getting lefort 1 or a modification of lefort 3 after mse

Rigor Mortis

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@Surgerymax

Would there be cause for concern ? My thoughts are as follows : with mse u are expanding the palate and the nasal and zygoma areas sort of rotate or flair outward , and it’s all held together in place by this new bone growth in the middle of palate . Well, when u disconnect the lower portion of maxilla w lefort 1 , or cut the zygomas w a modified lefort 3, what’s to stop the areas from just returning to where they were ?? Sort of rotating back in a proximal fashion??? Then any benefit , aesthetically , of mse over sarpe would be null and void .. and how would u even secure the bone now that it doesn’t line up?

Any help w this one is appreciated I’ve been ruminating on it for a while now and wondering if it’s better for people to get mse then double jaw then a modification of the lefort 3 or to just go w sarpe since at least we know about it w long term studies , double jaw , and then custom silicone to grant horizontal width on zygoma as well as anterior projection .
 

Surgerymax

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The upper expansion from MSE will remain permanent with only a little bit of relapse after sufficient retainer period and bone remodeling regardless if the palate is disconnected during LeFort I surgery.

The bones that bent above (like the temporal bone bending) are not such elastic bones that they are waiting to snap back right there on the operating table or anything like that. Further, during LeFort I the bones will be fixated back to Lower maxilla. After a 6 to 12 month retainer period the new expanded form of the Zygomatic bones, upper maxilla and temporal bone are fairly intrinsic.

If you had LeFort I immediately after expansion then yes severe relapse may happen. MSE’s that are removed mid-expansion because of a complication show that the diastema can literally diminish before your eyes.
 

Rigor Mortis

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The upper expansion from MSE will remain permanent with only a little bit of relapse after sufficient retainer period and bone remodeling regardless if the palate is disconnected during LeFort I surgery.

The bones that bent above (like the temporal bone bending) are not such elastic bones that they are waiting to snap back right there on the operating table or anything like that. Further, during LeFort I the bones will be fixated back to Lower maxilla. After a 6 to 12 month retainer period the new expanded form of the Zygomatic bones, upper maxilla and temporal bone are fairly intrinsic.

If you had LeFort I immediately after expansion then yes severe relapse may happen. MSE’s that are removed mid-expansion because of a complication show that the diastema can literally diminish before your eyes.
Thanks , super helpful as always my friend . So people ought to wait a year post mse before doing osteotomies (post the actual distraction , in my mind I include the reconciliation process in the 12 months )
 

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Thanks , super helpful as always my friend . So people ought to wait a year post mse before doing osteotomies (post the actual distraction , in my mind I include the reconciliation process in the 12 months )
6 months is probably a safe minimum, 9 or even 12 would be bette
 

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The upper expansion from MSE will remain permanent with only a little bit of relapse after sufficient retainer period and bone remodeling regardless if the palate is disconnected during LeFort I surgery.

The bones that bent above (like the temporal bone bending) are not such elastic bones that they are waiting to snap back right there on the operating table or anything like that. Further, during LeFort I the bones will be fixated back to Lower maxilla. After a 6 to 12 month retainer period the new expanded form of the Zygomatic bones, upper maxilla and temporal bone are fairly intrinsic.

If you had LeFort I immediately after expansion then yes severe relapse may happen. MSE’s that are removed mid-expansion because of a complication show that the diastema can literally diminish before your eyes.
What is the best way to protract using a reverse pull head gear? Is it better to use multiple MSEs or to go for the full 12mms at once? What about a slower expansion like 2 turns per 3 days in order to fully utilize the loose suture?
 

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What is the best way to protract using a reverse pull head gear? Is it better to use multiple MSEs or to go for the full 12mms at once? What about a slower expansion like 2 turns per 3 days in order to fully utilize the loose suture?
What is the best way to protract using a reverse pull head gear? I don’t know very much about headgear but there is a face bow that doesn’t put pressure on the chin which seems favorable. Is it better to use multiple MSEs or to go for the full 12mms at once? If the palatal vault is too narrow to comfortably accommodate a 12mm Expander then it’s best to use a 10 or an 8. Most people aren’t able to expand the full 12mm anyway with their lower jaw as a limitation, even with a quad helix lower expander meaning the only way now is MSDO which may not be aesthetic. What about a slower expansion like 2 turns per 3 days in order to fully utilize the loose suture? That could have some effect but there isn’t enough research to say for sure and I’m not an MSE expert to be extremely confident in one hypothesis over ther other but 3 hypothesis could happen that I can think of:

1. Little or no advantage
2. Gain more forward movement
3. Gain more forward movement with more downward movement.

You may also find it interesting that sometimes Dr Ting who is an MSE expert has advised patients to do reverse turns to loosen the suture. So actually turning the MSE back
 
