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MSE Procedure - Advice

Max_111
Active Member

Hello,

I've been looking at the surgically assisted MSE procedure that Dr. Ting in California specialises in, and was wondering whether I could get any advice from the members of this forum.

I'm from the UK and am 36 years old, and so was looking at the surgically assisted option as I'm sure my palate will not move without surgical assist.

I know Dr. Ting is probably the best in this field, but are local practitioners in the UK proficient at this procedure? I know we are quite far behind here in terms of orthodontics.

The majority of my issues were originally caused by a poor orthodontist on the NHS when I was 18 years old, in which I had two upper pre-molars extracted, hence why I need to re-create the width and length, as I've been suffering pretty much with low level TMJ and other issues related to a narrow palate since then.

Has anyone any experience or knowledge of the surgical assisted MSE procedure to gain some forward advancement and widening of the maxilla?

Thanks

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Topic starter Posted : 01/07/2021 1:58 pm
Apollo
Reputable Member
Posted by: @max_111

Hello,

I've been looking at the surgically assisted MSE procedure that Dr. Ting in California specialises in, and was wondering whether I could get any advice from the members of this forum.

I'm from the UK and am 36 years old, and so was looking at the surgically assisted option as I'm sure my palate will not move without surgical assist.

I know Dr. Ting is probably the best in this field, but are local practitioners in the UK proficient at this procedure? I know we are quite far behind here in terms of orthodontics.

The majority of my issues were originally caused by a poor orthodontist on the NHS when I was 18 years old, in which I had two upper pre-molars extracted, hence why I need to re-create the width and length, as I've been suffering pretty much with low level TMJ and other issues related to a narrow palate since then.

Has anyone any experience or knowledge of the surgical assisted MSE procedure to gain some forward advancement and widening of the maxilla?

Thanks

I'm a man slightly older than you and MSE successfully split my midpalaltal suture without surgical assist. It might be worth trying aggressive cortipuncture first before moving on to surgically facilitated expansion if your suture fails to disarticulate. With the SARPE cuts, most changes will be limited to the lefort 1 area, including any forward advancement if you added reverse-pull headgear.

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Posted : 01/07/2021 4:42 pm
Max_111
Active Member

@apollo Thank you for the reply Apollo.

That is interesting to hear, and I'd certainly be in favour of trying the most conservative approach possible, hence why I'm not looking at the full surgery. I probably need at least 2mm of advancement of the front teeth to be able to get a fairly comfortable jaw position, and then probably as much width as is possible mainly between the premolars and first molars which is were the original appliance was fixed. (For some reason they didn't fix it to the back molar or wisdom tooth which have remained fairly wide apart).

I went to a surgeon a while ago and he reckoned doing the typical surgery would be like taking a sledge hammer to crack a nut, which he was probably right about, but then standard orthodontists struggled to do anything either, and so I was stuck in the middle not really being suitable for either approaches.

I've been looking at MSE practitioners and it appears they are mainly in the US, and so I am looking to book the consultation online with Dr. Ting to see if he can recommend anyone, and to get an opinion on treatment options.

There is some great information in this forum though, and in fact this forum is how I found out about MSE initially, and so thanks to everyone who contributes on here. I have a lot of experience myself and will try to give something back. A lot better than when I was 18 when there was hardly any information on all the issues caused by orthodontics and underdeveloped jaws.

 

ReplyQuote
Topic starter Posted : 01/07/2021 6:10 pm
Apollo
Reputable Member

Someone named Dr. Hirari in Milton Keynes is currently the only UK MSE provider on Dr. Won Moon's provider list ( https://www.moonmse.com/distributors-1 ). I believe this means that he or she has completed Dr. Moon's training. Dr. Mike Mew (in London) says during his video with Ronald Ead on the TGW youtube channel that he has started using the MSE more frequently, but that COVID has kept him from taking Dr. Moon's MSE course. I'm not sure if either of them have experience with cortipuncture or have worked with an oral surgeon for surgical assist. I suspect Dr. Mew would be adverse to taking on surgical cases, but I could be wrong. 

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Posted : 01/07/2021 9:07 pm
serbian
Active Member

@apollo are you saying that SARPE changes will mostly change the LeFort I area, while MSE will do more? Could you explain further why MSE results are better if both proceed in similar ways?

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Posted : 02/07/2021 8:15 am
Max_111
Active Member

One benefit of the surgical assist might be that you can achieve greater forward advancement I wonder.

Where did you get your MSE treatment  out of interest Apollo? I am looking at European providers too as that wouldn't be impossible for me. 

I don't think Mike mew would be an option, as for one thing he doesn't often take on new patients, and even then I'm not sure if he is willing to do surgery as part of his treatment plans. 

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Topic starter Posted : 02/07/2021 9:09 am
Max_111
Active Member

@serbian Dr ting mentioned that you dont widen the zygomatic part of the skull if you use surgical assist, although I expect any widening would be very minimal anyway in an adult. 

