Metal Mouth Message Board

To begin, thanks for all your info... it really helped me get through this crazy process. A little regret when I look in the mirror (huge gap). My name is Angela and I had the expander and braces put on wed, then I had SARPE on Thurs April 29, 2010. I met with my ortho five days later who expanded 12 turns=3mm during first office visit. It felt tight. He wanted to be aggressive with the turning as I am on a timeline and need the gap to close by Sept when I am in a wedding. He suggested to turn 4 times a day=1mm a day. I felt it was too much, but if it was ok then why not. I expanded 4 turns for the next two days, by the third day my palate was blood red. I felt we were expanding too much and I took the red palate as a sign to slow down, but of course by then it was Friday when all orthos are off and I could not call them. So I made an executive decision and only expanded 2 turns a day for 2 more days and by Sunday i felt a sharp point at the roof of my mouth. I had felt it after surgery, I just assumed it was a staple or stitch or something. Well I took a pic and realized it was bone sticking out of my palate. I kinda freaked so on Sunday we only expanded 1 turn. Then Monday I called the surgeon and he told me we were expanding too fast and it causes the bone to die and come out. AHHHHHHHHH so tomorrow I go see the surgeon and he said he will cut it off and sand it down and hopefully that will take care of it. Has anyone had this happened?
My face is numb on the right side and my upper lip appears paralyzed and does not move. The good thing about that is that it covers the gigantic gap that is as big as a giant tooth. The expansion has created such a huge gap that one of the front teeth is climbing over another one. It is crazy!!!! Also did you guys experience fluid like/ air filling in their sinuses? I can feel this horrible pressure on my right sinus area and the cheek is swollen some and you can feel it moving when you touch it. Weird feeling!!!! I don't know how to get it to go away. I am sick of liquids.. and I am always hungry. I have lost 8 lbs and can't afford to lose more. Please I would appreciate any info on my questions. I am kinda regreting things right now just because I am so worried and I look horrible!!
Thanks again for sharing.
Angela

I don't want to add to your fear, but if I were you I'd be finding a new orthodontist.

SARPE needs to follow a very defined protocol. Sure, there are differences between doctors' methods, but what you are being told is (in my opinion) dangerous and potentially hazardous to your ability to recover and heal from the procedure.

First off, you shouldn't expand at all for at least 5 days - Typically it is 7 to 10 days in an adult. The bone needs to form a callous, otherwise it will not heal correctly and you may end up with what is called a non-union. Trust me, you don't want that or you'll be back in the operating room. After that period, you should turn SLOWLY. The average is .5 mm per day. I've heard of 1 mm per day but that's pretty aggressive and if you are doing 1 mm a day you should be closely monitored to ensure things are going as planned.

In any regard, I hope your OS can fix everything. You're clearly being expanded too quickly, and you need to get your surgeon involved ASAP.

SARPE is a very delicate thing and while it is wildly successful, it is only successful when it follows defined protocols that have come about after decades of practice. It seems to me your orthodontist is being too haphazard...

Also, and this is just my opinion, you shouldn't have done this surgery with such defined timelines. No doctor can say "everything will be back in order by X date"...There are way too many factors at play. Rushing through SARPE is not a good idea, and your orthodontist should be doing what is best for your health and your orthodontic outcome...they shouldn't be catering to your "schedule".

Best of luck.

-Chicago29

^is that true about not turning until a week after surgery? When I end up getting mine, my ortho wants me to turn 3 times a day starting a day post-op, for a week, and then he'll assess progress...hmmmm.....

I`ve read almost everywhere that you have to wait 5 to 7 days before turning. Normally 4 turns a days is way too much. That would equal to 1.3mm per day. That's alot. I do 1 turn a day which is equal to 0.33 mm per day. 30 turn of my hyrax = 10mm. 8 turn already done by the surgeon.

@DrBlur: Yes, everything I've read indicates there is a period to allow the formation of a callous. That ranges from 5 to 10 days, with 7 days being the norm from the literature I've come across. I'd talk to your surgeon and ensure your Orthodontist is on the same page. Turning immediately after surgery seems insane, and there's no chance I would have been able to do that.

@Hyrule: Each expander is made differently so a turn of one expander may be different than another. Most expanders I've heard of are calibrated to be .25mm per turn, but .33mm certainly seems feasible as well. In any regard, whether it is .25 or .33, I agree that 4 turns a day seems way too much.

A warning...I'm not an orthodontist or a surgeon, just a well informed patient The bottom line is you need to ultimately trust the professionals. However, it continues to blow my mind how many surgeons and orthodontists appear to be out there that don't subscribe to the standard protocols. Orthognathic surgery protocols are widely documented and accepted, and some simple entries in Google can net you most of this information.

