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Хирургическое расширение верхней челюсти. SARPE vs EASE

Ссылка на статью с описанием разницы между операциями SARPE (Surgically Assisted Rapid Palatal Expansion) и EASE (Endoscopically-assisted surgical expansion), которую делают за $23 тыс. в Пало Альто.

SARPE — это и есть установка дистрактора обычным способом, которую делают по всему миру и которую может покрыть страховка, если вы уболтаете непонятно кого — то ли хирурга, то ли ортодонта, то ли сомнолога.

Старая техника: надрезается нёбо вдоль, и потом надевается простой Hyrax http://www.quintpub.com/userhome/aoos/aoos_16_3_tavares4.html?fbclid=IwAR0vheMLKCRix5a5l6LNVe0JxY_jRuFep58MqGhbaO5n0tTM0vXJGgn6EAo

Описание EASE (Endoscopically-assisted surgical expansion) https://weblync.blob.core.windows.net/orthoquo/2018%20Endoscopically-assisted%20surgical%20expansion%20(EASE)%20for%20the%20treatment%20of%20OSA.pdf

Из новостей:
1) При EASE хирург расщепляет швы, по которым верхняя челюсть прикрепляется ко всему черепу.

2) При EASE хирург надпиливает нёбный шов изнутри через нос (это то, для чего нужен эндоскоп и почему операция так называется). Процесс нужен для того, чтобы расширялись дыхательные пути, а не разъезжались зубы спереди. При хорошо сделанной операции зубы могут не разойтись вообще, а дыхательные — расшириться.

Вот только в статье ничего нет по поводу того, как эта коррекция держится, не складывается ли через лет 5. Но всё лучше, чем просто расхождение нёба веером. В старом посте (https://healthy-back.livejournal.com/410603.html, https://healthy-back.dreamwidth.org/401437.html), кстати, новая картинка про то, как расширение веером выглядит. Это реальная КТ, не графика. Мне кажется, расщепление по швам между черепом с обеих сторон делают как раз для того, чтобы коррекция держалась.

Ещё ссылка на https://pubmed.ncbi.nlm.nih.gov/30393018/ , но там просто о том, как прекрасна EASE при апноэ, ничего нет про устойчивость коррекции.

Sarpe-ease

UPD 12/12/2020 Про MSE. Это НЕ исследование, там нет статистики об улучшениях сна, есть просто описание:
https://www.youtube.com/watch?v=LJ3H8eWbj1Q&feature=youtu.be&fbclid=IwAR0AOEm5TWHsMI_dZCTZPOx3WweG8GFu-DQJ7FdJ5ZlchM1Kc8_cK3ITP3E
https://www.facebook.com/groups/upperairwayresistancesyndrome/permalink/715869155801554
1. Dr Moon doesn’t have any financial association to the MSE manufacturer, he turned over his patent to them a while back. However he keeps innovating new changes to the MSE and a few new types are in the works (an extra narrow one, a double one for very thick palatal bones, and one with a replaceable screw so you don’t need to install a new appliance to do a 2nd MSE).

2. He presents data on sleep disordered breathing and MSE and the results are amazing: AHI reduced, airways volumetrically expanded, nasal airflow increased, and in one specific case, OSA completely cured in someone who had extreme OSA. Dr Moon said he really didn’t care or know much about airway issues when he started MSE and it wasn’t a focus for him, but patients kept reporting better sleep and breathing, so recently he has been working to get quantifiable data on sleep and airway improvements. He will be working with a sleep lab on a large study (unfortunately delayed because of Covid). But the data he does have is amazingly encouraging. I’m really surprised to see that not only is the nasal airway expanded (which is to be expected), but also the pharyngeal airway. He offers some theories on why that happens.

3. Contrary to numbers frequently used about MSE expansion being 70% skeletal and 30% dental (that figure was communicated to me by Dr Yoon last year), they came up with a new measuring method that accounts for the angle of expansion and now conclude that MSE expansion is basically 100% skeletal. **This is game changing, people!!** The expansion measured at the molars is due to true skeletal expansion, not dental tipping or alveolar expansion. He goes into detail on why this method of measuring is more accurate.

4. He recommends that mature MSE patients do quite a few turns a day because rapid expansion breaks the suture more easily. He also says he asks patients to turn until they feel resistance, then do one or two more turns after that.

5. When MSE fails, he does cortipuncture and then often sees success with a second MSE.

6. However if that fails too, he does SMARPE (surgical MARPE using MSE), which is much less invasive and possibly more successful than SARPE.

7. There is a much higher rate of tongue ties in MSE patients than in normal controls. This is probably not surprising to most of us, but still cool to see the data.

8. He’s thinking of changing the name to Midfacial Skeletal Expander instead of Maxillary Skeletal Expander, to better represent what it does.

9. He proposes a new class of malocclusion (Class IV), to describe having both retrognathic mandible and retrognathic maxilla.

10. Facemask for forward maxillary expansion is much more effective combined with MSE than with tooth-borne expanders because MSE loosens all the midfacial sutures, not just the midpalatal suture.
Tags: Зубы, Ссылки
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