SARPE
I am doing SARPE. This morning I had my consultation with my oral surgeon, and we decided that SARPE is the way to go. Which is to say, I went in expecting we would do SARPE, and he said that we could do it, although I am close enough to having a half-decent occlusion without further expansion. The idea of no more expansion is tempting, but I want to get my palate wider for better tongue posture, more upright molars, and get still more airway expansion. He was fine with that, he said that I would still get more benefits from continuing the expansion.
He said a few interesting things. He mentioned that some people are scared of surgery and want to go the non-surgical route, but that can put them in a situation where they will need surgery if something doesn’t work. That is basically what I said in my previous blog post about what I consider MSE’s biggest risk. I mentioned I had blogged about how SARPE needs to be considered at the start of MSE as a back up, he said that was the best thing he had heard in a while about MSE. I assume he meant from a patient, but it was nice to have confirmation that I have my head in the right area. He also briefly mentioned that we need to factor in all dimensions and not just think laterally. MSE and SARPE can lead to minor maxillary advancement, downward rotation, can result in a transverse twist or yaw if something goes wrong. My main concern right now was about the possibly of unequal forward movement or yaw because of one-sided expansion, so it was comforting to know that my surgeon is taking that into consideration. In a way I assume that he would, but it is good to hear it.
Get Class 3 MSE’s stories in your inbox
Join Medium for free to get updates from this writer.
The SARPE procedure he described to me is basically the one I was hoping for. He will open up the gums at the front, and then do a surface cut on the maxilla above the teeth and gumline from the very front all the way to the back, and then detach the septum. He said he will also do the cut down the suture, even though there has been some separation from the MSE. My wisdom teeth will not have to be removed, and there will not be any pterygomaxillary disjunction. If you are wondering what that is, the surgeon uses a curved chisel to cut the bone behind the molars to separate the maxilla from the rest of the skull. That cut is done without the surgeon seeing what they are doing, so they have to be very careful to not cut blood vessels and nerves. So doing it without means that I keep my wisdom teeth and really lower the risks.
We also briefly discussed maxillary advancement and double jaw surgery. He said that some people don’t get enough expansion from SARPE alone, so they have to do jaw advancement. I knew that. He said that if I only need the upper jaw advanced then I don’t need my wisdom teeth removed, the upper jaw can move with them in. it is the lower jaw where the cut for advancement is done where the wisdom teeth are. The lower teeth need to be removed a year in advance so there is sufficient bone there.
I have decided to wait until the expansion phase is done before making a final call on double-jaw surgery, but I am 95% sure I won’t have it done. The risks and long-term changes to my face are tough to accept, and taking out a large chunk of time from my life now is hard to do.
In a bit I’ll do another post where I speculate on how doing SARPE after MSE will affect the pattern of expansion, both dentally and nasally. I will also do a post about jaw advancement at some point.
