First “Jaw in a Day” surgery on West Coast for oral cancer
By Baber Khatib, M.D., D.D.S., FACS, head and neck oncologic and microvascular reconstructive surgeon, Providence Cancer Institute
Ashish Patel, M.D., D.D.S., FACS, head and neck oncologic and microvascular reconstructive surgeon, Providence Cancer Institute
For some patients with oral, head or neck cancer, a devastating diagnosis often is followed by news that removing the tumor, rebuilding the jaw and teeth, and then implanting new teeth may require a lengthy series of surgeries over a period of one to two years. During that time, the patient has no teeth for six months to a year, severely affecting their ability to talk and chew, which affects their mental health and can create a sense of isolation.
But a relatively new procedure developed in 2012, called Jaw in a Day®, has changed that. Instead of taking a year or two, the patient undergoes a complex procedure that removes the tumor, rebuilds the jaw using the patient’s fibula and implants new teeth – all within a matter of hours. The procedure also can be used to treat patients with head and facial trauma.
Terry Sambrailo, 74, was diagnosed with squamous cell carcinoma and was referred to Head and Neck Surgical Associates in Portland, which serves as the designated head and neck surgeons for the Head and Neck Cancer Program at Providence Cancer Institute. Terry was determined to be an ideal candidate for Jaw in a Day, which had never been performed on the West Coast for a patient with a malignant oral cancer.
Performing Jaw in a Day on a cancer patient is significant because, unlike benign disease, these patients require skin and muscle, in addition to bone, to adequately reconstruct their form and function and prepare them for the possibility of radiation therapy.
The surgical team uses computer surgical planning to digitally plan the removal of the tumor, shape a part of the fibula into a new mandible, design a custom plate to hold it all together, and ensure that dental implants will be placed correctly. Another recent innovation, 3D-printing, allows the team to create customed-designed oral prosthetics.
As with other Jaw in a Day patients, both surgeons worked simultaneously during the 10-hour procedure:
- Dr. Patel removed the tumor, at-risk lymph nodes, gum tissue, bone and muscle.
- Dr. Khatib shaped Terry’s fibula to rebuild her jaw; added dental implants and prosthetic teeth into the newly reconstructed jaw; transferred skin attached to the fibula bone and muscle to replace the missing gum tissue; and sutured the skin under the prosthetic teeth that he designed and created using 3D-printing.
Head and neck surgeons are part of a large, multidisciplinary Providence Cancer Institute team that includes radiation and medical oncologists, dental oncologists, radiologists, speech/physical/occupational therapists, pathologists, researchers, clinical trials specialists, oncology nurses and fellows. This team of experts is key to helping patients recover and regain their lives.
After the surgery, Terry began her recovery process, including radiation treatments five days a week for six weeks. Next steps coming up are some minor clinic procedures, followed by implantation of permanent teeth in about six months.
One of the most important aspects of Jaw in a Day, particularly in a cancer setting, is that it helps patients get back some sense of normalcy by facilitating their ability to talk, eat, swallow and interact with their loved ones.
The team also performed the West Coast’s first Jaw in a Day in 2014 and recently completed the first Jaw in a Day with simultaneous TMJ reconstruction for a patient with an aggressive tumor of his mandible and condyle.