SARPE Surgery

[goofylook]

Hi All,

This an awesome thread that was very helpful to me. So I thought to share my experience as well and hopefully I can get some tips as well as help others who are about to go through the same thing.

My story in short, I had my SARPE done on Jan 16th, 2013 so now it's about 50 days post-op. I feel very good, swelling all gone, still some numbness thou on my left lip and gum (alot milder than it used to be). I finished the expansion on Feb 28th, 2013 after 29 turns - 1 per day for the first 2 weeks and then 1 turn every other day for about a month (~7.5mm) and another 2mm in surgery. Everything looks good and both the surgeon and the orthodontist are happy with the results. I feel my upper jaw is HUGE!!! a lot wider and slightly forward than it used to be..

Yesterday Mar 5th, 2013 I got my braces on. Clear on top and metal on bottom and I gotta say it looks a lot better than I thought I would. The clear braces are barely visible. Now I m looking forward to move from looking like disney Goofy (tall slim and gappy teeth) to looking like my old self - hopefully with a lot better looking smile.

My question to the professionals and those who has been through this:
1) Isn't it pretty fast to get braces on and start moving the upper teeth just yet? I read stories of people waiting about 3 - 6 months after expansion to get their braces on?

2) How long is it gonna be till I get the gap closed? or at least to a point that is small (acceptable) gap?

I appreciate you all sharing you stories and looking forward to being an active member.

Regards,
Goofy LOL!!

[katsface]

Hi, Congrats on your surgery, and finishing expansion! I can't answer your second question (re how quickly the gap closes) because I'm not done expanding yet. But as for your first question, is it too soon to have braces put on, I had mine put on before surgery.

There was another poster in this thread named Brandy, I think, who had her braces on before surgery, and they started closing her up as soon as she stopped expanding.

I don't have an archwire on the top yet, but they're going to put one in as soon as I'm done expanding (I think they might wait a week or two.) In fact, they tried to put one on last week, and I had to remind them I just had surgery the week before, and I wasn't done expanding yet! haha They're more eager to get this show on the road than I am!

Seems like the treatment following SARPE is highly variable depending on what your surgeon and ortho are comfortable with. I've also read really different time frames for getting the RPE taken out. Some orthos do it in a few months and replace it with a TPA as a place holder. Other orthos seem to want to leave the RPE in for a full 6 months after expansion stops.

Anyway, like I said, it seems like your treatment will depend on your ortho.

[katsface]

I didn't want to watch any actual videos of the surgery beforehand, because I know it would freak me out. But I was really curious how a SARPE differed from a regular LeFort One. So I did a little searching and found this EXCELLENT explanation/illustration of the commonly used technique (the one I believe was used in my case).

I wanted to make it available to anyone who is interested in what's actually being done in the operating room, without it being gory. These are nice, sterile, illustrations of the bones involved. If you're not too squeamish, it probably won't freak you out.

https://www2.aofoundation.org/wps/porta ... 0281404005

[goofylook]

katsface.. thanks for your reply. Yeah I keep hearing different things, so I m just gonna trust my ortho I guess. My issue is I had braces when I was a teenager and they aligned the teeth but my ortho then didn't expand the palate (so pissed off!!) so now I have to go through this whole thing again but this time I m asking all sorts of questions and checking up on things - bad experience I guess. I reminded my ortho that the bones didn't quite healed up yet and he told me that this is a light wire to get things moving. He also assured me that he break my bones in the process . So also said that my upper teeth should be moving faster than usual because of the surgery and he would like to take advantage of that so he scheduled a check-up after 3 weeks rather than a month to tighten the wire I guess.

Also, thanks for much for that link, it is AWESOME explanation of the surgery I had. It was kinda confusing to me the difference between SARPE and a LeFort-I initially but I've done tons of research and asked tons of questions to orthos and surgeons to clear up the differences. Matter of fact, one of the orthos I consulted wanted to do a LeFort-I osteotomy rather than SARPE. I tell ya it sounded very appealing given that there is expander and all. But I couldn't get passed the fact that there will be screws in my head forever. So I took the route of 6 months (hopefully less) of hardship than screws forever.

Now, I m going through this the expander is not really bothering me much. I kinda got used to it being there, still I m looking forward to get it out but not because it is annoying but because it will make me feel that I m moving forward in the process.

Cheers,
Goofy

[katsface]

So also said that my upper teeth should be moving faster than usual because of the surgery and he would like to take advantage of that so he scheduled a check-up after 3 weeks rather than a month to tighten the wire I guess.

Before I knew I needed SARPE and BSSO I was actually looking into 'Wilckodontics' which is a surgery that involves scoring your jaw where the teeth are. It weakens the bone, and allows the teeth to move faster. So, I guess the same kind of principal applies after any kind of jaw surgery.

Also, update on my nose, I now officially like it more than the nose I started with. Please stay where you are nose!

[goofylook]

I did also consider "Wilckodontics" but I didn't want to pay the price. No insurance coverage and basically double the treatment cost.

Speaking of nose, I can breathe a lot better now which is one of the main reasons to do the surgery.

