Palate expansion (Jaw surgery soon)?

[LLJ]

Hi guys,

For around 10 months now, as an early-twenties male, for aesthetic purposes, I have been undergoing orthodontic treatment to straighten my teeth in preparation for jaw surgery. My orthodontist now thinks that I am more or less ready for the procedure.

The initial plan for my surgery was to merely advance my mandible and probably my chin, too. However, having done some research, I am wondering if more can be done (within the scope of this procedure) to maximise my results.

Although the orthodontic work has improved my smile, I am conscious that I have a relatively narrow palate. It is not horrendously narrow, but I do not show many teeth/much width, when smiling.

I understand that palate-expanding work can be done on the maxilla as part of the orthognathic procedure, but have read that this can be unstable (I have not yet asked my orthodontist about this, but I remember him mentioning that 'they' do not typically expand the palate as it can be 'unstable'. I assume he was talking about surgical work. At the time, I didn't think to ask any more questions) and the changes are only minimal relative to what is known as SARPE. I've only just begun to read about SARPE, but my cursory research suggests that it is both more stable and more effective. However, as far as I can tell, SARPE is a process unto itself, and takes a lot of time (and money!). I also wonder if SARPE is something that should've been done before beginning this procedure for my lower jaw (which undoubtedly needs to be advanced). That is not to say, though, that I would seriously consider SARPE, as I know I have to draw the line somewhere when it comes to accepting my appearance.

Hopefully you get a feel for what I want some advice on: Can the palate be reliably and significantly expanded via mere orthognathic surgery? Is SARPE something I should have done before this? What kind of commitment is SARPE relative to the 'standard' braces > orthognathic surgery > braces treatment?

Many thanks in advance for any advice.

[LLJ]

A further question has occurred to me: my orthodontist mentioned that impacting the maxilla often slightly widens the nose at its base and pushes the tip up. Is the same true when the palate is expanded via orthognathic surgery?

Thanks!

[jaime]

It's possible your surgeon didn't suggest SARPE in the first place because your upper arch already fits your lower arch correctly. You may not be a candidate for SARPE in that respect.

Above all, you should talk to your surgeon and/or orthodontist.

I have read a few jaw surgery blogs of folks who had SARPE along with Lefort I. Doublejawsurgery.com is one such blog and he is really good about answering reader comments.

I had SARPE at the very beginning of all my orthodontic work. I'm not sure SARPE by itself is ever performed later SPAM SPAM SPAMMING. If it is, I haven't seen anyone here or on a blog talk about it.

Stats about retention of palatal expansion in adults are a controversial topic but I can tell you that I spent exactly 2 years with the expander and later a transpalatal arch wire holding the expansion steady. Typically after Lefort I and/or BSSO, you'll be out of braces anywhere from 3-12 months later. It may impact the retention, I don't know.

As far as your commitment question...SARPE is sort of like the practice version of Lefort I/BSSO. It's very similar but not quite as intense and the recovery isn't nearly as long.

[LLJ]

Thanks for your helpful response jaime.

You are probably right about that - my arches are reasonably well balanced, as far as I can tell. The upper, though, is slightly more narrow. In that sense, the fact that a Le Fort I can only widen the palate a small amount (relative to SARPE) is probably okay, since I wouldn't need a lot of movement.

I am unsure, though, if my ortho/surgeon will recommend that we expand my palate that way, though, since my maxilla does not need work otherwise, and expansion is (as far as I can tell) the most unstable use of the Le Fort I. It might be a bit silly to go through a Le Fort I when a relapse is so probable.

I will of course take these considerations to my ortho/surgeon, I just want to be as well-informed as I can prior to our meeting.

Thanks again.