Sleep surgeon Dr. Kasey Li returns to JawHacks three years after his first appearance for an in-depth update on nasomaxillary expansion and maxillomandibular advancement (MMA). Dr. Li developed EASE, a minimally invasive surgical split of the midpalatal suture used alongside an expander. He explains why he now uses the FME in about 95% of his EASE cases, the risks of overexpansion, how FME compares with custom MARPE, and why he sees no value in sleep endoscopy (DISE). The conversation also covers expansion after MMA, the origin of the 10 mm advancement guideline, custom plates, and how MMA affects nasal breathing and aesthetics.
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TIMESTAMPS
0:00:00 - Intro
0:01:01 - Dr. Li's training and Dr. Guilleminault's legacy
0:07:34 - Misconceptions and treatments he doesn't believe in
0:13:09 - Can MMA replace nasomaxillary expansion?
0:17:06 - Why he now uses FME in 95% of EASE cases
0:23:26 - Overexpansion risks and when to stop
0:36:20 - Cheekbone changes with FME vs custom MARPE
0:40:14 - When he still uses MARPE and an FME failure case
0:47:33 - Stretching turns and the case for EASE
0:55:52 - Expansion after MMA and why to keep your plates
1:10:38 - Where the 10 mm MMA rule came from
1:14:52 - MMA success rates and long-term decline
1:17:08 - Pharyngoplasty and the only 3 surgeries he does
1:22:14 - Small advancements and why revision MMA is hard
1:26:58 - Septoplasty before MMA and the subspinal LeFort
1:36:27 - The patient who got worse after MMA
1:41:41 - Why he calls piriformplasty bogus
1:43:06 - MMA complications in 200 consecutive cases
1:47:50 - Why he doesn't believe in DISE
2:00:42 - How he diagnoses sleep apnea without DISE
2:08:40 - Sleep apnea, anxiety and hard-to-read symptoms
2:13:42 - The septum during expansion and how he performs EASE
2:26:21 - Pterygomaxillary release and adult MARPE protraction
2:29:51 - Stronger expanders and EASE after MMA
2:36:10 - How a pterygomaxillary release is done
2:41:26 - Asymmetry and rigidity with FME vs custom MARPE
2:53:28 - When one expander isn't enough and the future of FME
2:59:36 - Custom plates and mandible-first MMA
3:10:33 - How he seats the condyle and the limits of VSP
3:23:04 - Total joint replacement and condylar resorption
3:25:45 - Presurgical ortho and why he avoids segmentals
3:28:11 - How MMA changes the nose and nasal breathing
3:36:36 - Posterior maxilla downgrafting and nasal breathing
3:41:27 - Surgeons who dismiss expansion
3:44:17 - Aesthetics and expectations in MMA
DISCLAIMER
NO MEDICAL OR DENTAL ADVICE. Ronald Ead and JAWHACKS, LLC, dba JawHacks (collectively, "we") does not give medical advice. We are not licensed medical professionals. The information provided in this video is for educational and informational purposes only and should not be construed as medical advice. Always seek the guidance of a qualified healthcare provider with any questions you may have regarding your health or a medical condition.
