I'm a bit confused here.
I'm in braces for 8-10 months before I go in for surgery for a class III cross bite. I should have clarified with the surgeon, but I think he said that he would have to see how much expansion I need after everything is lined up because he won't do a Lefort for anything that needs more than 5 mm. In that case it would be SARPE. Makes sense. The confusion lies in that I'm pretty sure he said I would have to come back later for Lefort and BSSO to finally line everything up.
Does that sound right? Or is it SARPE in place of Lefort? I know I need the BSSO due to my asymmetric lower jaw. I'm also a bit confused because it seems most people get who need SARPE get it before the braces go on. Seems like it will be more time and work to get braces for a year, get SARPE done, fiddle around more and get lefort after.
Has anyone else gone through this?
Anyone else: Surgeon said maybe SARPE and Lefort after?
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Re: Anyone else: Surgeon said maybe SARPE and Lefort after?
Hello!
I have been in braces for 6 months now and may also have SARPE later, but I am not sure about this yet. So you are not the only one with braces before SARPE!
I have been in braces for 6 months now and may also have SARPE later, but I am not sure about this yet. So you are not the only one with braces before SARPE!
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Re: Anyone else: Surgeon said maybe SARPE and Lefort after?
Yes, this is normal. They never do a SARPE and Lefort together.
Re: Anyone else: Surgeon said maybe SARPE and Lefort after?
SARPE and a full LeFort I achieve two very different kinds of expansion. SARPE opens the palatal suture and "levers" the two halves of the palate apart from each other and the jawline bone kind of "stretches" so while there is a tooth gap, you don't have a bone gap. It can't really do any fine alignment work, and can't move anything forwards or backwards.
The LeFort I detaches your entire arch from your skull bone and then it is usually cut into more than one piece and then put where the surgeon needs to put it. If the pieces are moved too much, the bone may not bridge the gap with a mass of usable bone.
In my case, I needed expansion at the rear, and none at the front, along with asymmetrical movements; a SARPE, while less traumatic, would not have been appropriate.
The LeFort I detaches your entire arch from your skull bone and then it is usually cut into more than one piece and then put where the surgeon needs to put it. If the pieces are moved too much, the bone may not bridge the gap with a mass of usable bone.
In my case, I needed expansion at the rear, and none at the front, along with asymmetrical movements; a SARPE, while less traumatic, would not have been appropriate.
Re: Anyone else: Surgeon said maybe SARPE and Lefort after?
Excellent posts guys thanks a lot. Glad to know I'm not the only one. And thanks for that great explanation. I didn't know there was no bone gap!
Re: Anyone else: Surgeon said maybe SARPE and Lefort after?
I know this is a little old but I'm facing a similar situation and thought I would throw in my two cents.
Lefort can be used for different kinds of movement in addition to expansion, whereas SARPE is just for expansion. If they need to move your jaw forward, up, back or correct a slant, that's what a Lefort is for. They probably can't do this kind of movement at the same time as the SARPE because after this movement, they need to stabilize your jaw in its new position with plates and screws. If they did this in conjunction with a SARPE, the force from the expander would either damage the screws and move your new position out of place, or your jaw would not expand because it was screwed in place.
If you only need a little expansion, they can expand your jaw with a Lefort too. If that's the case I think they can do all of the movements at once since everything gets screwed in place and there's no force/expansion needed from an expander.
But, it seems like they'll use SARPE first if you need a lot of expansion. Then, if you need additional movements (like I apparently need my upper jaw impacted... or moved up) they will do that after your jaw has heeled. Hope that makes sense. As always, if I got this wrong someone please set me straight!
My SARPE surgery was almost exactly the same as a two piece Lefort 1 except there were a couple of small areas where the bone was not released from the skull, and there were no plates and screws. I did have a bone gap. At least, whatever bone was filling in was very soft, fresh, new bone. I expanded 13mm over a month, and I could feel the suture line and between my teeth was much softer until new bone filled in the gap. I think some of this is the preference of the surgeon, and some might be what the case demands? Your surgeon will be able to tell you exactly what they plan on doing though.
Lefort can be used for different kinds of movement in addition to expansion, whereas SARPE is just for expansion. If they need to move your jaw forward, up, back or correct a slant, that's what a Lefort is for. They probably can't do this kind of movement at the same time as the SARPE because after this movement, they need to stabilize your jaw in its new position with plates and screws. If they did this in conjunction with a SARPE, the force from the expander would either damage the screws and move your new position out of place, or your jaw would not expand because it was screwed in place.
If you only need a little expansion, they can expand your jaw with a Lefort too. If that's the case I think they can do all of the movements at once since everything gets screwed in place and there's no force/expansion needed from an expander.
But, it seems like they'll use SARPE first if you need a lot of expansion. Then, if you need additional movements (like I apparently need my upper jaw impacted... or moved up) they will do that after your jaw has heeled. Hope that makes sense. As always, if I got this wrong someone please set me straight!
My SARPE surgery was almost exactly the same as a two piece Lefort 1 except there were a couple of small areas where the bone was not released from the skull, and there were no plates and screws. I did have a bone gap. At least, whatever bone was filling in was very soft, fresh, new bone. I expanded 13mm over a month, and I could feel the suture line and between my teeth was much softer until new bone filled in the gap. I think some of this is the preference of the surgeon, and some might be what the case demands? Your surgeon will be able to tell you exactly what they plan on doing though.
Treatment-
- Braces: In-Ovation L (lingual) on top, and In-Ovation R (metal) on bottom
- SARPE
- BSSO advancement
- estimated 18-22 months
- Expander installed Jan 14th 2013
- Surgery Feb 18th 2013
- Turn 26 days to 13mm. Gap between teeth maxed out at 12-13mm.
- Gap down to 7mm Apr 18
- Gap Closed Aug 6
- Expander out Sep 19
- Insurance approved, surgery scheduled for Dec 18!
Re: Anyone else: Surgeon said maybe SARPE and Lefort after?
Thanks for your reply.
Wow 13 mm!! That must have been a serious gap. I'm nowhere near that. I think that's what's making me nervous. I'd hate a few mm to make the difference between two surgeries or one.
I mentioned to the ortho that the surgeon said if I needed more than 5 mm I would have to do SARPE too and she looked around in there, thought about it, and said "you know I'd be surprised if you needed it".
So that's at least somewhat positive though by no means exhaustive
.
Wow 13 mm!! That must have been a serious gap. I'm nowhere near that. I think that's what's making me nervous. I'd hate a few mm to make the difference between two surgeries or one.
I mentioned to the ortho that the surgeon said if I needed more than 5 mm I would have to do SARPE too and she looked around in there, thought about it, and said "you know I'd be surprised if you needed it".
So that's at least somewhat positive though by no means exhaustive
.