Jaw-in-a-Day Surgery Restores Function, Form and Confidence

“It’s a privilege to be able to do this for patients because we’re able to restore so many functions through this procedure — healing a wound in the oral cavity, creating continuity where there is missing bone, soft tissue and teeth, restoring speech, swallowing and sensory function,” says Ravi Garg, MD, a plastic surgeon at Scripps, who specializes in cranio/maxillofacial and head and neck microvascular surgery.  

“As surgeons it's rewarding to do this for someone, while also engaging our understanding of the complex anatomy of the head and neck,” he says.  

Though the surgery only takes a day, planning starts well in advance. Surgeons work with a bioengineer and maxillofacial prosthodontist to map out the surgery and visualize the procedure using computer-aided design (CAD) and computer-aided manufacturing (CAM).  

With these tools, they combine an impression of the patient’s teeth, and 3D scans of the patient’s facial bones and the donor bone into a detailed virtual model. This model is then used to create custom surgical guides. The result is a precision autograft that restores the arch of the patient’s jaw and preserves their bite once the temporary teeth are in place. 

Perry Mansfield, MD, an otolaryngologist at Scripps who’s been performing jaw reconstructions for more than three decades, says the new technology has transformed patient outcomes.  

“When we began, we didn’t have the capability to transplant bone in the way we do today,” Dr. Mansfield says.  

“For example, I would take out a segment of jawbone, then put a metal plate in and hand bend it to fit. There were no teeth, no donor bone and there was still significant deformity.  

“We started to try bone transplants and got better and better,” he continues. “Then we utilized 3D imaging, which allowed us to build the segments of bone into the facial structure.  

“Now every incision is designed on the computer before we start. By the time all is said and done, they look as if nothing was done. We go from great deformity to almost no visual deformity,” Dr. Mansfield says.  

Both Dr. Mansfield and Dr. Garg note that Jaw-in-a-Day reconstructions are team efforts, from nurse navigators who guide patients through every step and engineers who create the 3D models to the speech and language pathologists, physical therapists, nutritionists and prosthodontists who assist patients in their recovery.  

“We really strive toward a ‘center of excellence’ model,” Dr. Garg says. “We concentrate our expertise among a variety of collaborating disciplines to make something very complex, tangible and accessible to a patient to give them the best possible result.”