Cheers,
Goofy

[slb1982]

Kat - I'm SO happy to hear the screw in your expander was just stuck! Hopefully your expanding is going along smoothly now. This is my 12th day post op and my upper lip and nose are still slightly puffy so I'm still feeling anxious for my nose to return to normal. Probably not many people could notice a different in my face except me though at this point. My 6mm is gap is definitely much more noticeable than my nose/facial puffiness. I've only got about 2 more days to crank, though, and then I'll be done expanding to 7mm.

Goofylook - In regards to your question, my situation was similar to katsface. I also got my braces on before surgery. My SARPE surgery was February 26th and I got braces on both my upper and lower teeth about 5 weeks prior (on January 21st). I got clear on top and metal on bottom. They didn't move my teeth at all before the surgery - I think my orthodontist just wanted them on so the expander could be molded around them and also so my teeth would get used to them? (and maybe help my teeth start to loosen a little bit?). I started cranking the expander on the day of my surgery (surgery was at 10am, surgeon cranked it once during surgery, and my husband cranked mine for the first time that evening before bed). I've been cranking twice per day since, and will be at my 7mm expander on the 14th day. (1 crank = 1/4 mm, so every day I get 1/2 mm). Right now I'm at day 12 post op (6mm gap), and I go to my orthodontist on the 14th day (right when I get to 7mm) to get the continuous archwire on my braces so that the gap can start to close immediately. Hope this helps. I'm thinking that might be a bit soon, but it's the only day my orthodontist will be in the office next week since it's spring break :/ So I guess I'd rather have the gap start to close than have to wait longer... I'm getting a little tired of hiding at home.

Kat - Thanks for posting that link! That looks like exactly what I had done - My oral surgeon technically did a LeFort 1 (not a "SARPE") - although I'm having trouble figuring out what exactly a SARPE is (since it apparently isn't a LeFort). lol. and now I'm actually more confused - Goofylook, could you explain more about there being screws involved in a LeFort? or did I read your post wrong? I had a LeFort and don't have any screws. Just stitches and an expander. If anyone could explain the difference between a SARPE and a LeFort 1 I would really appreciate it.

[katsface]

Kat - Thanks for posting that link! That looks like exactly what I had done - My oral surgeon technically did a LeFort 1 (not a "SARPE") - although I'm having trouble figuring out what exactly a SARPE is (since it apparently isn't a LeFort). lol. and now I'm actually more confused - Goofylook, could you explain more about there being screws involved in a LeFort? or did I read your post wrong? I had a LeFort and don't have any screws. Just stitches and an expander. If anyone could explain the difference between a SARPE and a LeFort 1 I would really appreciate it.

According to that article I linked to, the difference is a 'down fracture' is done in a LeFort 1 and not for SARPE. As far as I can tell, that means in a SARPE surgery, they split the bone across the top, but they don't pull it completely down off of the rest of the jaw. In a Lefort 1, I think the bone is pulled down and completely separated from the skull. Also, there's no expander involved with a Lefort 1. All of the expansion happens durring the surgery. The jaw can be altered in other ways, too. Like they can remove excess bone from the top of the jaw to reduce a gummy smile. Or they can bring the whole jaw forward, or backward. After everything is in position, it's fixed together with plates and screws.

In a SARPE, there are typically no jaw movements. The jaw is cut in the same style as a Lefort 1, apparently, but nothing is removed, or shifted (although I suppose some surgeons may want to preform other movements while they're in there, and do like a combined SARPE/Lefort? That's just a guess, though). There are no fixation screws and plates, because the bone needs to be able to move while you turn the expander.

I think in the past SARPE may have been done differently. I've read some people say they only had one incision, and that only the palate was split. Maybe some surgeons still do it that way? But is seems like the common method is to do it like a modified Lefort 1. Maybe that's what your surgeon meant when he said he actually did a Lefort 1.

Anyway, they look REALLY similar from all of the illustrations I've seen.

Oh, BTW, my expansion has been pretty smooth since they loosened the expander for me. It was still pretty tight for a few turns, but it's been pretty easy to turn the last couple of days.

I did hear/feel a crack-pop last night when I was trying to sleep. It was accompanied by a sharp pain, but the pain subsided after a few minutes. I really don't know what happened. I have a bonded expander. Instead of molar bands, it's got acrylic that covers my teeth from my bicuspids all the way back. Something like this:

My canines aren't covered by the acrylic, but they did get stuck to the expander with cement when they installed it (IE I can't floss between my canines and the expander, b/c of the cement). But this morning when I woke up my left canine was partially released from the expander. Maybe that was part of the noise I heard. But the pain/cracking feeling didn't feel like it was coming from there, if felt like it was in my sinus or palate somewhere. I don't know what's going on, but I feel mostly fine today, so I'm going to try not to sweat it.

I'm glad your expansion is going well, and is almost over!! Please keep us informed about how quickly your gap closes!

