28 Y.O male and my journey trying to fix my very high narrow palate so far. Need advice from someone who is well read in the field. Is my only option surgery?

Hey mate hope your well. I'm in same situation as you. Im 19 right now. My background has been due to childhood allergy that was not found out, I started mouth breathing and that lead to my severe malocclusion with overlapping. This required me to have braces and a fixed retainer wire sometime during my early teens. Back then I had no clue of airways when it comes to braces and most orthodontics only care about aesthetics not holistically. Recently I came and saw Dr Mahony consultation since im located in Sydney and he recommended me take scans, CBCT but its likely that I'll start on MSE after he decides on what to do with my 4 wisdom teeth that's growing forwards. I've also got delayed bone growth by about 2 years so maybe that will put some play in having a theoretically bigger expansion. Let me know how your experience goes and maybe we can help each other

How would palate expansion without surgery not help at least somewhat?? Maybe not completely fix everything but start the body in the right direction?

Have you taken a look at TADs to reduce the VME (Vertical Maxillary Excess)?

The idea is to use the tads to push the whole dental arch upwards thus practically reducing the gummy smile.

The results are not as great as a lefort 1 surgery (2mm to 4mm gum reduction max) but I've still seen some crazy results.

Specifically take a look at dr Stuart Frost instagram.

Or this blog:

mybraces4vme.wordpress.com

I dont think lefort is good look at “chirurgie bimaxillaire de propulsion” surgeon practice it in the south of france and for now its the best surgery I saw to correct the maxilla and mandible 

@o_requeim would you mind sharing the name of the ortho in London whose name Dr Mahoney gave you? thanks!

Posted by: @0_requiem

Im a 28 year old male from England who's been researching this field of ortho, dentistry, myo, ENT for the past couple years. I have always excelled at Math and Science and graduated with a degree in a STEM subject. I am hoping I can reach out to someone on this forum who is also very well read in the field of jaws/bites/breathing/facial development.

I wanted to try and find a professional in England who had modern views on ortho ie. expansion > retractive orthodontics.

After many terrible consultations with Orthos in my local city that wanted to pull my teeth out or pull my lower jaw back and watching the same blank expressions on their faces as i explained the harm in removing teeth and reducing the space of the mouth by pulling jaws back i decided to hell with it and tried to reach out to the key figures in the field.

During my research I reached out to the big names in the industry anyway I could whether by email, social media or their websites and managed to get ahold of Dr Derek Mahony, a very prominent figure in the field and excellent orthodontist.

He is however based all the way in Australia, so instead, he gave me the name of a dentist that trained under him that was based in London.

I eventually went to visit this dentist and he did an excellent analysis including CBCT scans and found all sorts of issues I wasn't even aware of.

I have an intermolar width of 28mm, very high narrow arched palate, crossbite/underbite and potentially a posterior tongue tie. I have a tilted palate where 1 side is 5mm higher than the other, which he said he had never seen in his 40 years of practice. I have lost curvature in my spine (lordosis) and scoliosis to the left. I went in with hopes that he would tell me MSE would fix everything. However he explained he's not an orthodontist so could not provide MSE treatment, but felt my palate was too narrow for an MSE appliance to be installed. Although his analysis was excellent, his treatment plan was not great, he suggested AGGA. If anyone's done a bit of reading in this field they'd know AGGA is extremely dangerous and akin to snake oil.

I rejected his treatment plan and was feeling a bit down as i felt MSE was going to be the solution to all my problems. I continue my search for many more months until i find the one orthodontist in the entire country who does MSE. I got in touch, sent photos and had a zoom consultation and he also said he thinks the chance of MSE failing on me is very high. He would be willing to give it a shot but wanted to me to know it's unlikely to work. He said i would need surgery. I asked if he had any surgeons he knew of and he gave me the name of a surgeon based in London.

After doing my research, the surgeon very well educated and respected in the field. I had a consultation with him. He agreed that I am a classic class 3 patient with all the tell tale signs, high vaulted narrow palate, flat cheekbones, protruding lower jaw, forward head posture, mouth breather etc. He wants me to get some xrays and a caste before I have my second consultation with him where he will finalise the best treatment plan to fix my bite/jaws.

He wants to do a Le fort I advancement and segmental osteotomy. He said he will consider if SARPE is viable once i get my castes and xrays. I however am hesitant on both.

I want to do a DOME procedure (distraction osteogenesis maxillary expansion) which is specifically designed for high arched narrow palates like mine. It's very similar to a surgically assisted MSE. This way i can get a stable and safe transverse bone borne expansion that is not very invasive at all. And then do a simple Le Fort I advancement which will bring my maxilla forward. Does anyone know if the DOME procedure is possible on someone with a very high arched narrow palate as bad as mine ? If not, am i out of options? I was hoping to avoid extremely invasive surgery and i dont think it gets more invasive than a Le Fort I advancement with a segmental osteotomy. My maxilla is going to have to be broken in half, to expand and then broke at the back so it can be moved forward. I can't imagine a surgery like this not causing long term damage or having complications down the line.

Any advice would be much appreciated.

 

My two cents, try MSE first, with some surgery. If it fails, it’s just money and a few weeks