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best course of treatment for multiple issues

vplatt
Active Member

Hi everyone, I'm so happy to be here (well it'd be nice to NOT need to be here I guess, lol).

I am a 40 year old woman with a crossbite, TMD, very narrow palate, and malocclusion. My airway is narrow and mandible is receded somewhat (not the worst but it's there). I also think my nose has a hump and protrudes more because these jaw issues and the deviated septum that I discovered from the CBCT scan. I wake up congested every morning though I am pretty sure I breathe through my nose...I think the septum issues are causing problems. When I pull out my nostrils I get like a cocaine hit of air like never before! I also have postural issues like the forward neck thing as well as facial asymmetries! Phew.

I tried to use invisalign twice and could only get 2 months in before it became way too painful, triggering a TMD flare up. This is how I found out about all this. I've seen 2 dentists who specialize in appliances for this work.

The first wanted to just do a homeoblock with maybe a tongue tie release and physical therapy. They said $8500 for that. When they did my fitting for the homeoblock, they had to use a pediatric size impression kit 😐 I am a small person but like wow. This one seems to think there isn't much to be done about the mandible recession other than surgery. I kinda disagree because my recession is not the worst ever, I've def seen people with more, so if appliances can't help me, who can they help??

The second had a totally different suggestion, starting with the TMD myobrace and then either homeoblock or a Schwartz palate expander, top and bottom, followed by invisalign. This one seems to think the myobrace will address the TMD and the mandible recession and then the palate expansion either by homeoblock or Schwartz would be more tolerable. She wasn't convinced the homeoblock would expand the back of my palate (says it would only work in the first third of my palate). Does that seem accurate?? She still thinks I'd need braces after all that. I've read mixed reviews about straight palate expansion for adults versus homeoblock.

I'm leaning towards the second opinion but they would charge 5k just for the myobrace which I see can be purchased for like $150?? Then I also saw people have teeth tipping with it so I'm leery to do that on my own!!

What do you think?? Get a third opinion? Anybody have similar set of issues?

 

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Topic starter Posted : 13/04/2021 9:30 pm
vplatt
Active Member

bumpity bump and not a dorsal bump lol

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Topic starter Posted : 14/04/2021 11:32 am
sunflower
New Member

Yep, me, 37/f with most of those issues although no crossbite and TMD is minimal and only on one side. My back airway is good, but my IMW is 31 mm, my tongue doesn't fit in my palate, and CBCT indicated that the obstruction is my narrow nasal cavity. (Thanks to my mouth breathing during developmental years.) ENT's rec was MSE, possibly followed by septoplasty and turbinate reduction. ENT said Homeoblock could be a finishing touch (although I'd have to do braces/Invisalign after MSE, so I think that would do it), but because my palate is sooooo narrow I could only get the expansion I need from MSE.

I also wonder about MMA surgery. An ortho I consulted for MSE recommended it, but my mandibular recession also does not look too bad. I have vertical maxillary excess though, and difficulty closing my lips (although that is dramatically improved after a year of myofunctional therapy), so perhaps that's why.

An airway dentist I saw a year ago presented the Myobrace as something I could try, but based on what the ENT said it wouldn't do much for me. Also, I think Myobrace is mostly for kids, to guide their growth/expansion? Wouldn't it just tip an adult's teeth?

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Posted : 28/04/2021 1:24 pm
vplatt
Active Member

@sunflower that is interesting, I've never considered consulting with an ENT. Sounds like good advice you got there. 

My TMD is also only on one side and it isn't bad, but really flared up when I attempted invisalign (that is how I ended up here, from deducing that the jaw being underdeveloped wouldn't let my teeth straighten). She recommended the Myobrace for TMJ, there are myobraces for adults, and I honestly have no idea if it works or what. I was hoping to get other's experiences on it here...

I suspect that my nasal issues may have relation here too, as the CBCT showed a deviated septum. I am waiting for a radiology report to give me more info though. I believe the narrow nasal passages have made my nose grow bigger (this is my own theory, haven't seen it anywhere else, but to me it makes sense that the body would try to accommodate more air by growing in size).

Do you have any MSE specialists in mind? I may consult with Dr. Ting though I noticed he is only working with patients in the SoCal area these days..

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Topic starter Posted : 29/04/2021 10:38 am
Siegward
New Member

If I'm being completely honest, I've worked in a private clinic and have a few words to say about it. First and foremost, the biggest issue comes from the fact that many hospitals are just greedy, for lack of better words, and do not verify their tools in a reasonable timeframe. If you want to provide the greatest and most accurate medical care to your patients, you must constantly inspect your equipment. For example, https://www.biomedics.com.au/resources/medical-equipment-testing-maintenance-guide/ is an excellent place to start. Some of my coworkers are already doing it and seem to enjoy it.

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Posted : 07/07/2021 7:51 am
vplatt
Active Member

@siegward hi there, would you like to share your thoughts?

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Topic starter Posted : 07/07/2021 9:08 am