What goes wrong with MARPE? Audrey Yoon

What goes wrong with MARPE? Audrey Yoon
Join me for a lecture summary from this years AAO by Audrey Yoon. Don’t Make the Same Mistake I Did/ MARPE Complication.
Success MARPE
Overall separation: 87.8% Success rate of sutural separation: (Jeon 2021)
• 61.05% in male
• 94.17% in female
• Average expansion: 7.8 ± 2.4 mm.
Variation with age and gender
MARPE efficacy = Achieved Vs planned expansion
• Greater negative correlation with age in general
o More male than female
o Planned Vs achieved
a. 20 years old = 1:1 M:F
b. 30 years old = 0.5:1 : 0.8:1
c. 40 years old = 0! : 0.6:1 BUT NO DATA - extrapolation
No relationship with bicortical engagement
Asymmetric expansion
• = 50% of cases ANS level greater than 1mm
• 27% Greater than 2mm at ANS
• Severe: Similar to tripod fracture
• Causes of asymmetry Kim 2019
• Nasal-maxillary suture opening / remain closed
• 30% of case unilateral opening of suture
SARPE = 3-13% asymmetric expansion Williams 2012, Smeets 2020
Pain
• 45% report pain
• 19% Around band of 1st maxillary molar band
• 10% headaches
Gingival inflammation
• 83.9% of patients
• Design = flush
o Change to 1mm from palate and arms 3mm from palate = reduce
• Greater inflammation in retention
o Possibly due to palatal vault relapse and therefore TADs imbed in palate
Breakages
• 10%
• Usually guide rod / arm
Rare:
Loss of vitality 2%
• Required RCT maxillary incisors (SARPE 4.5%)
Fractures - potential tripod fracture
Infra-orbital numbness
• Temporary numbness 6 weeks
• 3 cases
• Management
• Turn backwards slowly
• Facial massage / myofascial
• Folate, Vit b - aid nerve regeneration
Hearing loss
• Zygomatic arch = hearing loss temporary, tetanus, trismus
Unexplained tears
• Lateral orbital rim = sagging eyeball, lacrimal gland
Popping in the ear
Lateral pterygoid fracture
• Click and popping to the ear - cheek shooting pain
• Lateral pterygoid plate fracture - asymmetric expansion
Consent
Audrey Yoon - youtube patient instruction video / leaflet
Growing consent
Audrey Yoon paper AJODO clinical companion - open access
A retrospective analysis of the complications associated with miniscrew-assisted rapid palatal expansion` Audrey Yoon 2022

Пікірлер: 26

  • @luke14946
    @luke14946 Жыл бұрын

    Very Frustrating how MSE/MARPE still isn't more widely available, I haven't seen it mentioned on any Orthodontist's site here in Ireland.... And similarly some people in the UK say they have a hard time finding anyone who does it.

  • @williamgustafsson8629

    @williamgustafsson8629

    Жыл бұрын

    There is a mse provider in Ireland.

  • @luke14946

    @luke14946

    Жыл бұрын

    @@williamgustafsson8629 what's their name?

  • @harrykinnear2592

    @harrykinnear2592

    2 ай бұрын

    Dr Vishal vij

  • @luke14946

    @luke14946

    2 ай бұрын

    @@harrykinnear2592 Saw his KZread vid before about MSE, looked him up and found results for Newland's Dental Clinic in Clondalkin, but there was NO mention of MSE/MARPE anywhere on the website.... and it had a page where it talked about 4 tooth (premolar/bicuspid) extraction for braces, aswell as incorrectly and misleadingly stating it as "too many teeth per the size of the jaw", i also tried to contact the clinic before a few times, without any success....

  • @CroElectroStile

    @CroElectroStile

    7 күн бұрын

    if you are over 30 i'ts just better to have DOME or SARPE

  • @entelechysea4580
    @entelechysea45804 ай бұрын

    There are about 15 people posting on Reddit with severe asymmetry after MSE. There are also interviews with people who got asymmetry with MSE on the KZread channel "Jaw Hacks." Facial changes reported: one eye drops, the over-expanded side of the mouth drops, one cheek bone bulges out. Health issues reported: vertigo, vision disturbance (loss of visual focus convergence, diplopia), descending asymmetry. Neck slant affected, one shoulder goes down, one goes up, scoliotic tendency in lower back. Surgery difficult to fix it. This risk must be disclosed to patients.

  • @AkunahsDream

    @AkunahsDream

    2 ай бұрын

    Thank you for this info. Do you know of - or how to find - info on how to prevent these types of affects ?

  • @BuddhaPepper

    @BuddhaPepper

    Ай бұрын

    Thank you so much, I was already doubting whether I wanted to do this before reading this comment but your comment sealed the deal 🙏🏻

  • @mariamaziz6448
    @mariamaziz644810 ай бұрын

    Thank you for posting this 👏

  • @RemieLebeau
    @RemieLebeau Жыл бұрын

    glad to come across this video. as a 38yo i was considering but now iºm second guessing :(

  • @entelechysea4580

    @entelechysea4580

    4 ай бұрын

    Asymmetry is a terrible consequence. Some people report becoming monstrous. Even the top MSE providers have damaged patients with MSE. Roblee, Mariana Evans, Ting.

  • @Raphael_NYC
    @Raphael_NYC Жыл бұрын

    Thank you.

  • @decekfrokfr3mdx
    @decekfrokfr3mdx Жыл бұрын

    Any views on SAMARPE (surgically-assisted, bone-borne rapid palatial expansion) vs. the EASE procedure in adult males? It seems SAMARPE guarantees suture split and reduces chance of asymmetric expansion compared to MARPE/MSE, but some poor results are still reported....so hard to get good info! Thanks.

  • @syedatifhussain7151
    @syedatifhussain7151 Жыл бұрын

    Awesome explanation👌👌👌

  • @tomgcolemangoplayer
    @tomgcolemangoplayer Жыл бұрын

    a youtube video is mentioned, please add link in description. Audrey Yoon - youtube patient instruction video / leaflet

  • @lHARDlCaps

    @lHARDlCaps

    Жыл бұрын

    I'm looking for the video and also can't find it.

  • @Spaghettificat
    @Spaghettificat Жыл бұрын

    What if I have Torus Palatinus? can I still do it? I am a 38 year old woman.

  • @alialhashmi1
    @alialhashmi1 Жыл бұрын

    Is it safe to travel if l put marpe ?

  • @laporte1625
    @laporte1625 Жыл бұрын

    So, would something like EASE or MSE be better solutions for middle-aged adults?

  • @DivadMick

    @DivadMick

    Жыл бұрын

    MSE is a MARPE. And yes, EASE is better than all of them but it’s an expensive surgically assisted expansion procedure.

  • @joannem8066

    @joannem8066

    Жыл бұрын

    @@DivadMick and EASE also has a failure rate which is never discussed by Dr. Li.

  • @chrisking6695

    @chrisking6695

    11 ай бұрын

    @@joannem8066 I haven’t heard of any failures from ppl who posted about it. But I’m sure every medical procedure has a failure rate. I’d be interested in knowing the exact failure rate vs MSE

  • @entelechysea4580

    @entelechysea4580

    4 ай бұрын

    @@chrisking6695 Yes I know someone in whom EASE caused asymmetry. Got it taken out at once.

  • @gregducati999

    @gregducati999

    Ай бұрын

    @@joannem8066 hey actually does discuss it that sometimes the distractor sinks into the bone and its position needs to be moved or even removed entirely