a days is to my knowledge alot. I had to turn mine once a day for a month if I remember well.

[Miroslav]

Hi, I am 7 days post op. SARPE. I am still swollen and in a lot of pain. I am doing 1mm a day ( 2 turns in the morning, 2 turns at night). My oral surgeon stated that I need another surgery on my mandible in about 10-12 months, but my orthodontist said that he can do a cover up. Only reason for second surgery is to have more prominent chin (since I am tall). Also he said that second surgery is more invasive with a lot of risk for nerves that are going through mandible.

My concern is- am I going to benefit just from one surgery and I am kinda afraid that my maxilla is going to be too big for mandible after I am done with braces.
If I understood my ortho. I Have transverse malocclusion cross bite on lateral sides and overbite up front.



If anybody had any similar experience please share it.

Thank you all

[goofylook]

Chadly, congrats on ur surgery and I m glad it went smooth but nose bleeding stopping in the afternoon is mighty fast! Good for you.. My nose bleed stopped after 2 days - wasn't too bad on the second day. And I too didn't have much pain just a tension sensation. The speech mumble you mention should go away pretty fast.

I would agree with Hyrules, 4x times a day seems a lot!! I turned mine 1x time a day for a month and then 1x time every other day for another month.. It seems Miroslav is turning it 4x times a day as well so I guess that something that can be done..

Miroslav, congrats on your surgery as well. Hopefully you are recovering pretty well. Unfortunately I don't know much about mandible - luckily I don't have any issue there! Hopefully someone here can help. I would also recommend posting your question as a separate thread since it is related to a different topic (mandible) and you might get more traction that way.


Cheers,
Goofy