[Music over the MUSC Hollings Cancer Center logo.]
[W. Greer Albergotti, M.D., head and neck surgical oncologist & microvascular reconstruction surgeon, stands in navy blue scrubs in front of a window showing the Charleston skyline and the Ravenel Bridge.]
Albergotti: Jaw in a Day is a new procedure, where we are rebuilding the jaw in what used to take months – six months to a year – and condensing that into a single day.
[An exam room with four people discussing. Dr. Albergotti leans against the sink. The patient, a woman in a blouse of soft blues, sits in a dental exam chair. Dr. Evan Graboyes is seated, as is a family member of the patient.]
[Evan Graboyes, M.D., head and neck surgical oncologist & microvascular reconstruction surgeon, wears a button-down shirt and a jacket in an exam room with a view of Charleston.]
Graboyes: For patients with a jaw bone that's missing, either because of cancer, a noncancerous tumor, or side effects of cancer treatment, when we think about how to care for these patients, first and foremost, making sure they're cured of their cancer is really the most important consideration.
[In an OR, a surgeon peers through loupes as fellow doctors and nurses swathed in blue drapes surround him.]
Graboyes: However, in addition to that, when delivering care for these patients, it's also critically important that we help them get the shape of their face back and ensure that they have a great quality of life.
[Two surgeons, one on each side of a patient, work in the OR.]
Graboyes: Reconstructive surgeons in our field have gotten really comfortable with doing their surgeries efficiently and highly effectively over the past 20 or 30 years. And as we've gotten better at doing these surgeries, we've learned that not only could we remove the cancer from the jaw bone, take a bone from the leg, make it a transplant into a new jawbone, and put implants into that leg bone, so that the end of one surgery, these patients are fully rehabilitated.
[Hands hold a model of three implants screwed into a model of a bone in front of a computer screen displaying a 3-D rendering of a patient’s teeth; computer screen displays a 3-D plan for removing part of the leg bone.]
Albergotti: We use something called virtual surgical planning, which is basically computer assisted software that allows us to visualize exactly what the patient's anatomy is, precisely define where the cuts in the mandible are going to be, and then pre-create a plate that fits to the patient's native anatomy. And that's really important because for this surgery in particular, we're talking about a millimeter, being the difference between a second - a successful surgery and an unsuccessful surgery.
[A wax model of teeth; Two men sit in a workroom and examine a model of a jaw and teeth; using dental tools, someone carefully etches at wax teeth to define them.]
[Byung Joo Lee, D.D.S., oral oncologist & maxillofacial prosthodontist, wearing a white doctor’s coat, stands in front of a window with a view of Charleston.]
Lee: There's a lot of teams that can reconstruct the jaw. But the patient will not be able to chew at the end. And in my world, that's considered a failure. So from the planning process, which is the most important process, we make sure we put the reconstruction in such a way that you can rebuild their teeth and function into it. For cancer patients, because most patients are being radiated, the surgery is more complex, not many teams are able to perform such a procedure for cancer patients. We have a really great head and neck team that is a true, interdisciplinary and multidisciplinary team. You know, we work cohesively as well as we can trust each other.
[Drs. Graboyes, Albergotti and Lee, all dressed in blue surgical scrubs and blue surgical caps, stand outside an OR and chat. The team, covered in blue drapes and surgical masks and wearing surgical loupes, work in the OR.]
Graboyes: When we do these complex multi-team surgeries, everyone has a very specific job to help patients get the best outcome. So during these Jaw in a Day surgeries, we typically have three or four teams of surgeons. One surgical team will be the ones removing the cancer from the jawbone. We have a different team of reconstructive surgeons who take the transplant from the leg. We have an oral surgery team and a prosthodontist team that put in the dental implants and then make the patient the teeth. It's really a huge team of people, all with very specific expertise.
Albergotti: When I was a resident 10 years ago we weren't even doing implants into fibulas. And now, we've surpassed that. That's the standard of care in all of our surgeries that we do. And now, to be able to move on to offering teeth in the same day is really a game changer. Head and neck cancer has an ability to rob patients of their humanity, so, being able to offer that is really important to be able to get people back to being the fullest version of themselves
Lee: It is important to offer this to a patient. Because the patient can go into the surgery knowing that they will retain part of their identity and their function when they wake up from the surgery.
Albergotti: As head and neck cancer surgeons, and especially operating at NCI-designated cancer centers, our goal is to not just put people back together but to create the best version of themselves going forward.
[MUSC Hollings Cancer Center logo.]
