Emory Winship’s Dr. James Jeong is the only surgeon in Atlanta and one of just a few surgeons across the country who performs this procedure.
Alan Brown, a 61-year-old male, came to Winship Cancer Institute of Emory University with significant complications following an oral surgery procedure he’d undergone elsewhere to remove a benign mandibular cyst and reconstruct the affected part of his jaw.
While recovering from the initial procedure, Brown began to experience excruciating pain and swelling in his jaw. His original surgeon urged him to go to the ER immediately. After testing for a range of issues from infectious diseases to thyroid problems, the emergency physicians determined that Brown’s jawbone was fractured, resulting in a dangerous infection caused by the breakdown of the material that had been surgically implanted in his jaw. Brown faced potential disfigurement and loss of oral function if not treated right away.
Treatment Strategy: The Jaw-in-a-Day Approach
The ER physician referred Brown to the head and neck cancer team at Winship Cancer Institute of Emory University. At Winship, Brown met with Michael Baddour, MD, an otolaryngologist and director of the Emory Facial Nerve Program, and James Jeong, DMD, MD, an oral and maxillofacial surgeon. After careful consideration was given to the extent of the jawbone compromise, Brown’s medical history and his functional capacity, Drs. Baddour and Jeong determined that a complex procedure called the “Jaw-in-a-Day” technique was the optimal treatment strategy. Dr. Jeong is the only surgeon in Atlanta and one of just a few surgeons in Georgia and across the country who performs this procedure.
The innovative approach combines ablative surgery to remove the infected bone and hardware with immediate reconstruction using free tissue transfer, followed by the simultaneous placement of dental implants and teeth. This single-stage procedure addresses both the structural deficit and the functional and aesthetic consequences of significant jaw resection. 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.
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, unable to chew or smile.
Procedure: Single-Stage Reconstruction and Immediate Dental Rehabilitation
The 12-hour surgical procedure involved resection of the affected jaw segment, removal of the previous implant, and immediate reconstruction using a free flap harvested from the patient’s leg. Simultaneously, dental implants were placed within the newly reconstructed bone, and a temporary, fixed dental prosthesis was fitted. The surgery was successful in achieving both structural reconstruction and immediate dental rehabilitation. Postoperatively, Brown was monitored closely for eight days in the hospital, then discharged with a functional jaw and immediate dentition, avoiding the need for multiple subsequent surgical procedures. Brown then spent three weeks recuperating at home with home health aide services.
Outcome and Follow-Up
At approximately three months post-surgery, Brown reported that he was recovering well, experiencing no pain and progressing towards a normal diet. He had returned to work and was regaining his strength. The immediate dental rehabilitation had significantly improved his ability to speak and eat, and he reported a marked improvement in his overall quality of life. Long-term follow-up will continue to assess the durability of the reconstruction and the dental implants.
This case highlights the potential of the Jaw-in-a-Day procedure to offer a more efficient and comprehensive solution for patients requiring significant jaw reconstruction and dental rehabilitation following complex surgical complications.
Make a Referral
Do you have patients who may benefit from the Jaw-in-a-Day approach? At Winship Cancer Institute of Emory University, we’re dedicated to giving patients the best chance of living a full life. We partner with referring physicians to provide patients with personalized, multidisciplinary care and the latest treatment innovations and clinical trials.
Refer a patient by phone at 404-737-8824, or online through Emory Healthcare Link. Our call center hours are Monday-Friday 8:00 a.m.-8:00 p.m., Saturday 8:00 a.m.-5:00 p.m. and Sunday 10:00 a.m.-3:00 p.m. Please fax patient records to 404-778-1251
Sponsored by Winship Cancer Institute of Emory University
