7.6 MARPE + Facemask for Protraction
Hope or Cope?
Hope for Non-surgical Advancement of the Jaws
Patients in the jawhacking space wish to reconstruct their face into a form that is normal and healthy.
Orthognathic surgery is the fastest, most precise, and most effective modality for accomplishing this.
But it is painful, expensive and risky.
MARPE has become popular because it is a non-surgical way of accomplishing the transverse dimension of jaw reconstruction — that is, making the palate wider.
But up to this point, there is no safe and effective non-surgical method of advancing the jaws.
Enter MARPE + facemask.
Theoretical Mechanism of MARPE + Facemask
The idea behind MARPE plus facemask is that MARPE loosens the circummaxillary sutures, and then facemask pulls the maxilla and midface forward.
Facemask is also known as a protraction device or reverse-pull headgear. It involves two pieces: the "facemask” itself, which is a device that is anchored somewhere outside of the mouth (usually but not always on the patients body, such as their neck or chest).
It also involves the anchorage or attachment point inside the patient’s mouth. This is the connection point where the protractive “pulling” motion happens.
Some sort of elastic band is used to connect the intraoral anchorage point to the facemask hub worn on the patient’s body, and voila, you have a forward pulling force being applied to the upper jaw.
Traditionally, protraction devices have been used only in children, and they were connected to the child’s teeth. The teeth were supposed to serve as anchors that would then transfer the force to the jaw itself, pulling the bones of the midface forward.
It was not considered a viable treatment option for adults because their bones were thought to be fused and totally immobile. Attaching a facemask to an adult’s teeth would surely only move those teeth, and not the ceramic-like bone of that patient’s face.
Then MARPE came along.
Now, there was an intraoral anchorage point, namely the MARPE appliance, that was connected directly to the skeletal bone via titanium screws (TADs).
Not only was there now non-dental anchorage, but there was also a way to disturb the rock-like sutures of that patient’s face.
The idea was that as the MARPE split the suture and began disarticulating other circummaxillary sutures in the midface, it was “melting the butter,” so to speak.
The sutures, now disturbed by MARPE, might succumb to strong protractive forces from a facemask.
This, at least, is the theory.
But as we shall see below, the reality may not be so elegant.