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Cope

upper and lower jaw can be expanded. but it can only help so much. I had an upper expansion 3 months ago. I still have high nasal resistance and still mouth breathe at night. My expansion helped but its only one piece to the puzzle.

@@teethree141 Thank you for your reply. What type of jaw surgery did you have? And are you planning on any other surgeries or expansions?

@@ryant6134 I had the MIND procedure. Minimally Invasive NasoMaxillary Distraction. I am going to see a second sleep specialist/neurologist who Is going to do a rhino manometer test to check nasal resistance, etc. Then he'll let me know if I should be referred out to any specialists. But Im anticipating MMA and septoplasty and tongue tie release.

@@ryant6134 Nasomaxillary expansion. I am planning to get a surgery to shrink my turbinates

yeah DISE is really useful...

but his contra points are still true about it

He lists some of the research papers in the vid.

2222

Nope.IMO once the maxilla and mandible are fixed with plates and screws,transverse skeletal expansion is no longer possible.

I agree, but do you believe the mandible can expand with it? Serene Holistic yt channel claims they can expand the mandible as well. I wouldnt want maxilla expansion without subsequent mandible expansion personally

@@Thleta I don't expand the mandible but it expands on it's own if you expand the maxilla and the patients corrects their posture

@johnmew9980 thank you for your input prof john mew if you are really him. You do excellent work and are helping people in the way that they should really be. God brings people like you to the kingdom

@@Thleta yes I am really me.

is why Myofunctional therapy helps ?

How are you suppose to avoid that tho if you get jaw surgery tho? Doesn’t the surgeon detach that joint to move the maxilla forward?

yes

Me too scary aff

YOU HAVE TO DO YOUR OWN RESEARCH. Figure out where your deficiencies lie skeletally and how to address them, both functionally and aesthetically. Don't go to any random surgeon. Don't trust any doctor to know what's best for you. Always ask question, always search for more knowledge. ITS YOUR FACE THEY ARE OPERATING ON. And find the best damn surgeon you can. Find someone who does idk 20 surgeries a week. It's worth the cost both functionally and aesthetically

@@miniweeddeerz1820 I decided not to go with the surgery, not worth the risk.

me too. not worth it

they use orthodontics to expand the bottom jaw, I think he told me he no longer does lower jaw distraction because the results were too unpredictable.

Did you check the scan to make sure your tongue isn't fitting up there. I mean if it doesn't fit then why not expand it?

​@@shuikai272I ask the sane question to my orthodontic but he said if you expand the maxilla we won't be able to expand the mandible

@@saileshjoshi5422There’s usually a few mm worth of expansion to be had just from tipping the lower teeth outward. In many cases they start out tipped inward so there’s no reason for the mandible to be a problem when doing a moderate maxillary expansion.

Ikr???!!

Limited time and ability to monitor patients?

If it was only a few thousand the the waitlist would be like 5 years

Ain't that better than not being able to do it?@@Sunrise-fr9jb

Seriously? This guy is an ENT, dentist, and an oral surgeon. You're paying for the expertise. You're also paying for the constant follow-up, device manipulation, and oversight in case something goes wrong during surgery (anesthesiologists don't just get paid $$$ to put you to sleep, they get paid $$$ because if something goes wrong, they'll know what to do, so you won't die). This is like saying invisalign should be the same price as a crappy knockoff that runs a huge risk of making your teeth fall out.

The way the expanders are designed it seems to be mostly dental. I predicted it like 4 months ago just a tiny split at the MPS and that seems to be exactly what is happening. I know a guy who did expansion with that method (piezo and lipkin's expander) and he didn't even get a split at the MPS just dental tipping and the ortho just says it was a success because the intermolar width changed and so therefore its a success and therefore thanks for the 15K sucker.

@@shuikai272 I think we have to remember adult maxillary expansion is still in its infancy. All these 'experimental' treatments lead the way to the next best thing. Now the hype is with FME and MIND, but there will be pitfalls there too I'm sure. Having said that though, we shouldn't fixate on treating numbers as we don't even know optimal nasal cavity volume numbers. We do know it's very individual. 1-2mm of maxillary expansion means a lot more than 1-2mm of IMW 'expansion' as it is 3d space ie. volume. Even if only 20-30% of the expansion is skeletal, that 2-3mm could be enough to address many issues, and the tipping can be usually fixed orthodontically. Another thing that's never mentioned is cost. EASE is very expensive and its reach limited. I agree with most of Dr. Li's points, but the bias is there.

