#113 – Dr. Kasey Li – Top sleep surgeon changed his mind on FME

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.Book a 1:1 Coaching Call with Ronhttps://jawhacks.com/coaching/Get the JawHacks Field Guidehttps://field-guide.jawhacks.com/Join the JawHacks Newsletterhttps://jawhacks.com/newsletter/TIMESTAMPS0:00:00 - Intro0:01:01 - Dr. Li's training and Dr. Guilleminault's legacy0:07:34 - Misconceptions and treatments he doesn't believe in0:13:09 - Can MMA replace nasomaxillary expansion?0:17:06 - Why he now uses FME in 95% of EASE cases0:23:26 - Overexpansion risks and when to stop0:36:20 - Cheekbone changes with FME vs custom MARPE0:40:14 - When he still uses MARPE and an FME failure case0:47:33 - Stretching turns and the case for EASE0:55:52 - Expansion after MMA and why to keep your plates1:10:38 - Where the 10 mm MMA rule came from1:14:52 - MMA success rates and long-term decline1:17:08 - Pharyngoplasty and the only 3 surgeries he does1:22:14 - Small advancements and why revision MMA is hard1:26:58 - Septoplasty before MMA and the subspinal LeFort1:36:27 - The patient who got worse after MMA1:41:41 - Why he calls piriformplasty bogus1:43:06 - MMA complications in 200 consecutive cases1:47:50 - Why he doesn't believe in DISE2:00:42 - How he diagnoses sleep apnea without DISE2:08:40 - Sleep apnea, anxiety and hard-to-read symptoms2:13:42 - The septum during expansion and how he performs EASE2:26:21 - Pterygomaxillary release and adult MARPE protraction2:29:51 - Stronger expanders and EASE after MMA2:36:10 - How a pterygomaxillary release is done2:41:26 - Asymmetry and rigidity with FME vs custom MARPE2:53:28 - When one expander isn't enough and the future of FME2:59:36 - Custom plates and mandible-first MMA3:10:33 - How he seats the condyle and the limits of VSP3:23:04 - Total joint replacement and condylar resorption3:25:45 - Presurgical ortho and why he avoids segmentals3:28:11 - How MMA changes the nose and nasal breathing3:36:36 - Posterior maxilla downgrafting and nasal breathing3:41:27 - Surgeons who dismiss expansion3:44:17 - Aesthetics and expectations in MMADISCLAIMERNO 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.