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Jaw Surgery



pasha
1

Jaw Surgeries and orthodontic expanders for sleep apnea purposes are very complex topics with many approaches and branches with slight variations. A lot of procedures are relatively new, used by only a few doctors. Procedures frequently go through refinement over time, sometimes getting new names. There does not seem to be a good central repository of all the possible surgeries and variations, which makes communication somewhat difficult. I am mainly considering the purpose of surgery being improvement in sleep apnea, sleep breathing as well as some potential postural and symmetry benefits. There are frequently aesthetic benefits (or looksmaxxing) to jaw surgeries or post / pre surgery teeth alignment work, however I don’t focus on those.

Of the good type of surgery and devices that are worth considering there are several commonalities. Generally, they target either low or upper jaw being either too narrow or too far back. It is common for the width of one’s jaws to match and therefore both be too narrow, necessitating a plan for both jaws to maintain long-term teeth alignment.

Tongue tie release

Tongue ties can prevent the tongue from properly reaching the upper palate. An adult tongue tie release surgery may or may not help with this problem.


Surgically Facilitated Orthodontic Therapy (SFOT)

Surgically Facilitated Orthodontic Therapy is generic name. However, in practice it usually refers to a procedure that “packs bone” onto the jaw, thus is capable of extending it a few millimeters as well as strengthening the bone. The teeth then can be safely moved in the desired position and tooth movement can also occur faster. Teeth can be moved using a fast Invisalign or an SFOT-specific device. Generally, the benefits of SFOT are said to be faster orthodontic outcomes, however in my view avoiding tooth extractions is likely the main benefit, as well as potential for safe movement of the teeth forward a few millimeters.

Lower Jaw Sideways Expansion Osteotomies (MSDO / DAME)

Mandibular Symphyseal Distraction Osteogenesis (MSDO) and Distraction Assisted Mandibular Expansion (DAME) are a single cut to the middle or close to the middle of your jaw.

After MSDO / DAME cut to the lower jaw, it’s followed up by an expansion using a device. I expanded the device around 8 mil, which made my lower jaw actually wider than the upper jaw (until I got the MSE). Preparing for surgery may need to do some orthodontic work. For example, I had to do Invisalign for 10 months in order to separate the two front teeth’s roots and simplify the surgical procedure. This is one of the least invasive ostetomies. 

Upper Jaw Sideways Expansions ( SARPE/ DOME / DONE / EASE)

This is a class of procedures used to help expand the upper jaw sideways. Ideally used with an MSE-style mini-screw appliance.

Surgically Assisted Rapid Palatal Expansion (SARPE) is the oldest and most invasive version and is likely not needed anymore. While it’s possible to use it with a tooth-borne appliance, the overall invasiveness is much higher and results are likely similar

Distraction Osteogenesis Maxillary Expansion (DOME) is the newer version of SARPE which makes fewer cuts. See also 

DONE is the version of DOME, which aims for nasal expansion as well. Many of the procedures mentioned aim for nasal expansion, so the differences are likely minor.

Endoscopically-Assisted Surgical Expansion (EASE)
Endoscopically-Assisted Surgical Expansion (EASE) by Dr Li is another procedure claiming to make fewer cuts than other surgeries, which uses a custom expansion device rather than a standard MSE. It claims to have better recovery time than other techniques and smaller eventual gab between the front teeth and therefore a smaller tooth movement required to close it.


Double jaw surgery / Maxillomandibular advancement (MMA)

Maxillomandibular advancement (MMA)  is a combination of Lefort 1 Osteotomy for the upper jaw and Bilateral Sagittal Split Osteotomy (BSSO). The upper jaw is cut from the rest of the skull and then held in place using either plates or wires. The lower jaw is cut on both sides and moved forward after which it’s help together by screws and/or plates. See image Both components of MMA are quite invasive. As a whole MMA is one of the most invasive jaw surgeries with a very long recovery time. It is highly worth exhausting all available alternatives, both less invasive surgeries mentioned here, various devices, night-time devices, Neuro-Cranial Restructuring and postural correction, before coming to this path.

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2022/09/21