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MSE Asymmetry and Protraction

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Rockyp33
(@rockyp33)
500+ Forum Posts

@apollo damn so all in or bust

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Posted : 14/05/2021 11:38 pm
Apollo
(@apollo)
500+ Forum Posts
Posted by: @rockyp33

@apollo damn so all in or bust

All I can say is that I'm happy with the results from my MSE treatment, but it's not for everyone. For a perspective from someone who took a different treatment path, you might be interested to read @greyham's blog post on choosing the DNA appliance over other options like the MSE here:

https://cfs-survivors.org/blog/2020/10/27/why-i-chose-dna-over-homeoblock-mse-dome-mma-and-agga/

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Topic starter Posted : 14/05/2021 11:58 pm
Silver
(@silver)
100+ Forum Posts
Posted by: @apollo
Posted by: @rockyp33

@apollo Any reccomendation for my case

I am happy that I went ahead and committed to MSE treatment. The cut-and-dried either the suture splits and expansion is successful or it fails quality of MSE treatment appealed to me. You say you want something "more natural" or "a level below MSE," and I can understand the appeal of that, but I'm still unsure about what is accomplished with appliances like homeoblock, vivos, or ALF. I guess some people report that these improve sleep quality, but it seems like a long, expensive process that may or may not work.

Completely agree. Ronald Eade has made some excellent videos outlining this exact thinking, as well.

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Posted : 15/05/2021 4:37 am
Rockyp33
(@rockyp33)
500+ Forum Posts

Well then DNA must get the job done

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Posted : 15/05/2021 5:19 pm
Apollo
(@apollo)
500+ Forum Posts
Posted by: @rockyp33

Well then DNA must get the job done

I guess it depends on what the job is. Greyham hasn't reported significant improvement in his sleep quality yet after 7 months of treatment. There are some case reports of satisfactory results, like James Nestor's experience with the homeoblock reported in his book Breath, or Tom Colquitt (posted earlier in this thread), but even in those cases the evidence isn't as stark as the CT scans of the midface swinging apart with MSE and the effects on the nasal airway volume and the collapsibility of the pharyngeal airway. They might have less risk of exacerbating asymmetries or even improve them, but they also might have less potential benefit to the airway and midface structure. Even with the MSE, Dr. Moon says that a slower protocol gives less perimaxillary change.

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Topic starter Posted : 15/05/2021 9:57 pm
mr.mewing
(@mr-mewing)
200+ Forum Posts
Posted by: @apollo
Posted by: @apollo

If rapid procedures like a LeFort surgery or the MSE separate the pterygoid process of the sphenoid from the maxilla and leave the sphenoid behind as they advance the maxilla forward, are these gaps eventually filled in with new bone like the midpalatal suture separation, or does the sphenoid change shape and eventually bring the pterygoid processes forward to meet up with the new position of the maxilla? Maybe a little bit of both.

24 year old class iii MSE  pterygomaxillary separation

The MSE+FM case of the 24 year old with class iii from the Dr. Won Moon article shows a cross section that doesn't go through the pterygomaxillary junction. So both the before and after layer in this superimposition show a gap between the pterygoid process and the maxillary tuberosity. What's interesting however, is that visible portion of the pterygoid plate has moved forward in the after layer along with the maxillary segment. In other words, there doesn't appear to be significantly more pterygomaxillary separation in the after layer. The pterygoid process of the sphenoid bone appears to be dragging forward with the maxilla in this case, while the Sella Tucica landmark of the sphenoid is aligned in the before and after of the Sagittal CT. Does this mean that the sphenoid is remodeling or repositioning, perhaps realigning at the sphenobasilar synchondrosis?

sphenobasilar synchondrosis

The gif I posted earlier showing the narrowing of the cranial base angle from the basion to the sella to the nasion makes me think there might be a cascade of realignments that result from pulling the maxilla forward, allowing me to posture my mandible farther forward, and posturing my mandible farther forward allows me to correct my forward head posture, and elongating my occiput shifts the basion, and potentially brings the pterygoid process of the sphenoid back closer to the maxillary tuberosity. My forward head posture has already improved, but maybe I should be more mindful of my head posture and practicing more chin tucks.

I am also curious if you can fix bad posture also when your skull is out of balance (dropped maxilla set back jaw)

even when the whole body has mobility issues like for example pelvic tilt?

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Posted : 15/05/2021 11:15 pm
Apollo
(@apollo)
500+ Forum Posts
Posted by: @mr-mewing

I am also curious if you can fix bad posture also when your skull is out of balance (dropped maxilla set back jaw)

even when the whole body has mobility issues like for example pelvic tilt?

I think it's all interconnected. You have to start somewhere to get a virtuous cycle rolling. It just seems more feasible to treat a structural issue and follow that up with good habits than the other way around.

