Physicians at the University of Alabama at Birmingham (UAB) recently performed the first “jaw in a day” surgery in the state—a radical mandibulectomy fibula free flap reconstruction with simultaneous 3-D guided dental implant and immediate previsualization on a patient who had a large, destructive tumor in the front of her chin.
Carried out preoperatively using 3-D navigation and computer-aided design, the surgery removed the lower jaw, tumor, soft tissue, and eight teeth. It also immediately replaced the missing bone with a fibula free flap from the patient’s lower leg and placed dental implants to replace the missing teeth.
Patients who lose their jaw to cancer or trauma usually require at least 12 to 18 months to replace the jaw with bone from the leg, place dental implants, and fit a permanent dental prosthesis. The UAB team wanted to perform the surgery in a single day to expedite healing and normalcy for the patient, Traci Bacon, and minimize its psychological impact.
“Traci’s tumor, an ossifying fibroma, was noncancerous and would not metastasize, but the tumor had invaded her jaw bone,” said Anthony Morlandt, MD, DDS, associate professor and chief in the section of oral oncology at UAB’s Department of Oral and Maxillofacial Surgery and associate scientist in UAB’s Comprehensive Cancer Center.
“Without surgery, the tumor would eventually destroy and collapse her jaw bone entirely, taking away her ability to eat, drink, and speak normally,” Morlandt said.
“I had so many concerns. Would my face look different? Would my speech be impaired? How soon could I get teeth?” Bacon said about facing the prospect of surgery. “I prayed a lot. The team at UAB were patient with me, answered all my questions, gave me weeks to make a decision, and really included me in every step of the treatment planning.”
The team used 3-D technology for planning and navigation as well as to print models of Bacon’s existing and future jaw. Collaboration between American and German engineers helped the UAB team virtually complete the surgery before performing the procedure in the operating room.
After a successful eight-hour surgery, Bacon’s recovery process began. Nearly five months after surgery, her leg is fully healed, and the surgical incisions on her neck and face are hardly noticeable. The site where the tumor once resided looks as if nothing had been there. The team notes that the surgery sets a new standard of surgical care that will help other oral oncology and oral surgery patients.
“What we learned from this procedure is that we have the team, resources, and technology in place at UAB to give oral surgery patients the absolute best outcome in Alabama and in the country,” Morlandt said. “A mandibulectomy and fibula free flap reconstruction isn’t a new surgery. But we are helping to evolve the manner and level in which the surgery is completed, which only betters the lives of our patients here at UAB moving forward.”
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