As always, I highly encourage anybody going through any sort of jaw surgery to do your own research, and ask tons of questions. I know it sucks that you have to do this, but it is entirely too risky not to. Every patient needs to know what they're committing to.

Best Regards
Chicago29

Hi Angela, are you feeling any better today? Have you been to see the surgeon yet? I do hope he's able to set you back on track OK. Try not to worry too much: at least it sounds like he has a plan for dealing with things. Just make sure he communicates what he wants to the ortho as well!

If you're still struggling with the liquid diet, have a look at the threads on here with food suggestions. There are quite a few things you can do to boost calorie intake, including special drinks. I've heard things like Boost and Ensure mentioned but that doesn't mean too much to me where I live. I found it easiest to cook a meal as normal then simply blend it, adding extra liquid as necessary. Looks disgusting but tastes surprisingly OK! I can recommend potato soup made with milk and lots of spicy flavouring.

I'm one of the least expert people on here so I won't hazard a guess whether you started expanding too quickly. 12 turns in one go sounds a heck of a lot -- but I saw from your post that that was 5 days after surgery. In my case, I started expanding immediately. The first turn or two were done while I was still in the operating theatre (I think that's usual, to make sure the expander is working properly), and I wouldn't have been allowed to go home from hospital if I hadn't been able to demonstrate that I could turn the key.

Once back home, I did 4 turns a day for 10 days, without any waiting. That's quite a rapid rate of expansion, but if I remember correctly I'm not the only person from the long SARPE thread who started expanding right away. In all other aspects of my treatment my ortho has been almost painstakingly slow and cautious, so I'm sure he had his reasons for doing things that way. I should add that my expander might have been a bit different, too. I know I turned the key exactly the opposite way to everyone else -- pulling forward towards the teeth rather than pushing back toward the throat -- which caused a bit of confusion on here at one point!

Whatever might have happened in your case, I just wanted to say well done for acting on your instincts and getting back to the surgeon about it and I really hope all goes well for you. Please come back and let us know how you're doing

Thanks for the info chicago I also like to be well informed. I`ve also done alot of research post op. To my knowledge you are right. I recall my orthodontist saying that each turn is a quarter millimeter. So 4 turn is 1 mm that still alot of stress for a broken bone.

I just wanted to put my 2 cents in about my experience...

I had to wait 3 days post op then turn once a day which was 0.25mm so I had a very slow expansion. I ended up doing 9.75mm in total. I then had to wait 6 weeks after the final turn to get my braces on to avoid relapse. I then had to wait a further 6 months from the brace date to have the expander removed. From what I have read mine was very methodical and 'by the book' but I believe thats the best way to be. My ortho didnt care I wanted my expander out before xmas because she knew it would compromise my result. Even though I was disappointed at the time I know it was the right decision. You cant rush these things and if your ortho is trying to meet your deadline and not caring about the consequences then he isnt a good ortho (more like a terrible one). I would seek alternative advice immediately to avoid any more damage.

Hey guys,
Thanks so much for your input it's nice to be heard from someone that knows the process. I went to the surgeon he injected me, which hurt more than anything else and then cut the bone off and stitched me back up. We are stopping the expansion and letting me heal a bit. He said he will reassess and let me expand maybe one turn a day or every other day once stitched heal. He talked to my ortho and they are both in agreeance. I then went to see the ortho and he was shocked at how big of a gap I had, the front tooth was climbing on top of another, he also said stop expanding and that we were being to ambitious. He was really concerned about my gap and placed a spring to try and close it up. He said we will expand later and slower. So I feel better now. I hate that my teeth look like they are sticking out making it look like my chin has receded. They say this is normal, also I have a huge open bite now and cant close my mouth. I hate feeling so gross, I cover my mouth when I talk to my student's parents.
Thanks for the heads up on the food link. I am starving again... urghhh my OS said absolutely no soft food, all liquids!!! Now I have lost 10lbs, I am already small so cant lose no more.
I appreciate your insight and all your info. Thanks so much for responding.
Angela

If you lost 10lbs that mean you aren't eating all your calories needed. Try adding a boost or 2 per days and tofu or cottage cheese. Since the beginning of my surgery i lost only 3-4lbs even then i should eat more. I dont have any to lose myself i was at 143 - 145 now at 139 - 141. I drink special milk 2% with powedered milk and i drink a boost before going to bed and a prune juice to help with bladder problems. You have to eat more because you wont heal well if you dont feed properly. My diet is liquid to soft food. I can eat mashed vegetables like oven potato or canned carrot. I can also eat magic bulleted meat. Yesterday i ate pork chop passed in the blender with added beef juice with oven baked potato mashed with a fork and carrot. Needless to say that i cannot chew anything my OS warned me not to. So everything i eat goes directly in with no chewing. I can also eat spaghetti. Just cut it with a knife in small pieces and you can easily swallow it. I hope you get better and everything settles as planned.