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Topic starter Posted : 16/05/2021 12:33 am
mr.mewing liked
Apollo
(@apollo)
500+ Forum Posts

Dr. Mike Mew posted a video recently ( https://www.youtube.com/watch?v=lAeSziw-Jok ), which I didn't watch initially because it just seems to be an announcement for an instructional app they are developing. However, it actually includes several general updates about his practice and his personal health. Most interesting to me is what he says about the MSE appliance:

"Of course we're also doing some MSE, and clearly I'm doing it in my own style. That's taking off very nicely. We've got quite a few people using that method with some very nice results, and as I said with these feedback loops I hope we're going to get better, and we're trying to bring in other methods and techniques as well, which is just really interesting; it's fascinating. It's fascinating to see these changes we're gaining in the slightly older group, you know the sort of the 25-35 year old group that we're focusing on at the moment. I'm also interested in watching others because I'm on a few forums where people are discussing MSE and it really brings home the ideological difference between how I'm using and viewing MSE and what many other people using this technique are viewing it. Whereas for me, MSE is pretty consistent with everything I'm thinking and doing, I'm seeing a lot of other people how some of the effects of MSE seem to be a little contrary to what they're trying to gain, and that fascinates me because we're looking at these things surprisingly different although we're using the same technique and same methods."

It's unclear what he means by the undesirable effects other MSE practitioners are reporting on their forums. Maybe it has to do with the asymmetry issue discussed in this thread. I can't tell if he's saying his MSE protocol is different or not. Do you have any idea what he might be referencing?

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Topic starter Posted : 22/05/2021 11:45 pm
bentspoon liked
Silver
(@silver)
100+ Forum Posts
Posted by: @apollo

Dr. Mike Mew posted a video recently ( https://www.youtube.com/watch?v=lAeSziw-Jok ), which I didn't watch initially because it just seems to be an announcement for an instructional app they are developing. However, it actually includes several general updates about his practice and his personal health. Most interesting to me is what he says about the MSE appliance:

"Of course we're also doing some MSE, and clearly I'm doing it in my own style. That's taking off very nicely. We've got quite a few people using that method with some very nice results, and as I said with these feedback loops I hope we're going to get better, and we're trying to bring in other methods and techniques as well, which is just really interesting; it's fascinating. It's fascinating to see these changes we're gaining in the slightly older group, you know the sort of the 25-35 year old group that we're focusing on at the moment. I'm also interested in watching others because I'm on a few forums where people are discussing MSE and it really brings home the ideological difference between how I'm using and viewing MSE and what many other people using this technique are viewing it. Whereas for me, MSE is pretty consistent with everything I'm thinking and doing, I'm seeing a lot of other people how some of the effects of MSE seem to be a little contrary to what they're trying to gain, and that fascinates me because we're looking at these things surprisingly different although we're using the same technique and same methods."

It's unclear what he means by the undesirable effects other MSE practitioners are reporting on their forums. Maybe it has to do with the asymmetry issue discussed in this thread. I can't tell if he's saying his MSE protocol is different or not. Do you have any idea what he might be referencing?

I bet it's not more complicated than just old-school orthodontic thinking, which would be that MSE makes aligning teeth—without doing anything else—more time-consuming and complicated, because he says that the effects of it are contrary to what they're trying to gain, not that they're getting different effects

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Posted : 23/05/2021 1:07 am
Apollo liked
Apollo
(@apollo)
500+ Forum Posts
Posted by: @silver

I bet it's not more complicated than just old-school orthodontic thinking, which would be that MSE makes aligning teeth—without doing anything else—more time-consuming and complicated, because he says that the effects of it are contrary to what they're trying to gain, not that they're getting different effects

It seems to me like most MSE providers are all about achieving good skeletal expansion. Where they seem to differ with Dr. Mew is their skepticism about the potential for expansion in adults from tongue posture or removeable appliances. If Dr. Mew has started using the MSE in more cases, maybe he is coming around to the idea that bone-anchorage and disarticulating the midpalatal suture is the best strategy in the 25-35 year old demographic he mentioned.

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Topic starter Posted : 24/05/2021 12:13 am
Loliboly
(@loliboly)
200+ Forum Posts

@apollo @silver

I would encourage you to comment on the video and ask him about his MSE protocol and it'd differences to others(as I have done myself). Hopefully his team that runs the youtube channel will take note if they see enough people ask about this issue, and he may provide us with a clear answer in the future.

On another note, I would also find it interesting to hear him discuss his differences with his father regarding the MSE, preferably in person. I remember seeing a comment in in the facebook group(craniofacial action group) written by John himself, and he wasn't very fond on the MSE it seemed.