@@OrionL7 The question we need to know is, what is the most effective treatment plan? How do we transform an unhealthy airway into a healthy one? We may not know all the answers right now but we cannot stop asking the questions and trying to find the answers.

Yeah. I don't always trust other people to measure it themselves as they could do it wrong. You have to ensure that there is no invisible bone that isn't being picked up by the viewer. So basically I'm hearing people say, it didn't make my breathing better, or my breathing stopped improving halfway through, things like that, or my breathing is way better, and then cross referencing what people are saying with the widths. It seems that you want the airway to be adequate the entire way through. So if someone has a 18-19 mm aperture, 28-30 mm IMW, and you don't expand and do an MMA, it may not really matter how far you advance them, the problem is they have this bottleneck in the nose. Vise versa, if they have a 25 mm aperture, but their pharynx is narrow, they are recessed, there is a pharynx problem, it doesn't matter how much you expand them, there isn't any point to lose molar contact so you can get a >28 mm aperture. Which Kasey Li doesn't typically expand that wide, that's an extreme example, but I'm also looking at one case (patient from BC Canada), and personally I think this was likely incorrectly evaluated (truly, we'll never know, maybe he just needed MMA). I don't really blame Kasey Li because this stuff is so new, I feel like before this he was under-prescribing EASE, so I think he might have done the switcheroo and started over-prescribing. But this case, went from 24 mm aperture, to around 28-29 mm aperture. Personally, I'm not sure what was really accomplished, maybe the benefit will be "unlocked" when he does the MMA, but yeah.. Did he really need it? I don't know. I'm really concerned about losing molar contact if the benefit is in question. What I do see is that when people say "I feel so much better, my life is changed, etc.", you know what they also say? "I breathe so much better". So my thinking is, how do we facilitate this effect? How should the overall treatment be planned, so that this happens? In regards to aperture, how wide does this thing really have to be? Another topic is, "who cares about intermolar width?", well I care somewhat, like what if it is so narrow that the patient cannot fit their tongue between their molars? If you look at CT scans, you'll notice in the majority of scans, the tongue fits between the molars and is on the roof of the palate. If you have a width SO NARROW that it physically cannot fit, then that's a problem. That isn't normative. That needs addressing. If the patient is not normative and they are sick, can't breathe, etc. you shouldn't be surprised. The human body is a system, if you disobey the best practices for how it should be configured, you'll have problems.

@@shuikai272 Thank you. So people were expanding and told the doc that breathing was improving. At the same time they took CBCT and sent it to you to confirm that they have reached 25 mm width but because they wanted to get better smile so they told the doc that they were still improving so they can keep going even though the CBCT showed normal width?

@@DMCap No, I think it is more that they either, had like a placebo effect of optimism, they want to feel better they want to breathe better, so keep expanding. Other reason could be, they have a narrowing somewhere else in the airway, in the throat for example. Maybe they need an MMA, they need their jaws moved forward, no chin, no jawline. So because the throat is bad, their breathing is bad, and so they keep expanding hoping that will change, but it may not if the problem is elsewhere. And then the ortho sees the teeth and maybe there is no molar contact. So this is like, really the only downside with the expansion I've seen so far. Other than damage to the alveolar bone I guess, which is just a side effect of using the TPD from KLS Martin, and no other 100% skeletal expander works so what else are you going to do. Everything else about his procedure is extremely good, especially in comparison to the competition, which realistically hasn't been doing a great job as shown in the video.

@@shuikai272 If you didn't analyze the CBCT when they were expanding and the individuals that you interviewed didn't analyze the CBCT or even know how to analyze it (according to you) or if a CBCT was even taken, how is it possible that "expanding the nasal aperture past, generally 25 mm or so (average height male) did not yield improved nasal breathing, or if it did, it was very minimal at best, and basically the consensus was that it was more or less unnecessary to expand to 27 mm, 28 mm". No one knew the width when people stopped improving. We are all suffering from OSA and trying to learn but so many on the internet are pretending to be experts and have never treated anyone or even set foot into a surgery room but are telling people how surgery should be done or how treatment should be rendered.

