Dental News - Jaw-in-a-day surgery successfully performed for the first time in Alabama

Dental Tribune International

Tue. 11. December 2018

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Birmingham, Ala., U.S.: The University of Alabama at Birmingham (UAB) recently completed a surgical procedure in the jaw area of a patient—which would usually take several months—within a day. For the patient, who suffered from a tumor in her chin, the surgical procedure ensured her ability to eat, drink and speak normally.

Around 20 years ago, Traci Bacon, a Birmingham, Alabama, resident, noticed small bumps in her mouth. When her general dentist at the time told her that she had nothing to worry about, she heeded his advice. After two decades, the tiny bumps grew into a large, destructive tumor—an ossifying fibroma in the front of her chin. After three different referrals to area oral and maxillofacial surgeons, Bacon was sent to the UAB School of Dentistry’s Department of Oral and Maxillofacial Surgery for another opinion.

“Traci’s tumor was non-cancerous and would not metastasize, but the tumor had invaded her jaw bone,” said Dr. Anthony Morlandt, associate professor and Chief of Oral Oncology in UAB’s Department of Oral and Maxillofacial Surgery. “Without surgery, the tumor would eventually destroy and collapse her jaw bone entirely, taking away her ability to eat, drink and speak normally.”

Morlandt, along with his colleagues from UAB’s Department of Oral and Maxillofacial Surgery, developed a surgical and prosthodontic treatment plan for Bacon that would be the first of its kind in the state of Alabama and one of only a handful in the country. Coined the “jaw-in-a-day” treatment, the procedure includes a radical mandibulectomy, a fibula free flap reconstruction, simultaneous 3-D-guided dental implants and immediate previsualization—all in one sitting.

The surgical plan, carried out preoperatively using 3-D navigation and computer-aided design, involved removing the lower jaw, the tumor, the soft tissue and eight teeth, then immediately replacing some of the missing bone with a fibula free flap from the patient’s lower leg, while simultaneously placing dental implants.

According to Morlandt, for patients who lose their jaws to cancer or traumatic events, such as gunshot wounds, the replacement of the jaw with leg bone and the placing of dental implants and prostheses takes at least 12 to 18 months. The UAB team, however, was determined to complete it in one day as a way to expedite healing and normalcy.

Upon learning about a proposed reconstructive jaw surgery, Bacon knew that she had a challenging decision to make. “I had so many concerns. Would my face look different? Would my speech be impaired? How soon could I get teeth? How long would my leg take to heal?” Bacon said.

A key in the preparation for the patient’s “jaw-in-a-day” surgery included using state-of-the-art, 3-D technology for planning and navigation, as well as printing models of Bacon’s existing and future jaws. A collaboration with American and German engineers helped the UAB team to virtually complete the surgery digitally before completing the procedure in the operating room.

After a successful eight-hour surgery, Bacon’s recovery process could begin. Nearly five months post-surgery, her leg was fully healed and the surgical incisions on her neck and face were hardly noticeable. The site where the tumor once resided appeared as if nothing had ever been there before.

“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. Our fellowship-trained surgical team, together with our full-time, in-house maxillofacial prosthodontist, made this case possible and paved the way for the future of jaw tumor surgery in Alabama.”

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