anarlord
Iron
- Joined
- Aug 15, 2021
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TL;DR
- 5 failed expanders (conventional MSE, hybrid MARPE,) — suture never opened because of how THIICC my bones were.
- Custom MARPE (CBCT designed 8 TADs placed a little more forward due to anatomy and how vaulted and narrow my palate was) finally cracked it → ANS
NS ≈ 1 : 0.8. - Nasal floor widened to 37 mm → I can breathe through a cold.
- alar base only +2 mm each side (will cinch during surgery).
- Next stop (August): 8 mm LF I + 10 mm BSSO + 2 mm posterior impaction + CCW rotation
I’m a heavy sports guy, and the split turned my cardio from congested and struggling to breate to insane I can full sprint and still nose breathe.
The game changer is the +6 mm ANS spread; that’s the zone where airflow matters. PNS gain is cool for symmetry, but ANS is what cleared my airway. Since thats where most of the air restriction is.
Lifelong nasal congestion? Gone. Even with a head cold my nose stays open.
AHI tracking went down : Sept 2023 pre-expand. See images below.
Not sure if that counts as “over-expanded,” but my CBCT shows an ANS : PNS ratio ≈ 1 : 0.8, so pretty parallel but still ANS.
Next stop: 8 mm LF I + 10 mm BSSO + 2 mm posterior impaction + CCW in August hoping that evens out the last aesthetic quirks in terms of recessed maxilla and Mandible.
| Before | After MSE | Change / comment | |
|---|---|---|---|
| Eye level (interpupillary line) | Right eye sat a touch lower (slight head tilt could exaggerate) | Looks level no obvious cant | Better (tilt mostly gone) |
| Eyebrow height / forehead width | Mild right side droop | Even brows meet the horizontal ceiling seam symmetrically | Better |
| Nasal deviation | Tip angles a hair to your right | Same tiny lean unchanged (this is cartilage, not palatal) | Unchanged |
| Cheek fullness | Left cheek flatter right malar had more shadow | Cheeks read equal volume mid-face looks less narrow | Improved |
| Occlusal cant / smile line | Subtle dip on your right | No change? | Not sure |
| Lower third / chin point | Chin projects slightly toward your right | Still drifts right (jaw hasn’t been advanced yet) | No change will correct with BSSO |
My before and afters showing my eye area improvements
Pre:
Post:
Obviously front on
Cons:
Much Wider nose
In hindsight I could have stopped at +4 mm, but after years of garbage sleep and mouth breathing I was trigger happy for every millimetre of airflow. Went overboard with the cranking. My Teeth still need to be put back together, but currently on invislign.
Still have a hair of dental mid-line drift and the open bite (both scheduled to disappear with the 8 / 10 mm bimax).
Pros: Breathing, More Alert due to better sleep. My asymetry was reduced because THANKFULLY it went towards the under developed side. I believe it is an improvment in terms of asymetry since my right side was dropping. This does set me up nicely for the Double Jaw.
AGAIN. first time in my life I can nose-breathe through a cold. Resting HR on runs is down ~20 bpm, I wake up clear-headed instead of groggy.
split pushed toward my under-developed side, so the right-side cheek drop is much less obvious in photos.
Perfect setup for double-jaw: level smile-plane and parallel palate = surgeon can advance/rotate without fighting a cant.
Skull pics:
We created a small ortho diastema between the incisors, then my ortho did a piezo cut along the mid palatal suture to weaken it before the next attempt.
My next move:
| Move | mm | Purpose |
|---|---|---|
| Le Fort I advance | +8 | Mid-face support |
| Posterior impaction | −2 | Hide gummy smile |
| BSSO advance | +10 | Fix recessed mandible |
| CCW rotation | ~3° | Sharpen jaw neck angle |
| Alar-base cinch + V-Y | — | Control nose & lip |
