3 piece le fort vs marpe - need advice

[bonesymmetry]

I’ve had a few consults with maxillofacial surgeons and they’re all pretty aligned on the main movements:


- 6mm advancement of maxilla and mandible
- 3mm genioplasty setback
- 6mm maxillary expansion

However one surgeon wants to just handle it with a 3-piece segmental Le Fort during surgery to get the expansion. While the other surgeon said I could do marpe and then surgery after, but that would obviously delay everything.

my main concern with marpe is potential aesthetic changes. i’ve heard it can affect things like ipd/harmony, even if it provides better skeletal expansion. trying to figure out if that risk is worth it. Would like to hear thoughts

 

[lurking truecel]

why would you even go thru the hustle of jaw surgery, wasting years for nothing in terms of aesthetics for you. Since it wonr change your front at all

 

[bonesymmetry]

why would you even go thru the hustle of jaw surgery, wasting years for nothing in terms of aesthetics for you. Since it wonr change your front at all

I can’t fit my tongue on my palate, and i also have uars and my right tmj is displaced without reduction from my jaws being uneven with each other - maybe these pics don’t do enough justice but i am quite recessed as well

 

[lurking truecel]

I can’t fit my tongue on my palate, and i also have uars and my right tmj is displaced without reduction from my jaws being uneven with each other - maybe these pics don’t do enough justice but i am quite recessed as well

who said your tmj are displaced ? For injury or what? They are not, you just got regular assymetry in the jaw. Surgeons allways say they have control over the condyles in surgery but they dont, since it will allways remodel ans place where it wants itself. If amything you risk getting reduction or you will for sure get some reducrion(the inevitable reduction phase) with bimax. Tmj treatment with bimax is a stupid idea even if it can help if the bite is extremly off.

Your tongue wont have more space with three piece, not noticably esp since it often relapses to a big degree and is only posterior. A anterior expansion from mse could improve space but you would need to go beyond the aesthetic limit to get noticable tongue space improvment. But to be fair you peob just have seen to many mew coping shit vids so your brain is rotted and think your tongue is trapped

 

[bonesymmetry]

who said your tmj are displaced ? For injury or what? They are not, you just got regular assymetry in the jaw. Surgeons allways say they have control over the condyles in surgery but they dont, since it will allways remodel ans place where it wants itself. If amything you risk getting reduction or ypu will for sure get some reducrion with bimax. Tmj treatment with bimax is a stupid idea even if it can help if the bite is extremly off.

Your tongue wont have more space with three piece, not noticably esp since it often relapses to a big degree and is only posterior. A anterior expansion from mse could improve space but you would need to go beyond the aesthetic limit to get noticable tongue space improvment. But to be fair you peob just have seen to many mew coping shit vids so your brain is rotted and think your tongue is trapped

i got an mri done and they found it’s displaced anteriorly without reduction. my max opening is 20mm, im scheduled for an arthroscopy next month to improve range of motion and stabilize the joint.
I am aware double surgery can either make the joint worse, better, or the same. That’s why surgeon #2 would rather me do marpe instead of a segmental cut to reduce the relapse risk.
Also, I’ve never been able to comfortably rest my tongue on the palate my tongue is too big for it

 

[lurking truecel]

i got an mri done and they found it’s displaced anteriorly without reduction. my max opening is 20mm, im scheduled for an arthroscopy next month to improve range of motion and stabilize the joint.
I am aware double surgery can either make the joint worse, better, or the same. That’s why surgeon #2 would rather me do marpe instead of a segmental cut to reduce the relapse risk.
Also, I’ve never been able to comfortably rest my tongue on the palate my tongue is too big for it

yea a arthoscopy makes more sense. I mean marpe is better for function. Segmental is not really worth. Have ypu allways had that problem with the tmj ?

 

[bonesymmetry]

yea a arthoscopy makes more sense. I mean marpe is better for function. Segmental is not really worth. Have ypu allways had that problem with the tmj ?

i’ve had tmj issues for the last 6 years about but it was mostly just clicking and popping, no pain or limited range of motion. 10 months ago i was at my orthodontist and i had to open wide and that’s when i believe it became displaced without reduction.

 

[lurking truecel]

i’ve had tmj issues for the last 6 years about but it was mostly just clicking and popping, no pain or limited range of motion. 10 months ago i was at my orthodontist and i had to open wide and that’s when i believe it became displaced without reduction.

i mean seems weird, have ypu tried soi g excerices or does that not work at all? Is arthoscopy the only option ? I dont know to much of this stuff more then jaw surgery often being unpredictable for placing joints since its extremly hard during surgery and also because of the changes post op

 

[bonesymmetry]

i’m currently going to physical therapy to help with the range of motion, i doubt it’ll work. Also am taking muscle relaxers and naproxen to help with the inflammation and that helps with pain but not the opening.
but the root cause seems to be skeletal asymmetry in my jaws, which is putting uneven stress on my TM joints.

 

[lurking truecel]

i’m currently going to physical therapy to help with the range of motion, i doubt it’ll work. Also am taking muscle relaxers and naproxen to help with the inflammation and that helps with pain but not the opening.
but the root cause seems to be skeletal asymmetry in my jaws, which is putting uneven stress on my TM joints.

Whats your bite like, because the jaws themselves will allways put uneven pressure since you have diffrent size on the bone itself. Making the length(bsso) the same wont help with that. Your ramus will still be shorter and less volume on one side, you also have diffrent size on the condyle itself for sure. The displacement should be able to go back with splints and excerizes. Even if surgery might be needed. But bimax is not a solution or its a very bad and risky solution at best. Not saying you cant get bimax but for that it wont prob help much with the tmj issue

 

[bonesymmetry]

here’s my bite it’s cagefuel.
i’m currently using a splint as well with the pt. hopefully that combined with the arthroscopy will solve the displacement.
and i’m glad you’re able to see the right condyle looks flatter. i’m a bit worried about condylar resorption in that regard.

you make some good points - mycase is complex all around still trying to navigate the right way to proceed

 

[justjutting]

Whats ur sna/snb?

 

[lurking truecel]

here’s my bite it’s cagefuel.
i’m currently using a splint as well with the pt. hopefully that combined with the arthroscopy will solve the displacement.
and i’m glad you’re able to see the right condyle looks flatter. i’m a bit worried about condylar resorption in that regard.

you make some good points - mycase is complex all around still trying to navigate the right way to proceed

yea your bite is ass

 

[ascension to heaven]

3 piece high cut lf 1 with sunil

 

[tyler1234]

I’d say depends if u need decomp mayaswell do marpe if not just do segmental

 

[gnwitch]

if ur condyles are weak doing bimax is sketch its prob gonna relapse bc it cant handle the movements, i had to replace my condyles for my bimax lol