SARPE Problems/Le Fort Solutions

[Ruby79]

I had the SARPE surgery two months ago. Apparently, during this process my mouth overexpanded on one side and the teeth "tipped" - they shifted outwards and raised about 1/4 of an inch higher than the teeth on the other side. Rubberbands didn't bring that side down, so my doctors actually took out my RPE device (4 months ahead of time) in hopes that I would have relapse. Alas, I'm a super quick healer, and the bones have healed and won't move. Now, my orthodontist is saying she thinks I will need a LeFort 1 to fix the side that has gone higher and out. All this in mind, I have a few questions:

1) Has anyone had this problem with the teeth going upwards with SARPE? If so, how long did it take to fix and how was it fixed?

2)What is the recovery like for a LeFort 1 only? Most of the posts I've seen are from people who are also getting BSSOs or genioplastys. I'm curious what the comeback looks like solely for a LeFort i.

Thank you1

[goku]

Hi Ruby79,

I am pretty much going through the same problem. During the expansion phase, my left palate expanded more than my right. My teeth tipped as well but I am unsure of how much. I can see that there is a tilt going on. I am still in rubber bands and praying it fixes everything. I looked into how it's fixed and a Lefort 1 is required.

It has happened to others as well. Here is a documented case on allexperts. http://en.allexperts.com/q/Oral-Surgery ... ansion.htm

Here is the results of braces and rubber bands: http://en.allexperts.com/q/Oral-Surgery ... ansion.htm

He went back for a 2nd surgery and here's the result contrasted with other results: http://0.tqn.com/w/experts/Oral-Surgery ... arison.jpg

Did your expansion look similar to his?

[sirwired]

LeFort I - only recovery appears to be a lot easier than Double-Jaw. Speaking for myself, I had a splint wired to my upper archwire (this was a plastic plate that was designed to mold to the post-surgery-state (created by cutting up the final pre-op models and moving them around) that sits underneath the top arch, with a ridge on the underside for the bottom arch to rest in.) For bands, I was on the lightest rubber bands I ever had; it was just enough to remind my mouth to close.

I was back at work in two weeks, but that splint was in for nine. (Should have been six, but I have very thin, slow-to-heal bone, so it took me longer.)

There was not the problems with drooling and dribbling reported by BSSO patients. Just the normal incredibly cracked and dry lip (from being stretched so much during the OP.) This made drinking a lot easier. I was on liquid for just a little while, and then "no more chewing than scrambled eggs" after that. The worst part was the fact that the splint was impossible to clean well. Blech.

[Ruby79]

Goku - Yes, my experience is similar to the guy in the picture, although I'm not dealing with as much facial asymmetry as he is.

Sirwired - was the splint visible? Did it hinder your speech? I'm a professor, so I must speak clearly.

Thank you for responding!

[sirwired]

The splint was not visible, but it did hinder my speech slightly. But I was perfectly understandable if I annunciated.

[denox9]

Hi Goku

I know this post is old but I wondered if you could share how things developed for you afterall.

I had SARPE 5 weeks ago and at week 4 I noticed my right side only expanded and now the incisive is tipping forward and it looks as if the right side of my jaw has lowered. it is asymetrical expansion and I noticed the expansor seems only to push one side and one of the screws seems to be loose. I am seeing the surgon tomorrow - I was due to end my expansion in 3 days but the surgeon asked to stop until he has seen me tomorrow. I am very scared this asymetry and tipping and lowering are going to be permanent and I fear I am not going to get results I wanted.

I have a class 3 underbite and upperjaw crowed and small hence my plan has been SARPE then ortho to fix upperjaw and then DJS to fix the underbite. My orthodontist told me braces should be put in the second week of Feb.

Any help please from people with the asymetric expansion or that might know more then me about this.

Thanks

[Carno]

Hi Goku

I know this post is old but I wondered if you could share how things developed for you afterall.

I had SARPE 5 weeks ago and at week 4 I noticed my right side only expanded and now the incisive is tipping forward and it looks as if the right side of my jaw has lowered. it is asymetrical expansion and I noticed the expansor seems only to push one side and one of the screws seems to be loose. I am seeing the surgon tomorrow - I was due to end my expansion in 3 days but the surgeon asked to stop until he has seen me tomorrow. I am very scared this asymetry and tipping and lowering are going to be permanent and I fear I am not going to get results I wanted.

I have a class 3 underbite and upperjaw crowed and small hence my plan has been SARPE then ortho to fix upperjaw and then DJS to fix the underbite. My orthodontist told me braces should be put in the second week of Feb.

Any help please from people with the asymetric expansion or that might know more then me about this.

Thanks

I had asymmetric expansion with my Lefort 1 maxillary osteotomy with SARPE. In my case, the surgeon performed the surgery, inserted the palate expander, and then expanded my upper jaw by about 7 turns. Following my surgery, I was to wait 3 days, then begin to crank the palate expander a few turns each day for about 2 weeks (maybe less, I can't remember). My orthodontist put braces on after the expansion was complete.

Within a few days I noticed that my jaw was not expanding symmetrically, with my right jaw moving out and up, and my left side remaining in place. The surgeon asked my orthodontist to put rubber bands in to try to pull my upper jaw over, but the rubber bands had no effect. In the end, my teeth only touched on my left side, and I had about a 2mm gap between my molars on my right side. I found this very frustrating to eat like this, and basically only chewed with my left side teeth for about 2 years. Visually it was not noticeable at all, so that was my only saving grace.

I just had my second surgery, and my surgeon corrected the upper jaw and moved it around so that it matches my lower jaw. I was supposed to have both upper and lower jaw surgery, but during the surgery apparently I was only 1.5mm off with my lower jaw, so the surgeon made the decision to NOT operate on my lower jaw. He was going to slide it forward by about 4mm, but I guess it did not need that much after all. I'm not exactly sure why this all happened, he showed me the models and told me all about what he was going to move and how far he was going to move it. Following the surgery, I was initially upset (during the first week), but as my healing has progressed, I'm okay with him not moving my lower jaw forward. At the very least it made for an easier recovery.

Bottom line is that if you have asymmetrical expansion, the only fix is surgery. After 3 weeks, the bone begins to connect itself together, and after 6 weeks, it is fully fused. There may have some possibility of moving the upper jaw during the first week or two, but after 5 weeks your jaw is certainly almost fused in place.