[slb1982]

Kat - thanks! What a great explanation. I will assume then that I had a SARPE that was just cut like a Lefort I do know for sure that I had 3 cuts made (two on the sides and one in the middle). And also I'm using the expander, so I guess I didn't have a real LeFort since they didn't do the whole expansion during the surgery (Makes me wonder why my insurance paperwork calls it a Lefort 1 if it's actually a SARPE). Confusing, huh? Thank you! Oh, how many mm were you at with your gap when you heard the pop? I've read about others having a similar pop-sound, but I haven't had that. Also, I don't have the bonded-type expander like you showed. Mine doesn't have that acrylic over the teeth. I'll upload a picture of the inside of my mouth/my expander whenever I finally have made 7 posts and am able to do that

[goofylook]

katzface did a fantastic job explaining the difference. The only thing I would like to add is that a LeFort is a fracture of the skull. There are 3 types of LeFort; LeFort 1, 2, and 3. Here is a link to read more and see the fracture line for each LeFort:

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.

Here we are talking about two surgeries (SARPE and LeFort 1 osteotomy) which both include fracturing the maxilla on the LeFort 1 line. It 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.

So to answer your question, slb1982, the insurance paper doesn't say SARPE because the surgery you are getting is basically a LeFort 1 fracture.

Hope this help
- Goofy

[slb1982]

Goofylook - THANK YOU! Between you and Kat it now makes complete sense to me. I had looked online a lot and hadn't found anything that explained it as well as you both have described. I hope your posts come up in searches for people who are looking for info on SARPE vs. LeFort.

Quick question for anyone who was gone through this SARPE surgery before - I'm 2 weeks post op and still having a lot of trouble opening my mouth very wide AT ALL. I tried to eat a small fork-full of cake last night and couldn't even open my mouth wide enough to get it in my mouth. It seems to be that my jaw joints are extremely tight. That has actually been my biggest problem with expansion. Cranking the expander doesn't hurt (just a bit of pressure), but it does hurt my jaw joints every time I try and open wide enough for my husband to crank it. I try warming my face and doing stretching excercises with my face and it seems to help temporarily, but then when I go to try and open my mouth later in the day its like it has seized up and won't hardly open much again. I'm wondering if my surgeon over-extended my jaw during surgery or something because I have such a small mouth. Has anyone had this problem? If so, how long before your jaw seemed to open a normal amount again? Thanks to everyone who posts on this forum!

[Vantwins]

slb - sounds like you are recovering really well! I'm so jealous actually that you've done so well. My recovery was way worse than I expected. Although I also have 3 young children I was trying to still take care of, so I'm sure that's part of the problem! We are going to figure out some sort of live in childcare help before my double jaw surgery. The swelling and your nose will get better for sure! Hang in there.

Kat - phew, so glad they "unstuck" your expander!

I've got another follow up with my gum doctor tomorrow. If all is well, I'll get my top braces on (back on!) on Monday. I'm excited for that. My gap has come together alot on it's own at this point, but it still looks like a crooked mess! Then I've got my next gum grafting on 4/12. Now that I can eat normally, I've been eating a TON, so it probably won't hurt to be back on mush for a few days after the grafting.

Otherwise, I've got to tape a video of me teaching step to get officially certified to teach and I'm planning a fun luau party for my twins' 7th birthday in a few weeks! We are also going to FL for a few days soon and I'm so excited for some sunshine (hopefully!).

Vanessa

[MissMelissa]

cru199nine your post was SO helpful for me!! I had a one sided expansion done, the surgeon said my upper jaw was underdeveloped on just the one side. I also had stitches on the roof of my mouth and I also had a tooth drop down lower which looks terrible and totally gets in the way. I was also really worried about it but they said I'm going to "see some changes"...no kidding! My surgery was over 3 weeks ago and I'm feeling pretty good. I find I'm in a bit of discomfort when I wake up in the morning because I can't sleep on my back the whole night. I have a sharp pointy thing sticking out of the roof of my mouth. The surgeon said its either a stitch or a little chunk of bone. I'm going to ask the orthodontist when I see him in a few days.

I must say having the expansion has been great for weight loss! I finally have the flat stomach I always wanted! LOL! But looking like a hillbilly with this giant gap does kind of take away from it ahahaha.

Its so nice to hear other peoples stories going through the same thing

[ddr84]

I must say I am feeling a bit better about my upcoming journey reading all of your posts.

I am just starting out; I have TMJ along with a narrow palate and a crossbite. My surgeon requested an MRI which I received Friday. That was an interesting experience in itself, as I had to use an awful contraption to pry my mouth open as far as it would go (which isn't far anymore due to the TMJ) without moving my head!

I am now waiting to hear from my surgeon. I am looking forward to moving ahead with this process and being able to live my life pain-free, even if it means I have to go through the SARPE experience. Thanks to all of you for posting regarding your experiences!

[lizart]

Wow!!! This thread has been extremely helpful especially the links to explain the surgical procedures. Thank you, thank you, thank you! I have been in braces since Jan 3, 2013, and am seeking opinions about the necessary surgical interventions. SARPE seems unavoidable, one surgeon is advising both SARPE and Laforte... two seperate surgeries! Yikes!!! Perhaps both upper and lower jaws will need to be altered. I'm seeking one last opinion in April before I commit. I feel as if I can ask even more intelligent and informed questions after reading postings by Goofy and Kat thanks for doing the heavy lifting, I truly appreciate your research. Liza