@@DMCap If you scroll up and read my reply to your question of "did these individuals send their CBCT to you for analysis?", I replied with "Yeah". So the answer is that yes, I measured and was aware of what the measurements were. I don't know a single person who says they benefited from expanding from 26 mm to 28 mm, or 30 mm, that is just the truth. Maybe someone will, but I have yet to find anyone. This is statistically significant. Another example. I recall a woman from China I believe, who expanded and had it reversed because she "felt too much air", or something to that effect. She started at around 24-25 mm I think, so she was already above average for her height. I would consider that Dr. Kasey Li did explain part of this point in his lecture. The treatment of choice for OSA is CPAP. Consider how wide an aperture of 28-30 mm really is, this is an extremely wide aperture, and few homosapiens will even have one that wide, mostly only the widest apertures for African ethnicity. The purpose of expansion is to reduce the negative pressure.

@Denny Yeah I agree the patient bears a lot of responsibility as well, most of the time they are turning themselves after all. With that said, it is the aperture width, not height, and from what I've seen there appears to be quite a lot of normative data out there.

Can I send you my CBCTs for analysis by any chance?

You mean the suture has to split to see improvement?

can you expand your upper jaw if you already had an MME operation done? and how much can you expand?

@@CroElectroStile yes you can

Could be bad planning or patient doesn’t want a massive advancement due to more likely having issues. Also patient may want lower jaw when the only real way is double.

dont know seems werid that they dont advance more

most surgeons focus on the bite more than the aesthetic and function

Kasey Li does the exact same thing for splitting the palate, same piezotome, if anything he might be a bit more daring with going between the roots. The difference with Kasey Li's method are the limited pterygomaxillary osteotomies, which are cuts to the back of the maxilla to reduce chance of failure to expand, and the fact he uses the KLS expander. The other difference with Dr. Lipkin and Dr. Coppleson as well, both seem to be doing basically the same thing, and have a so-called "100% success rate". Now... Even Kasey Li doesn't have a 100% success rate, and he is having a VERY hard time successfully expanding with MSE, and from my experience his success rate is the highest out of anyone by far. So, I'm pretty sure their definition of success is carefully worded, and I have some info about Coppelson's definition of success which led me to speculate on how they achieved their 100% rate. My guess is that their definition of success is: - Separation at the mid-palatal suture. Now, the issue here, is that it appears to me that whenever a surgeon successfully performs a mid-palatal and mid-line osteotomies, like what all these providers are doing, the suture is obliterated and there is a slight separation. Therefore, the definition of success could very well be tied to whether the surgical-assist is done correctly. The issue, is that once the surgery is complete and you turn the appliance, it could still fail to overcome the resistance of the expansion, however if your definition of success is any separation at the mid-palatal suture then even though the treatment was a failure it would qualify as a success under that definition. This is how I believe they achieve their 100% success rate. So, if you undergo a treatment with one of these guys, I would get it in writing or on tape that they agree, that once the surgery is done it is your expectation that the expander overcomes the resistance and successfully expands. I mean if they're not willing to acknowledge that, I think it'd be really sus.

​@@shuikai272 Is there a difference between using a TPD or MSE device with the EASE procedure? Does MSE result in less expansion even if the EASE cuts are made?

Good for young kids

ALF hasn’t been proven for adults, which already completed growth

Maybe vertically shortening the chin could elevate the digastric and hyoid? If function follows form, I might intuitively think that a long lower anterior face height/hyperdivergent mandible could have functional issues

@@Burneracct I feel like the vertical wouldn't really make much of a difference, I would say just do whatever will look best aesthetically. Most surgeons will bring the genioplasty up in order to decrease the bone gap anyway I guess.

They definitely aren't narrower. Judging photos of faces is pointless.

Maybe due to expansion mid face expand but lower face doesnot

Maybe due to expansion mid face expand but lower face doesnot

@@deezuschrist No. You have an unscientific mind.

@@saileshjoshi5422 The whole face seems narrower.

Yeah it seems like DOME procedures can be successful, right? I had DOME and I noticed a significant improvement in my nasal breathing

@@bgorski you don’t get it. This is not the expander. The entire approach is difference. EASE expands the entire maxilla including the nasal space which means you gain more nasal airspace and thus better breathing. DOME doesn’t.

@@chrisking6695 yes it makes sense. The amount of expansion I needed was probably not possible with EASE. I needed 12mm. DOME isn’t perfect, but I’m happy with the results. Nasal breathing did improve, even if it didn’t improve as much as it would have with EASE. I actually can’t wear breathing nasal strips now as it opens up my nose so much that I get the false turbine syndrome where it feels like I’m not inhaling enough air.

⁠@@bgorski DOME doesn’t do anything to the nasal aperture itself, though. For you a 3 piece lefort might have been an option where the maxilla is widened during surgery.