Here's a pic of my skull before MSE: ![[preoperative-3D.jpg]] And after: ![[postoperative-3D.jpg]] Note the screws! They're the yellow bits that can be seen them through my airway in the second pic. That scan was taken right before I got my device taken out. My teeth are a bit wonky now, but my invisalign should straighten them out in time. ## What is MSE? An MSE appliance is looks like this: ![[mse-hero.jpg]] It's a type of expander. Specifically, it's a bone-borne expander. The bits that attach to your molars are flexible and don't push on your teeth, the only reason they're there is to keep the expander from rotating inside your mouth. The expander is anchored to your mouth via the four screws in the middle. Every day, you use a small wrench to rotate the nut in the middle of the expander, which forces the expander to push outward horizontally, applying pressure to the bone (called the maxilla). (You may be familiar with tooth-borne expanders that they often give to kids. Those are great, but don't work on adults because our bones are too sturdy. A tooth-borne expander on an adult will just tip the teeth.) If all goes well, after a few days of expanding the _suture_ at the top of your mouth will split. That allows the two halves of your upper jaw to move independently, so further turns cause real expansion of your skeleton. After you're done expanding, you leave the appliance in there for a few months to hold it steady while the gap fills in with new bone. I got my expander when I had just turned 22, and got it removed the other day. I genuinely think getting an expander was one of the best decisions I've made in my life. ## The downsides 1. **Cost**: Getting the expander installed isn't cheap, and then you need invisalign to fix the giant gap it'll leave in your front teeth. For me the total cost came to around $10k, and I'm still not close to being done with the invisalign. Even after invisalign, you are liable to have gaps between your teeth, depending on how much expansion you get. 2. **Discomfort**: Having a giant appliance in your mouth isn't pleasant. Food gets caught in it all the time, and the screws scrape up your tongue until it feels like ground beef. The installation isn't great either. It starts with a corticotomy, where they drill about 15 holes in your suture to weaken it, then they attach the device to your molars, then they screw it in. But it's all done with local anaesthesia and after a few days your mouth stops hurting. 3. **Complications**: It's possible that your suture won't split, or that you'll develop facial asymmetry where one half expands more than the other, or that you'll experience "screw drag" where the screws drag through your bone instead of your bone moving with the screws. I actually had some minor screw drag and it was pretty painful. (The drag is where the screws are tilted in my postoperative scans above.) Women can get MSE at any age, but men's risk of complications rises with age. I wouldn't recommend any man over 25 get MSE without surgical assistance. ## The upsides I got MSE for two reasons: 1. **Improved breathing**: I had a problem with snoring. But you probably noticed in the scans that my airway is now much bigger. That's what makes MSE such an effective treatment for sleep apnea. I have no data to confirm this, but my chronic fatigue has completely gone away and I'm told I no longer snore. If I didn't get MSE, I feel that the fatigue from never getting enough sleep would have lead to me losing my job. The increase in my quality of life is hard to articulate. 2. **More tongue space**: I have a tongue tie which my orthodontist thinks is preventing me from speaking properly. For as long as I can remember, people have told me to "stop mumbling" and "open your mouth when you talk", but I haven't been able to figure out how to talk clearly. Pre-MSE, my tongue couldn't fit inside the roof of my mouth, but now that that's resolved I feel I already speak more clearly – once I get my tongue tie cut I hope that I'll see further improvement. There's one other benefit I wasn't expecting. I feel that MSE has substantially improved my facial aesthetics. I've always been insecure about my smile, thinking it looks "weird" without being able to put my finger on why. ![[smile-before-1.jpg]] ![[smile-before-2.jpg]] Since MSE, my smile has obviously gotten much wider. Also, even when I'm not showing my teeth, I feel like you can see a difference in my cheekbones. ![[smile-after-1.jpg]] ![[cheekbones-after-1.jpg]]