Is MARPE Needed Before MMA? Where the Evidence Stands

<p>In this episode, Dr. Bobek and Dr. Wasson take on a question both of them hear regularly in consultation: whether patients should undergo maxillary expansion (MARPE, MSE, DOME, EASE) before maxillomandibular advancement for obstructive sleep apnea. They cover who they think expansion is for, what is and is not established about nasal airway change compared with segmental Le Fort, and the cost, time, and surgical trade-offs of doing both. Dr. Wasson also shares a six-week post-operative MMAW case with intermolar and nasal base width measurements.</p><p><br></p><p>This podcast is produced for oral and maxillofacial surgeons, orthodontists, and other clinicians. The hosts discuss clinical reasoning that depends on training and experience, applied to specific scenarios, and nothing here is a treatment recommendation. The discussion assumes a clinical background and is not a substitute for an individual evaluation with your own surgeon.</p><p><br></p><p>Topics covered in this episode:</p><p>- Who is a clear expansion patient, who is a clear MMA patient, and why the middle group is hard</p><p>- Cost and time: roughly $10,000 to $30,000 and a year or more before jaw surgery</p><p>- Whether MARPE widens the nasal airway more than a segmental Le Fort</p><p>- Widening the nasal aperture by tilting segments in a three-piece Le Fort</p><p>- How prior expansion changes the Le Fort: scar tissue, blood supply, and resistance to advancement</p><p>- When expansion first makes sense: the anxious patient and the tongue-space complaint</p><p>- Whether expansion followed by MMA is any better than MMA alone</p><p>- Whether surgeons are going along with expansion to keep patients and referrals happy</p><p><br></p><p>📬 Questions or topic suggestions: downfracturedpodcast@gmail.com</p><p><br></p><p>*The Down Fracture Podcast is for informational and entertainment purposes only and does not constitute medical advice. All opinions expressed are solely those of the hosts and their guests.</p>