Photo By Petty Officer 2nd Class Jacob L. Greenberg | 201118-N-DA693-1031 SAN DIEGO (Nov. 18, 2020) Lt. Cmdr. Daniel Hammer, a...... read more read more
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SAN DIEGO – Surgeons assigned to Naval Medical Center San Diego (NMCSD) performed the Department of Defense’s (DOD) and California’s first ever immediate, jaw reconstruction surgery with 3D-printed teeth Nov. 18.
Doctors with varying specialties from a multitude of departments collaborated to remove and reconstruct a patient’s tumor-stricken lower jaw.
The novel procedure is one of the first of its kind in the U.S., and the teeth were completely designed on board NMCSD.
Lt. Cmdr. Daniel Hammer, a maxillofacial surgical oncologist and reconstructive surgeon assigned to NMCSD, was the lead surgeon during this multifaceted procedure.
In this case, the patient had a tumor on his jaw, called an odontogenic myxoma, said Hammer. The very aggressive, but benign, tumor made the patient a prime candidate for the immediate, jaw reconstruction surgery.
Previously, this level of reconstructive surgery would take 18 to 24 months and span at least four separate procedures, but now, with Hammer and his team, just hours.
“We’ll access the facial bone through the neck, then remove the effected portion of the jaw,” said Hammer. “Once we remove the lower jaw, we’ll make sure we have blood vessels ready [for the new jaw] to be sewn into. Meanwhile, another team will access the fibula, the smaller of the two bones in the lower leg. They’ll apply a cutting guide, place dental implants to allow the delivery of the 3D-printed teeth and then form the bone into the shape of a jaw. These two procedures are done simultaneously to reduce surgical time while the patient is under anesthesia.”
The cutting guide fits perfectly over the patient’s partially-removed fibula, and contains holes for doctors to deliver the dental implants and eventually, the denture. The guide also has slots that they’ll saw through, to create V-shaped notches. This allows them to bend the fibula into a jaw shape while the bone is still alive and attached to the patient’s leg. The harvested fibula will fuse together in four to six months, becoming one cohesive lower jaw for the patient.
“Basically, I’m going to assemble a new lower jaw while the bone is still receiving its blood supply from the leg,” said Hammer. “We’ll then fully remove it, and transplant it into ready and waiting blood vessels in the head and neck, specifically into branches of the carotid artery and the jugular vein. The sutures we use are called 9-0, which are approximately half of the thickness of a human hair.”
The surgical teams don’t remove the entire fibula.
“In order for the ankle and knee to stay supported, we preserve sufficient bone structure at both joints,” said Hammer. “A patient may put only 10 percent of their weight bearing on their fibula, and this is likely lower in young, healthy and active patients.”
Hammer said that while it’s useful to have the fibula for extra support, it’s very rare for a patient to have a permanent, functional deficit in regard to their mobility post-operatively.
The best kind of surgery for any patient is safe and efficient.
“We harvest the fibula and remove the lower jaw at the same time because the longer the patient is under anesthesia, the more complications can occur,” said Hammer. “In this case, by the time we had removed the tumor and lower jaw from the face, we’ve already harvested the fibula and were fitting the dental implants. That’s the beauty of our two-team approach.”
Hammer and his team came up with an operating room optimization plan to utilize all available resources simultaneously. His role during the procedure as lead surgeon is to keep the concurrently-operating surgical teams on track and on the approximate timeline.
Hammer established the Early Recovery After Surgery (ERAS) protocol for all maxillofacial reconstructive surgeries at NMCSD. The ERAS protocol consists of numerous teams focused on multidisciplinary, patient-centered care. The goal of this dynamic team is to optimize every patient’s recovery and rehabilitation.
“As surgeons and healthcare providers, it’s our duty to have our patients feeling their best, with the highest quality of life, as soon as possible,” said Hammer. “Team members from Oral and Maxillofacial Surgery, Maxillofacial Prosthodontics, Plastic Surgery and Anesthesia all worked together to ensure a successful outcome in the OR. The ERAS protocol outlines day-by-day what everyone involved is supposed to do to ensure the best possible outcome for the patient.”
In addition to the surgical teams, team members involved in the patient’s care include those from the Intensive Care Unit, Physical and Occupational Therapy, Speech-Language Pathology, Respiratory Therapy, Clinical Nutrition, Social Work and Nursing.
A dedicated microsurgery team was formed at NMCSD to care for these complex patients. Capt. Craig Salt, Cmdrs. Eamon O’Reilly and Yan Ortiz from Plastic Surgery and Hammer perform all of the microvascular surgeries at NMCSD for challenging extremity, breast and head and neck reconstruction. Cmdr. Yu Zhang, a maxillofacial prosthodontist, has spent the past two years on cancer-related reconstruction of the oral cavity, and is an integral member during the immediate, jaw reconstruction procedure. Cmdr. Patrick Morrell led one of the surgical teams charged with the removal of the patient’s lower jaw.
“The military sent me through residency and fellowship to figure out how to deliver the best possible care for our wounded warriors,” said Hammer. “Through collaboration with multiple surgeons and the knowledge obtained in my training, we can forever change a person’s life for the better in just one day. In terms of psychosocial damage and military readiness, there’s no question that the immediate, jaw reconstruction procedure is better in every aspect versus the antiquated approach.”
Compared to the older methods of jaw reconstruction, the value of performing a complex, immediate jaw reconstruction is immense. A patient won’t have to endure multiple procedures or take multiple periods of convalescent leave. In just one procedure, a wounded warrior can return to duty faster without anywhere near as many physical or emotional scars.
NMCSD’s mission is to prepare service members to deploy in support of operational forces, deliver high quality healthcare services and shape the future of military medicine through education, training and research. NMCSD employs more than 6,000 active duty military personnel, civilians and contractors in Southern California to provide patients with world-class care anytime, anywhere.
Visit navy.mil or facebook.com/NMCSD for more information.
| Date Taken: | 11.18.2020 |
| Date Posted: | 11.30.2020 12:24 |
| Story ID: | 383704 |
| Location: | SAN DIEGO, CALIFORNIA, US |
| Web Views: | 2,873 |
| Downloads: | 1 |
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