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Posted : 24/05/2021 1:27 am
Apollo liked
Apollo
(@apollo)
500+ Forum Posts
Posted by: @admin

These past years I've seldom gone more than 3 waking hours without thinking about this topic, and I've taken to spending considerable time paying attention to my body to see where the issues are through awareness. I am getting better daily, subtly, in form and function. My health is improving rather than declining with age.  

When I check on my houseplants, it's always exciting to find little signs of new growth or blossoms. Even though that's also a gradual process, it seems easier to recognize such hints of change in my plants than it is in myself. When I look in the mirror in the morning and try to decide if my bite is changing from my reverse pull headgear, or if the circles under my eyes aren't quite so dark, or if my cheeks appear a little more hollow, it's always a matter of degrees without a definitive answer, unlike discovering the nub of a new leaf forming on a branch I trimmed back. I want that same gratification, but I'm not sure what proof I'm really searching for. Certainly the day the diastema popped open between my front teeth during my MSE expansion brought that kind of excitement for unequivocal evidence, but I can't think of any similar incidents. If I reflect on myself the way TGW spoke about in the forum update thread quoted above, I can't say that I'm getting better daily, but I can pretty definitively say that my health and appearance have improved over the past few years. There seem to be measurable improvements in the symmetry of my face. Still, it's hard to be encouraged by progress when the problems persist. In the video about his upcoming orthotropics app, Dr. Mike Mew spoke of some kind of 3D scanner they got for his clinic to help track changes and iterate effective treatment methods, and this sounds like a good idea. I got discouraged when I saw a recent adolescent MSE+FM case where the orthodontist was apparently proud to present the superimposition of before and after CBCT scans, showing maybe a millimeter or two of forward change. The views were impressive, but the results were utterly underwhelming. It got me doubting if I've even had the minimal advancement that I think I've noticed in my bite. I tried overlaying my own profile photos again, but there's so much room for error in lining up these images, and it didn't show much. However, if I examine them separately, the person in the "after" photo looks obviously healthier than the person in the "before." I guess I'll have more concrete answers when I get follow-up imaging at the appointment when my MSE is removed in a few months. If I knew the traction was still having an effect, even very gradually, I'd ask to keep the MSE and continue, but the discomfort of the headgear also hinders my ultimate goal of restful sleep, so I'd stop if I knew the window had closed on its efficacy.

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Topic starter Posted : 09/06/2021 12:07 am
TGW liked
danksch
(@danksch)
New Member

Very interesting thread, thanks for the read so far.

Do you think somethin like a facemask with only or more force on the right side can prevent the dominant left side from expanding more ? My ortho was initially against a facemask, since he said I already have an overbite, but as the maxfac surgeon later said, both of my jaws are retruded, so I will probably get DJS after MSE/Invisalign anyway, so why not slap on the facemask for now ? I have to ask him this again.

Also, I could get a surgical assist with a stronger cut on the right side, if that makes sense (his surgeon performs it in the way that you still get nasal breathing benefits, not the full cut).

And if I want to brake the dominant side via a splint, that splint must be worn on this dominant side, correct ? I wonder if this makes the externally rotated side even stronger, because in my imagination, for correcting a cant, I should wear splint on my weak side, that makes contact first, so the other side can drop, no ? 

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Posted : 20/07/2021 6:57 pm
Apollo
(@apollo)
500+ Forum Posts
Posted by: @danksch

Very interesting thread, thanks for the read so far.

Do you think somethin like a facemask with only or more force on the right side can prevent the dominant left side from expanding more ? My ortho was initially against a facemask, since he said I already have an overbite, but as the maxfac surgeon later said, both of my jaws are retruded, so I will probably get DJS after MSE/Invisalign anyway, so why not slap on the facemask for now ? I have to ask him this again.

Also, I could get a surgical assist with a stronger cut on the right side, if that makes sense (his surgeon performs it in the way that you still get nasal breathing benefits, not the full cut).

And if I want to brake the dominant side via a splint, that splint must be worn on this dominant side, correct ? I wonder if this makes the externally rotated side even stronger, because in my imagination, for correcting a cant, I should wear splint on my weak side, that makes contact first, so the other side can drop, no ? 

I don't think uneven forward traction with the facemask is going to correct a discrepancy in the transverse expansion. Cross elastics make more sense to me for putting a break on the wider/externally rotated side. For me, artificially cutting the bone at a spot where there isn't a suture doesn't make sense for unwinding a torsion in the cranial bones and might just mask the problem. There are different types of splints. The homeoblock appliance puts a unilateral bite block on the "less developed" side. This tends to be the side canted higher and internally rotated. The MCB splint tries to put the mandible in the correct position and then register the bite. In effect, this would put more space on the side canted higher like the homeoblock. It's unclear to me if starectica operates on the same principle. There are also flat splint activators like the myobrace system and the splint that is used in-between MCB treatments.