I don't think there is much difference other than that, although sarpe is much more invasive, and completely disconnects the maxilla from the skull, so changes are only going to be around the maxilla in this case. 

ReplyQuote
Topic starter Posted : 02/07/2021 9:12 am
Apollo
Reputable Member
Posted by: @serbian

@apollo are you saying that SARPE changes will mostly change the LeFort I area, while MSE will do more? Could you explain further why MSE results are better if both proceed in similar ways?

See this old post comparing the midface changes from surgical and non-surgical skeletal expansion:

Posted by: @apollo
Posted by: @greyham
 
I'm curious about one thing here: while DOME/SMARPE/MSE-with-Surgical-Assist reduces the risk of expander failure, I wonder if it also reduces the potential for midfacial growth with the appliance when it is successful, because releasing the zygomatic resistance will also reduce the strain available to trigger bone remodelling. What do you think? Did you have surgical assist with your MSE? (And do you want fries with that?)

I agree that cutting or even scoring the buttress reduces the tension translated to the upper maxilla and zygoma. The palatal tongue space and floor of the nasal cavity would still expand, but there would likely be less increase in the total volume of the nasal cavity and midface. This is one reason I insisted on only cortipuncture despite the higher failure risk for a man my age. EASE seems like a good option for older men with airway/sleep issues because it releases the midpalatal and pterygopalatine sutures but doesn't cut the buttress. Here's a slide Dr. Rebecca Bockow shared when @ronaldead asked her about this issue.

Her answer was a little vague, but I think the imaging confirms our suspicions that changes are limited to the Lefort 1 area with procedures like SMARPE, DOME, or SARPE while MARPE without surgical assist has the potential to change an area analogous to Lefort 3 cuts, although the midpalatal suture separation will probably be less because of the increased resistance, as illustrated in this slide from Dr. Marianna Evans.

 

JawHacks has since taken down the interview with Dr. Bockow from his channel for some reason. Dr. Evans' slide appears around the 43:27 mark in this video: https://www.pathlms.com/pcso/events/1648/video_presentations/143837

 

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Posted : 02/07/2021 11:12 am
Max_111
Active Member

Thanks for the information Apollo.

Did you manage to achieve good forward advancement and widening with just cortipuncture out of interest?

Also what is EASE as its not something I've heard of before?

I think forward advancement of the maxilla seems to be the most difficult thing to achieve according to all the dentists I have spoken with, and so I am thinking a minor surgical procedure such as MSE that achieved this would be worth doing despite the drawbacks.

I feel that advancement of the maxilla and therfore mandible also, generally outweighs widening procedures in term of health and aesthetics, particularly if you have a recessed mandible and TMJ issues.

The issue is so far no procedure reliably can do this without significant disadvantages. 

ReplyQuote
Topic starter Posted : 02/07/2021 12:01 pm
Apollo
Reputable Member
Posted by: @max_111

Thanks for the information Apollo.

Did you manage to achieve good forward advancement and widening with just cortipuncture out of interest?

Also what is EASE as its not something I've heard of before?

I think forward advancement of the maxilla seems to be the most difficult thing to achieve according to all the dentists I have spoken with, and so I am thinking a minor surgical procedure such as MSE that achieved this would be worth doing despite the drawbacks.

I feel that advancement of the maxilla and therfore mandible also, generally outweighs widening procedures in term of health and aesthetics, particularly if you have a recessed mandible and TMJ issues.

The issue is so far no procedure reliably can do this without significant disadvantages. 

I definitely got good transverse expansion with improved nasal breathing from cortipuncture-facilitated MSE. I think I got at least a couple millimeters of forward advancement using my reverse pull headgear diligently, but I haven't had follow up imaging to measure, and I still wish I could get more to correct my skeletal class iii tendencies. I agree that forward advancement from MSE+FM requires a lot of effort for little reward, at least for a man my age. EASE (endonasal assisted surgical expansion) is a procedure performed by Dr. Kasey Li in San Francisco to expand the nasal airway and treat sleep disordered breathing. As far as I know he is the only one using an endoscope through the nose to cut the midpalatal suture. It also involves cutting the pterygomaxillary junction (so it is an in-hospital surgery). A different type of expander made by KLS Martin is placed on the palate and turned by the patient daily. Because they don't cut the zygomatic buttress, the expansion should translate to the whole midface like MSE, but they generally only expand enough to open the nasal airway, often with little to no dental diastema, and it isn't marketed as an aesthetic procedure. I think it might be a good option for older men who fail to disarticulate with MSE.

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Posted : 02/07/2021 3:02 pm
Apollo
Reputable Member

These are the only UK MSE providers I'm finding:

Richard Cousley in Peterborough at www.priestgateclinic.co.uk

Sunil Hirani in Milton Keynes at www.smilelux.co.uk

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Posted : 02/07/2021 9:11 pm