You Couldn’t Be in Better Hands Alan, a Winship head and neck patient

“I’m forever grateful – it’s a bit of a miracle that I’m sitting here today,” says Alan Brown, 61, regarding his experience at Winship Cancer Institute of Emory University. By the time he arrived at Winship, Alan had already endured one unsuccessful surgery performed somewhere else and was consequently facing the loss of his jaw, lips and teeth. “My biggest fear was waking up completely disfigured, or not being able to talk or eat.”

Alan was recovering from oral surgery he’d undergone elsewhere to remove a stubborn cyst and reconstruct the affected part of his jaw. Shortly after the initial recovery period, he began feeling ill, with excruciating pain and swelling in his jaw. When the symptoms didn’t subside, he returned to his surgeon, who sent him directly to the ER, where they ran many tests. “The doctor was afraid I could lose my lips and much of my face to what he thought may be a flesh-eating bacterial infection,” said Alan. After testing for a range of issues from infectious diseases to thyroid problems, the emergency physicians determined that Alan’s symptoms were the result of complications from his oral surgery. His jawbone was fractured, resulting in a dangerous infection caused by the breakdown of the material that had been surgically implanted in his jaw.

The ER doctor recommended that Alan see a different oral surgeon for a second opinion on his options moving forward, and he referred him to the head and neck cancer team at Winship Cancer Institute of Emory University. That’s when Alan met H. Michael Baddour, MD, otolaryngologist and director of the Emory Facial Nerve Program, and James Jeong, DMD, MD, an oral and maxillofacial surgeon. “Dr. Jeong made everything come together – he made it happen. I probably wouldn’t be working or even talking to you today without Dr. Jeong,” Alan says. It was Jeong who pulled all the necessary resources together and coordinated the surgeons to get the job done right, according to Alan.

Jeong is the only surgeon in metropolitan Atlanta and one of just a few surgeons in all of Georgia and across the country who performs the Jaw-in-a-Day surgery. This innovative technique involves reconstructing the jaw using free tissue transfer, accompanied by the immediate placement of dental implants and teeth. It combines concepts from ablative tumor surgery and conventional jaw surgery to remove a tumor or cyst, reconstruct the jaw, graft new bone and perform dental restoration all in one surgery. “There are only a handful of institutions in the country that are doing this type of Jaw-in-a-Day surgery, and I am proud to say that Emory is one of them,” Jeong adds.

The Jaw-in-a-Day approach offers numerous benefits over the standard free flap jaw reconstruction. “Despite a high degree of success with standard free flap reconstruction, there is often little to no emphasis on comprehensive dental rehabilitation, and patients may be permanently left without teeth and may never be able to chew or get their smile back. This is one of the biggest complaints from patients after they recover from their free flap surgery,” says Jeong.

“Now, with advances in technology through virtual surgical planning and digital workflow, combining both medicine and dentistry, patients have the opportunity to wake up after their 12-hour jaw tumor surgery with not only a new reconstructed jawbone, but also new teeth that mimic their natural dentition and occlusion,” Jeong explains. “This approach provides patients with a quicker and more efficient solution for full mouth restoration compared to traditional techniques that may require multiple operations and healing periods. Literature has shown that immediate dental rehabilitation improves patient outcomes by enhancing their ability to speak, swallow and chew, and most importantly, their quality of life.”

The Jaw-in-a-Day technique offers financial benefits to patients as well. By getting implants as part of the ablative/reconstructive surgery, the implants are considered “medical” and are therefore more likely to be reimbursed by medical insurance. “If the same implants were to be placed literally the next day, they are considered ‘dental’ and elective,” says Jeong, requiring patients to pay for the costly implants out of pocket.

“Patients with benign or malignant tumors of the jaw can benefit from the Jaw-in-a-Day procedure,” Jeong explains. “Ameloblastomas, ossifying fibromas, odontogenic myxomas, squamous cell carcinomas and osteoradionecrosis of the jaw are some of the more common diagnoses we typically see here at Winship. We do our best to educate our patients about the opportunity for immediate dental rehabilitation through the Jaw-in-a-Day approach.”

Historically, dental implants could be delayed for months, if not years, in free flap reconstructive patients. “But I truly believe the Jaw-in-a-Day surgery will soon be the standard of care, providing immediate dental implants and teeth to these patients,” Jeong predicts.

Not all patients with benign or malignant tumors of the jaw can receive this treatment. “There are some important things to consider, including the size of the tumor, size of the ablative defect, patient’s medical history and their functional capacity, which all can make the surgery much more challenging. All the stars must align for patients to be able to wake up with teeth after their big operation. Having said that, we can at least place dental implants in their newly reconstructed jaw at the time of their surgery, so even if the patient is unable to get teeth during the operation, they’ll have the dental implants for the dental provider to restore 4-5 months after the operation,” Jeong explains. “I tell patients that even if they are not able to get teeth immediately, if they can get the dental implants in at the time of surgery, they are already ahead of 95-99% of patients who get free flap reconstruction of their jaw.”

“Dr. Jeong and the team took the time to explain everything that was going to happen – exactly what they were going to do and the expected outcomes. They had to remove bone from my leg, rebuild my jaw, and take out the titanium plate from the first surgery and replace it with the new plate. They had to remove all my bottom teeth and replace them with implants. They said I would wake up with permanent teeth. I couldn’t believe it,” said Alan.

Alan was relieved that he would only have to go through one more surgery rather than three more separate surgeries, which he felt would be more than he could handle at that point, after everything he’d already endured over the previous few months.

 

“The whole experience couldn’t have been better – from the hospital care to the aftercare and beyond,” recalls Alan, who spent eight days in the hospital and about three weeks recuperating at home with aftercare services. He had to take about 12 weeks of leave from work. At Winship, “they even worked with me to try to get me some programs that helped me financially. They went above and beyond from beginning to end.”

Today Alan looks forward to being able to return to a normal diet, and maybe even enjoying a burger and fries again one day. He feels fortunate to be able to continue to work, gain his strength and get back to working out and just enjoying life, pain-free. Before the surgery, “I almost couldn’t remember a time when I wasn’t in pain,” he says, of the months-long ordeal during which he also lost his hair and a lot of weight. He now looks forward to putting this chapter behind him as the health issues are finally resolved, thanks to Jeong and the Winship team.

Alan highly recommends the head and neck cancer team at Winship Cancer Institute to anyone who is facing a similar health challenge. “I’ve always been a mentally strong person, but this is by far the biggest challenge I’ve had in my life,” he says. When facing major reconstructive surgery and a long arduous recovery time, one needs a knowledgeable team to set a plan in action and reassure you that you will get better and be alright. Alan says this is exactly what the Winship team did for him: “They instilled confidence from the very beginning. I’m eternally in their debt. You couldn’t be in better hands.”