Midpalatal ostetomy + MSE + FM?

[ketoIsCrucial]

Hi all i am 26 male who is currently doing MSE with and orto in Italy. My first install just failed so the doc suggested me the midpalatal osteotomy(without the horizontal cuts) instead of Corticopunture(the doc thinks Corticopunture do not help very much). My first install failed because of the left side screws dragging through the bone. I want to know if someone have had the same osteotomy with MSE and if it worked or not. Also i want to know the opinion of @Sergio-OMS about this. Would this still help with the facemask or the horizontal cuts are absolutely necessary?

 

[Sergio-OMS]

Hi all i am 26 male who is currently doing MSE with and orto in Italy. My first install just failed so the doc suggested me the midpalatal osteotomy(without the horizontal cuts) instead of Corticopunture(the doc thinks Corticopunture do not help very much). My first install failed because of the left side screws dragging through the bone. I want to know if someone have had the same osteotomy with MSE and if it worked or not. Also i want to know the opinion of @Sergio-OMS about this. Would this still help with the facemask or the horizontal cuts are absolutely necessary?

I like that osteotomy, never failed. I don’t think that adding a horizontal cut at your age is necessary, unless you want to protract (and it looks like you do)

 

[ketoIsCrucial]

@Sergio-OMS Thanks for the answer!
So you are telling me that horizontal cuts are absolutely necessary for protraction... that's sad... I will have to say goodbye to the upper area of the maxilla I guess
Would something like Alt-RAMEC protocol work?
Will this solve the problem of the screws dragging in the bone?
Have you ever successfully treated cases using the facemask and MSE?
Btw I want to add that I have an edge to edge underbite and i am trying this route to avoid double jaw surgery. My ortho also suggested me this way....

 

[Sergio-OMS]

@Sergio-OMS Thanks for the answer!
So you are telling me that horizontal cuts are absolutely necessary for protraction... that's sad... I will have to say goodbye to the upper area of the maxilla I guess
Would something like Alt-RAMEC protocol work?
Will this solve the problem of the screws dragging in the bone?
Have you ever successfully treated cases using the facemask and MSE?
Btw I want to add that I have an edge to edge underbite and i am trying this route to avoid double jaw surgery. My ortho also suggested me this way....

I didn’t say absolutely, you can try. It should work in your case, but I would also add plates.

 

[ketoIsCrucial]

@Sergio-OMS Thanks again. What should work? Alt-RAMEC or the midpalatal osteotomy? Soon i have the appointment to remove the old MSE i will definitely ask about the bollard plates! Anyway how much do they cost generally? I guess i will need 4 of them. Do they require general anesthesia to be placed?

 

[aspieSavage]

Hi all i am 26 male who is currently doing MSE with and orto in Italy. My first install just failed so the doc suggested me the midpalatal osteotomy(without the horizontal cuts) instead of Corticopunture(the doc thinks Corticopunture do not help very much). My first install failed because of the left side screws dragging through the bone. I want to know if someone have had the same osteotomy with MSE and if it worked or not. Also i want to know the opinion of @Sergio-OMS about this. Would this still help with the facemask or the horizontal cuts are absolutely necessary?

How much does your treatment cost in total?

 

[Deleted member 3020]

@Sergio-OMS Thanks again. What should work? Alt-RAMEC or the midpalatal osteotomy? Soon i have the appointment to remove the old MSE i will definitely ask about the bollard plates! Anyway how much do they cost generally? I guess i will need 4 of them. Do they require general anesthesia to be placed?

ALT RAMEC is used to protract the maxilla faster with FM. It’s essential because of longer duration pulling and more loosen sutures. I’m glad your ortho knows this technique.

100% midpalatal ostetomy, but why not go through bimax surgery when you’re already going under the knife? and skip the facepullng since a horizontal cut will be made

Bollard plates will work with ALT RAMEC too and it’s said that it provides CCW rotation so it mogs regular FM and yeah it’s a surgery, but really not invasive imo but still a surgery.

 

[Sergio-OMS]

@Sergio-OMS Thanks again. What should work? Alt-RAMEC or the midpalatal osteotomy?

Midpalatal osteotomy. But... why not combining it with Alt-RAMEC? it just makes sense, doesn't it.

Soon i have the appointment to remove the old MSE i will definitely ask about the bollard plates! Anyway how much do they cost generally? I guess i will need 4 of them. Do they require general anesthesia to be placed?

They can be placed under local anaesthesia as an office-based procedure.

 

[ketoIsCrucial]

How much does your treatment cost in total?

4000 euro for MSE + braces

 

[Deleted member 3635]

Midpalatal osteotomy. But... why not combining it with Alt-RAMEC? it just makes sense, doesn't it.



They can be placed under local anaesthesia as an office-based procedure.

the mid palatal cut will lead to no cheekbone changes right?

 

[Sergio-OMS]

the mid palatal cut will lead to no cheekbone changes right?

It is the horizontal cut that interrupts the transmission of the forces and “disconnects” the cheekbones so they don’t receive any effect from the MSE.

No problem with the midpalatal osteotomy regarding that.

 

[NorwoodStyle]

It is the horizontal cut that interrupts the transmission of the forces and “disconnects” the cheekbones so they don’t receive any effect from the MSE.

