Chat #11- Dr. Yousefian, The Man with a Plan for the Mandible

Dr. Joseph Yousefian is the only American orthodontist I know who uses mandibular distraction (~MSDO) alongside MSE expansion. 

This means that Dr. Yousefian does not simply tip teeth in order to get the mandible to match the maxilla following MSE expansion. Rather, his approach is to give the mandible skeletal expansion of its own.

A few years ago I did a video called “Don’t Do MSE Without a Plan for the Mandible.” Well, Dr. Yousefian is the man with a plan for the mandible.

1-on-1 Chat with Ron

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0:00 Intro
3:08 Discovering airway orthodontics
5:35 Experience with TAD-supported expanders
7:55 Hundreds of expansion cases
9:01 MSDO vs. DAME
12:06 Why MSE (MANE) alone is not enough
15:11 Supporting airway during expansion with ApnoTX
18:44 Sleep apnea discussion
19:53 Preventing upper back teeth collapse during MSE
27:40 Preventing lip support collapse during MSE
42:45 Combining MSE and DAME / MSDO
46:03 Why SFOT is not good enough for the mandible
47:23 DAME / MSDO and TMJ Problems
56:09 Limits of MSE (MANE) without DAME / MSDO
1:00:05 Airway benefits of DAME / MSDO for sleep apnea
1:05:57 MSE (MANE) surgical assist
1:07:42 Piezoelectric bone saw for MSE
1:10:32 MSE asymmetry case study
1:15:39 What causes MSE asymmetry?
1:23:20 ApnoTX combined with MSE (MANE) and MSDO (DAME)
1:27:35 Fixing MSE (MANE) asymmetry case study
1:28:50 Must wait months after MSE (MANE) before doing sleep study
1:29:59 ApnoTX deep dive
1:31:50 Appliance for maxillary advancement
1:35:25 MMA case study
1:40:25 Conclusion

DR. YOUSEFIAN KEY TERMINOLOGY
DAME (Distraction Assisted Mandibular Expansion) = mandibular distraction similar to MSDO
MANE (Micro-implant Assisted Nasomaxillary Expansion) = maxillary distraction similar to MSE
DONE (Distraction Osteogenesis Nasomaxillary Expansion) = MSE-like expander that also does dentoalveolar advancement
ApnoMed - Dr. Yousefian’s company (which develops his proprietary appliances)
ApnoTX - sleep apnea appliance designed for use during skeletal expansion
ApnoDent - more basic sleep apnea appliance

Ron's Instagram:

[AB-tzno]

Wow, what a lovely man. He understands the patient's needs. Doctors like this are rare. Thanks so much for this interview. You're really helping so many people with this, Ron. Thank you!

[friendlyhuman]

Please keep these coming. You’re creating a change in the world video by video.

[augustaimsley]

Fantastic interview Ron, you are a very good interviewer. One of your most important videos to date for sure.
Looking forward to future content that utilises this information that Dr. Yousefian generously bestowed upon us. 👍

[tjam]

I have to give him credit. I’ve never seen as much nasomaxillary expansion as represented by huge diastema and larger skeletal nasal orifice post-expansion. Nice!

[grimartificial]

Fantastic interview! Glad I persevered through the rough audio.

[tjam]

Excellent interview. Innovative treatments.
Thanks to you both! I know it takes a ton of time putting this stuff together.
It’s now 1:36am, and time for me to get some interrupted sleep ;-)

[kartikchahal]

Another great video brother thanks and respect for serving the community

[skinnydippingdiver]

Ron, for someone that is having or had EASE but still needs more expansion, is Yousefian's approach compatible starting during or after the EASE consolidation period? EASE seems superior for nasal expansion, but it lacks the ability to maximize expansion and correct asymmetrical expansion/cant. How would it work?

[HappyCupsInc]

Great chat, I think I could greatly benefit from his treatments. I have sleep apnea and UARS and a very small airway. Would be cool to have him on the channel again.

[Natalie-ften]

So if I had very mild UARS (RDI 7) and went through MARPE already do you think it’s fine to just do SFOT for the lower or still need DAME? I have minimal tooth crowding on the lower jaw. That being said I don’t want to risk relapse in the future.

[timothyjudson]

You should get him back on! I think that it would be an episode well worth redoing with better audio and a better understanding of jaw expansion. I’m considering trying to move to the north west so I can get the mse with mandibular expansion but it would be nice to have a better presentation on it

[BaigoClips]

59:34 Does the coronoid process move about 2-3 on each side or both ? @JawHacks

[DanEMO]

Great channel! I got MMA surgery in 2017 and it’s super interesting to see people learning more about jaw surgery nowadays. I think my new achilles heel is posture with a neck hump. People in junior high called me hunchback 😢

[mennehgambia]

I had an idea similar to the Apnodent, didn't know it existed, and its actually an excellent solution for severe cases of narrow nasal airways, at least before and during MSE treatment. Good interview so far!

[gummybuggy]

As someone who is newer to these things why would the maxilla drop down and forward as someone who is looking for ways to combat that in their own face is there no solutions for a downsunh face besides lefort 1 surgery? I am incapable of having the correct toungue posture and am still actively trying to find help with it. With your amount of knowledge do you know any thinsg that can be done to help with beinh downswung

[ericzhao]

Hello Ronald, do you know any providers that install tandem/double MSEs for people who don't succeed with a single MSE?

[tjam]

1:33:20 he states the maxillary appliance can drop the maxilla down and forward.
(I don’t think you want to drop the maxilla in most cases. That would be a clockwise rotation, which is usually an unwanted movement. It causes a longer face, and open vertical dimension. If anything, you’d want to anteriorly reposition the maxilla and get a counterclockwise rotation)

[joedimaggio]

Hey Ron, really enjoyed this one. Loving the upload frequency. I wonder if it would be feasible going to Yousefian from the UK, do you think the amount of visits needed would make it impractical?

[Jackk]

Does he visit his patients in iran too? I'm so done going to dentists and being rejected cause they just don't want to think about other methods 😢

[tjam]

I just thought of something:
I see large nasal expansion in the radiographs for the younger patients…but can the treatment shown here give the same predictable results in adults? Ie. (Radiographic documentation of enlarged nasal orifice post-operatively)…or does the more extensive surgery seen in adults limit the expansion (because expansion is limited to maxilla only vs naso-maxillary complex)