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Topic starter Posted : 21/07/2021 3:46 am
Apollo
(@apollo)
500+ Forum Posts

I've mentioned the rational behind the homeoblock's unilateral bite block and its impact on asymmetry a few times in this thread. Last night, I decided to add a flat thermoplastic splint covering the first molar and second bicuspid onto the "less-developed" side of my lower removeable acrylic expander to mimic the homeoblock. Dr. Belfor's stated rational is that the extra chewing force on the less developed side encourages growth. Maybe this will be true over the long term, but I noticed immediately that biting down brought the side without the block closer together, straightening out my mandibular cant and allowing me to rest close to the end-on-end position where it's most comfortable without the incisors hitting. The MCB therapy principle is that getting the mandible into the correct position allows the rest of the cranial torsion to unwind itself. It seemed promising enough that I'm going to keep the splint in place for now.

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Topic starter Posted : 23/07/2021 7:00 am
Apollo
(@apollo)
500+ Forum Posts

I've been noticing over the past few months that my nasolabial folds seem to be getting more symmetrical. Interestingly, most of this change seems to have happened in the time after I completed the MSE expansion. Maybe it's from the forward protraction of my reverse pull headgear. Maybe it's from changes in the position of my mandible. Maybe it's from my lower removeable expander, or even the unilateral bite block I recently added. I can't really figure out what's causing the change, but it's encouraging.

I've always had one side where the nasolabial fold wrapped around the corner of my mouth and a separate fold came up from the chin lateral to it. On the other side the nasolabial fold joined the fold coming from my chin and there was a separate little crease medial to it at the corner of my mouth. When I smile now, especially a wide smile, the crease from my chin to my cheeks is separate on both sides. The nasolabial fold on the side that used to meet up with it now seems to be splitting the difference between two smaller separate folds at the corner of my mouth. I'm hoping that these will consolidated and meet up with the nasolabial fold like the opposite side as I continue with my current interventions.

Anyway, my nasolabial folds are just a sign, like the deviation in the bridge of my nose and my maxillary cant, that MSE treatment might improve some aspects of symmetry even though there's a risk it could make symmetry worse. My suspicion is that the transverse expansion from the MSE itself is likely to exacerbate existing asymmetries, especially in the bite. So the wider side of the arch is likely to expand more. However, the loosening of the perimaxillary sutures as a result of the expansion might allow some torsions in the skull to unwind for improved symmetry from other interventions like the facemask, or a bite splint, or postural changes, or improved nasal breathing.

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Topic starter Posted : 10/08/2021 9:16 pm
Silver
(@silver)
100+ Forum Posts
Posted by: @apollo

I've been noticing over the past few months that my nasolabial folds seem to be getting more symmetrical. Interestingly, most of this change seems to have happened in the time after I completed the MSE expansion. Maybe it's from the forward protraction of my reverse pull headgear. Maybe it's from changes in the position of my mandible. Maybe it's from my lower removeable expander, or even the unilateral bite block I recently added. I can't really figure out what's causing the change, but it's encouraging.

I've always had one side where the nasolabial fold wrapped around the corner of my mouth and a separate fold came up from the chin lateral to it. On the other side the nasolabial fold joined the fold coming from my chin and there was a separate little crease medial to it at the corner of my mouth. When I smile now, especially a wide smile, the crease from my chin to my cheeks is separate on both sides. The nasolabial fold on the side that used to meet up with it now seems to be splitting the difference between two smaller separate folds at the corner of my mouth. I'm hoping that these will consolidated and meet up with the nasolabial fold like the opposite side as I continue with my current interventions.

Anyway, my nasolabial folds are just a sign, like the deviation in the bridge of my nose and my maxillary cant, that MSE treatment might improve some aspects of symmetry even though there's a risk it could make symmetry worse. My suspicion is that the transverse expansion from the MSE itself is likely to exacerbate existing asymmetries, especially in the bite. So the wider side of the arch is likely to expand more. However, the loosening of the perimaxillary sutures as a result of the expansion might allow some torsions in the skull to unwind for improved symmetry from other interventions like the facemask, or a bite splint, or postural changes, or improved nasal breathing.

I've noticed more or less the same. This may be because of my osteopathic treatments almost every month, but I'm not sure. My appliance comes out soon! I may post or comment about the results.

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Posted : 11/08/2021 1:03 am
Apollo liked
Apollo
(@apollo)
500+ Forum Posts
Posted by: @silver

I've noticed more or less the same. This may be because of my osteopathic treatments almost every month, but I'm not sure. My appliance comes out soon! I may post or comment about the results.

I'd love to hear more about your results! I'm still going to see my osteopath, but much less frequently since I completed the expansion, now every few months rather than every few weeks. So it might be another factor helping to improve my symmetry.

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Topic starter Posted : 11/08/2021 5:34 am
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