No problem with the midpalatal osteotomy regarding that.

Hi doc. I thought that mse was too risky for people above 25. Is that the case? And if so what is the alternative for adults to widen the palate?
Thx

 

[Sergio-OMS]

Hi doc. I thought that mse was too risky for people above 25. Is that the case? And if so what is the alternative for adults to widen the palate?
Thx

Why risky?

 

[NorwoodStyle]

Why risky?

I actually got the idea from you in this thread

https://looksmax.org/threads/mse-in-europe.91991/

Basically you said that age and maturation of the skull sutures could cause relapse.
You also said I quote "Let’s say that I wouldn’t do MSE without any surgical assistance in males over 25 ( and maybe even younger ) "

If I understand this correctly, standard mse works for young people but older adults need surgical assistance, although the risk of relapse beomes higher.

Please elaborate on what surgical assistance would be needed, and correct me if I'm wrong.

 

[NorwoodStyle]

@Sergio-OMS bump^

 

[ketoIsCrucial]

Anything you do will have a minor relapse. Even SARPE. Retention is a way to avoid relapse but in severe cases, there is always some kind of relapse. Function and muscles take time to adapt. In the case of MSE without surgical assist or Cortipuncture, there should be less relapse since all the primary structures are affected by the expansion and not only some parts of it I guess. But MSE without assistance does not always work.

 

[ketoIsCrucial]

@Sergio-OMS I have asked my ortho about Alt-RAMEC and bollard plate and he said that none of them are necessary in my case since I need only 2-3 mm of advancement. For bollard plates, he said that they are usable only when you are very young. Alt-RAMEC he said is not practicable with MSE and he said that the expander needs to be changed and moved more forward to be able to do it. The doc called these two protocols experimental and not yet tested on anyone which I guess is the main reason he denied them for me.
Sadly I have no alternatives so I can't leave this ortho and I hope the route he is suggesting me will work

 

[optimisticzoomer]

@Sergio-OMS I have asked my ortho about Alt-RAMEC and bollard plate and he said that none of them are necessary in my case since I need only 2-3 mm of advancement. For bollard plates, he said that they are usable only when you are very young. Alt-RAMEC he said is not practicable with MSE and he said that the expander needs to be changed and moved more forward to be able to do it. The doc called these two protocols experimental and not yet tested on anyone which I guess is the main reason he denied them for me.
Sadly I have no alternatives so I can't leave this ortho and I hope the route he is suggesting me will work

What exactly is alt-ramec? I briefly looked it up but didn't read enough to understand

 

[ketoIsCrucial]

What exactly is alt-ramec? I briefly looked it up but didn't read enough to understand

It is a protocol made by dr. Eric Liou and used to correct severe underbites with the headgear. The protocol consists of two pahses. The first phase is the expansion phase where you open the expander by 1 mm per day for 7 days. After the expansion phase there is a contraction period where you simply close the expander by 1 mm per day for 7 days. The two phase are repated untile the maxilla becomes very mobile(this is verified by the orthodontis by manually moving and feeling the mobilty of the maxilla). Probabily the cycles of expansion and contraction helps the maxilla to disarticulate from the surrounding structures or sutures. Anyway with the MSE i have read they have achieved(at least in kids) huge amounts of forward movements without using this protocol so i guess the MSE works better then other expanders which used to open the sutures only partly and so something like Alt-RAMEC was necessary to fully open the sutures.

 

[optimisticzoomer]

It is a protocol made by dr. Eric Liou and used to correct severe underbites with the headgear. The protocol consists of two pahses. The first phase is the expansion phase where you open the expander by 1 mm per day for 7 days. After the expansion phase there is a contraction period where you simply close the expander by 1 mm per day for 7 days. The two phase are repated untile the maxilla becomes very mobile(this is verified by the orthodontis by manually moving and feeling the mobilty of the maxilla).

And does this work in adults?

 

[ketoIsCrucial]

And does this work in adults?

II don't know. It might but I have not yet read a paper where it is used on adults or in conjunction with MSE for kids. There are stures in adults that can only be opened with a surgical saw or a hammer(at least for now) i guess
By the way it is only a matter of time. Before MSE everyone belived maxillary expansion in adults was impossible. If they are able to invent a very solid ancorage to the maxilla than all problems will be solved i think.

 

[Alwaysevolving34]

At the end of the day, you have to keep these treatments are still in their infancy. You won't really know until you try.

 

[spark]

@Sergio-OMS I have asked my ortho about Alt-RAMEC and bollard plate and he said that none of them are necessary in my case since I need only 2-3 mm of advancement. For bollard plates, he said that they are usable only when you are very young. Alt-RAMEC he said is not practicable with MSE and he said that the expander needs to be changed and moved more forward to be able to do it. The doc called these two protocols experimental and not yet tested on anyone which I guess is the main reason he denied them for me.
Sadly I have no alternatives so I can't leave this ortho and I hope the route he is suggesting me will work

Pretty sure they would tell you the same about the facemask. @Sergio-OMS only uses the plates with MSE if I am not mistaken. When the MSE splits the face there apparently is some wiggle room. I am very interested in this myself. MSE + Bollards + FM all at the same time.