Dr. Tawfilis is great. He went to USC and is an honored lecturer at UCSD. I like his style and I'm feeling pretty good about him. I think for the purposes of this blog I might keep calling him The Chainsaw though because that's how nicknames work. Sometimes they just stick and you get no say in the matter.
So Dr. Styrt wanted a consult for a Lefort I expansion and posterior impaction in addition to lower mandibular advancement. Three things happening there: Upper jaw gets cut vertically and is spread apart, Upper jaw gets tilted forward, and Lower jaw slides forward. Dr. Tawfilis said he prefers to be minimalist when it comes to surgery and believes that the lower advancement won't be necessary but if the chin deficiency is a problem for me that he recommends just a genioplasty. (He showed me some pictures of other genio patients and I'm not sure how I feel about it but I've got plenty of time to ponder.) He also said he isn't sure that the Lefort expansion will be necessary and that seemed to think that SARPE (surgically assisted rapid palette expansion)would do the trick. This confused me a little bit. I guess by Lefort I expansion they mean like a three piece expansion? Anyone have any insight? And the prize indeed goes to Erin for calling the wisdom teeth extraction. He said we could do it at the same time as the SARPE since I'd be under anyway. As for the implant down the line, the bone grafting will happen at the same time as the Lefort I and the actual implanting will happen around the time I get the braces off. The great news is he said I can save some money by doing the grafting at the same time because implants aren't usually covered.
Speaking of coverage. He said my insurance is usually really good about approving this type of treatment and that yes indeed, we're talking 100%. Sweetness.
So we talked a little bit about timeline and here's the big rundown:
1. Make an appointment with Dr.Styrt to get the hyrax (hirax?) cemented in, meanwhile Dr.Tawfilis will put in the request to insurance for the SARPE.
2. Have SARPE, remove wisdom teeth, and start clicking. (For those of you out there who've had this done, how long post-op until the braces go on?)
3. Get braces on and start closing "the gap"
4. 12-18 months later, have a Lefort I and bone grafting and perhaps a genio (I really think I'm going to decide against it though.)
5. 6 months later, get braces off and install implant post.
6. Then whatever the timeline for the implant is, I didn't see any need to go into it in detail since it's so far away yet.
7. Fin!
As I'm writing this I got a call from Dr.Tawfilis who had a chance to speak with Dr.Styrt. They're in agreement about The Chainsaw's plan and now I need to get that awful thing cemented in. Here's the rub. I'm going on vacation to Chile in a couple weeks and think I'd like to wait until I get back to get everything started. I'd hate for something to go wrong while I'm there or have to deal with that thing any longer than I have to, especially when I'm supposed to be enjoying myself.
The only bad part of the appointment was with the confirmation of the SARPE means I'll have to stop playing hockey 12 months sooner than I was hoping. *shrug* I guess that's the way it'll have to be then.
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6 comments:
Actually I'm one step ahead of you, that is, I've already been reading but have been dragging my ass at commenting and linking you in to my blog. So here I am picking up said ass, and saying hello to a fellow SARPE victim!
You've definitely got some good writing going on, I like the level of detail you're using, so good on ya.
About the LeFort. There are a few things that can be done to widen the maxilla. SARPE, segmental LeFort (ie. 2 or 3 piece usually), and in rare cases both at once. And just to confuse the issue a little bit more, SARPE is technically a special kind of LeFort and you may see it referred to as such, but not very often. The LeFort is also used to move the maxilla up, down, backwards (rare) , forwards, or to rotate.
Typically people get braces at the same time the RPE comes out but sometimes even before. I find that odd but it happens. And some even have their braces before SARPE, so I guess it really depends on your case.
By the way, the gap will begin to close as soon as the expanding is finished. In my case the expansion took 3 weeks, the gap took about 5 weeks to close (if you can call it that, really), and then I got braces 3 months post-op.
I'd like to offer two pieces of advice if I may:
First is to defer any decision making about what procedures you think you want (except for SARPE obviously) because things may change in time. Your OS and OD may have a different idea of what needs to be done once you're ready for surgery. The real answer doesn't come until you get your final pre-op models done.
Second, try not to get too attached to specific dates or timelines (within reason obviously). Ortho and jaw surgery is an enormous test of one's patience and you can expect things to happen in a different order than you thought they would. Spare yourself some frustration and try to just roll with it as it comes.
So yeah, from my experience, that is my $0.02US. I'm looking forward to seeing your results, which look to be pretty awesome.
Segmental LeFort, that must be what he was referring to. Thanks for the clarification. I'm totally with you on your bits of advice. I'm far less concerned with what/how specifically they decide to move my jaws around as long as my bite works in the end. And I know well enough from everyone else on here that timelines get pushed back normally more than we would like. I'm a laid back kind of guy and will go with the flow, but I'll do everything on my end as quickly as possible to facilitate the doctors.
Thanks for the $.02, quite generous considering the exchange rate :)
So personally for me, I would take the route that did not involve an RPE. I despise those things and they failed on me 3 times as a kid, so I am just anti-RPE.
I knew when I started looking into all of this that I absolutely did not want to go through that again, and would do any kind of surgery to expand my jaw without it. Perhaps I could be called RPE phobic. Anyway, oddly enough, my tiny little arches were widened a LOT with braces alone. Weird huh? I don't think that's usual. I also think that my strict avoidance of going the SARPE route is usual either. So basically, do not take my advice at all on this matter.
But Graham gives great advice. :D So definitely listen to him!
Oh boy, I knew you were well on your way to receiving that lovely HIRAX device that we all love sooo much. Sucks for you dude! Just kidding. I have had AMAZING results already and I am 3 1/2 mths POST SARPE. Believe me, one of the best days since was the day I got the HIRAX removed. Here was my time line: Hirax in 1 week before SARPE. Surgery April 2nd, Braces on 7 weeks later, and HIRAX OUT little over 3mths POST SARPE.
Everyone is so different though, like Graham said. Patience is key!
I also have the Lefort1 w Bone Graft and Genio recommended by my OS and I too, doubt I'll do it. However, I am also taking Grahams advice and I will make that decision down the road. Well, have fun on vacation can't wait to hear the HIRAX stories!
Chow
You should check out archwired.com, there's a section in the forum for orthognathic surgeries (Le Fort, SARPE, and others). You'll find people who've been through it as well as others who are considering it or preparing for surgery. I myself had a Le Fort many years ago, 1980 ! Never regretted it. I had posterior impaction to correct an open bite. Best of luck to you while you research your options and make some very important decisions !
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