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elmoggerino

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What is the best way to protract using a reverse pull head gear? I don’t know very much about headgear but there is a face bow that doesn’t put pressure on the chin which seems favorable. Is it better to use multiple MSEs or to go for the full 12mms at once? If the palatal vault is too narrow to comfortably accommodate a 12mm Expander then it’s best to use a 10 or an 8. Most people aren’t able to expand the full 12mm anyway with their lower jaw as a limitation, even with a quad helix lower expander meaning the only way now is IMDO which may not be aesthetic. What about a slower expansion like 2 turns per 3 days in order to fully utilize the loose suture? That could have some effect but there isn’t enough research to say for sure and I’m not an MSE expert to be extremely confident in one hypothesis over ther other but 3 hypothesis could happen that I can think of:

1. Little or no advantage
2. Gain more forward movement
3. Gain more forward movement with more downward movement.

You may also find it interesting that sometimes Dr Ting who is an MSE expert has advised patients to do reverse turns to loosen the suture. So actually turning the MSE back
Well my mandible is slightly recessed so I am actually interested in IMDO. Btw why would it not be aesthetic? IMDO results tend to be incredible from what I have seen on the net. I have heard Ting speak about that, very interesting. The reason for my questions is that I am trying to avoid a bimax by doing the MSE+FM and an IMDO for the bottom.
 

Rigor Mortis

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What is the best way to protract using a reverse pull head gear? I don’t know very much about headgear but there is a face bow that doesn’t put pressure on the chin which seems favorable. Is it better to use multiple MSEs or to go for the full 12mms at once? If the palatal vault is too narrow to comfortably accommodate a 12mm Expander then it’s best to use a 10 or an 8. Most people aren’t able to expand the full 12mm anyway with their lower jaw as a limitation, even with a quad helix lower expander meaning the only way now is IMDO which may not be aesthetic. What about a slower expansion like 2 turns per 3 days in order to fully utilize the loose suture? That could have some effect but there isn’t enough research to say for sure and I’m not an MSE expert to be extremely confident in one hypothesis over ther other but 3 hypothesis could happen that I can think of:

1. Little or no advantage
2. Gain more forward movement
3. Gain more forward movement with more downward movement.

You may also find it interesting that sometimes Dr Ting who is an MSE expert has advised patients to do reverse turns to loosen the suture. So actually turning the MSE back
What rate of turning would be best in a surgically assisted mse case. ?
 

Surgerymax

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Well my mandible is slightly recessed so I am actually interested in IMDO. Btw why would it not be aesthetic? IMDO results tend to be incredible from what I have seen on the net. I have heard Ting speak about that, very interesting. The reason for my questions is that I am trying to avoid a bimax by doing the MSE+FM and an IMDO for the bottom.
Typo -
MSDO*

It's unlikely you will have a similar aesthetic effect to double jaw advancment without surgery.

Are you aware IMDO still requires a full-fledged jaw surgery and an osteotomy?
 

elmoggerino

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Typo -
MSDO*

It's unlikely you will have a similar aesthetic effect to double jaw advancment without surgery.

Are you aware IMDO still requires a full-fledged jaw surgery and an osteotomy?
I know IMDO is a surgery but afaik there are no left over plates when it's all done not to mention a mandibular surgery is always less invasive than a le fort surgery.
 

Surgerymax

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I know IMDO is a surgery but afaik there are no left over plates when it's all done not to mention a mandibular surgery is always less invasive than a le fort surgery.
There are metal plates attached to the distractors which are screwed in the bone in a similar manner and rods come through the gums into your mouth that require removal after distraction and a lengthy consolidation period.

The difference with a plated advancement is that the plates could just be left in if you aren’t up for a plate removal, but just like the IMDO could be removed later.

So that is no real advantage over the other.

It would be very interesting if you could advance your maxilla an aesthetically appreciable amount.

Facepulling in an adult without MSE does absolutely nothing. 0.0 millimeters advancment.

Facepulling with MSE can gain you one mm, two if you’re lucky and 3 if you are very very very lucky but that is highly unlikely. Maybe with your proposed protocol you could make the 2-3 mm the reliable standard. We will see.

But it’s important to understand orthodontist work in tenths of millimeters. To them, a mm is something to get excited about. But from a surgical aesthetic standpoint, that is not noticeable at the soft tissue level.

By all means, if an orthodontist will go along with your endeavor, try it and please report back. But realistically I think you will probably be underwhelmed friendly advice.
 
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The upper expansion from MSE will remain permanent with only a little bit of relapse after sufficient retainer period and bone remodeling regardless if the palate is disconnected during LeFort I surgery.

Would he not maybe be better off (or it’d just be easier) to do a three piece Lefort 1 to also expand the maxilla? Instead of MSE first followed by Lefort 1
 

Rigor Mortis

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Would he not maybe be better off (or it’d just be easier) to do a three piece Lefort 1 to also expand the maxilla? Instead of MSE first followed by Lefort 1
Three piece lefort is more comparable to sarpe in that it doesn’t do anything to zygoma . Plus it has a limit / ceiling of around 8 mm iirc which isn’t ideal for some patients
 

Surgerymax

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Would he not maybe be better off (or it’d just be easier) to do a three piece Lefort 1 to also expand the maxilla? Instead of MSE first followed by Lefort 1
Good question but no. Segmented LeFort I:
-is the least stable of all LeFort I variations.
-Does not provide higher expansion
 
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