In this episode, Dr. Bobek and Dr. Wasson discuss large maxillary transverse corrections in orthognathic surgery, covering how their comfort with expansion magnitude has evolved over time and what strategies they use when the plan pushes the limits of what a segmental Le Fort can reliably achieve.

Topics covered in this episode:

- How comfort with large maxillary expansion develops over a surgical career

- The difference between bony expansion on a 3D plan vs intermolar expansion and why that distinction matters

- Flat palatal vault as a key risk factor for large transverse corrections

- Step by step approach to a large segmental Le Fort expansion including mobilization, palatine release, and progressive stretching

- Having multiple backup splints ready and how to use them intraoperatively

- Mandibular midline osteotomy as a backup plan and when it actually makes sense

- Bone grafting the segmental gaps: what materials to use and why grafting is hard to argue against

- Palatal splints: design considerations, relief adjustments, and how long to leave them in

- SARPE vs segmental Le Fort: what the existing stability data actually shows and why the common teaching may be backwards

- DOME, MARPE, and MSC expansion: what we still do not know about long-term stability

- When SARPE is clearly the right answer and when segmental Le Fort is the more direct path

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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.