Around 20 years ago, Traci Bacon, a Birmingham, Alabama, resident, noticed small bumps appearing in her mouth. When her general dentist at the time told her she had nothing to worry about, she heeded his advice.
After two decades, the tiny, unassuming bumps grew into a large, destructive tumor – an ossifying fibroma in the front of her chin. After three different referrals to area oral and maxillofacial surgeons, Bacon was sent to the University of Alabama at Birmingham School of Dentistry’s Department of Oral and Maxillofacial Surgery for another opinion.
“Traci’s tumor — an ossifying fibroma — was non-cancerous and would not metastasize, but the tumor had invaded her jaw bone,” said Anthony Morlandt, M.D., DDS, associate professor and chief in the section of Oral Oncology in UAB’s Department of Oral and Maxillofacial Surgery and associate scientist in UAB’s Comprehensive Cancer Center. “Without surgery, the tumor would eventually destroy and collapse her jaw bone entirely, taking away her ability to eat, drink and speak normally.”
A surgery the first of its kind
Morlandt, along with Yedeh Ying, DMD, M.D., and Michael Kase, DMD, assistant professors in UAB’s Department of Oral and Maxillofacial Surgery, developed a surgical and prosthodontic treatment plan for Bacon that would be the first of its kind in the state of Alabama and one of a handful done in the country — a radical mandibulectomy, fibula free flap reconstruction, with simultaneous 3D-guided dental implant and immediate previsualization in one sitting. It is also coined as “jaw in a day.”
The surgical plan, carried out preoperatively using 3D navigation and computer-aided design, involved removal of the lower jaw, tumor, soft tissue and eight teeth, immediately replaced the missing bone with a fibula free flap from the patient’s lower leg, while simultaneously placing dental implants to replace the missing teeth with a new smile. Using 3D planning and navigation, the surgery is the most comprehensive restoration of the jaw and teeth performed in Alabama.
Morlandt notes that, in patients who lose their jaw to cancer or traumatic events like gunshot wounds, at least 12-18 months are necessary replace the jaw with bone from the leg, place dental implants, and fit the patient with a permanent dental prosthesis. The UAB team, however, was determined to complete it in just one day as a way to expedite healing and normalcy for the patient and minimize the devastating psychological impact on the patient and her family.
Upon learning about a proposed reconstructive jaw surgery to remove the tumor and rebuild her jaw, remove more than eight of her teeth, and use bone and skin from her leg, Bacon knew that she had a challenging decision to make: Should she let the tumor stay put and eventually lose the ability to use her jaw, or undergo a radical, intense surgery and recovery with the hope of normal jaw functionality in the future?
“I had so many concerns — would my face look different? Would my speech be impaired? How soon could I get teeth? How long would it take my leg to heal?” Bacon said. “I prayed a lot. The team at UAB were patient with me, answered all my questions, gave me weeks to make a decision and really included me in every step of the treatment planning.”
A surgical success
A key in the preparation for Bacon’s “jaw in a day” surgery included using state-of-the-art 3D technology for planning and navigation, as well to print models of Bacon’s existing and future jaw. Collaboration with American and German engineers helped the UAB team virtually complete the surgery digitally before performing the case in the operating room.
After a successful eight-hour surgery, Bacon’s recovery process began. Nearly five months post-surgery, Bacon’s leg is fully healed and the surgical incisions on her neck and face are hardly noticeable. The site where the tumor once resided looks as if nothing had been there.
For the UAB OMFS team, the completion of the “jaw in a day” surgery sets a new standard of surgical care that will help other oral oncology and oral surgery patients.
“What we learned from this procedure is that we have the team, resources and technology in place at UAB to give oral surgery patients the absolute best outcome in Alabama and in the country,” Morlandt said. “A mandibulectomy and fibula free flap reconstruction isn’t a new surgery; but we are helping to evolve the manner and level in which the surgery is completed, which only betters the lives of our patients here at UAB moving forward. Our fellowship-trained surgical team, together with our full-time in-house maxillofacial prosthodontist, made this case possible and paved the way for the future of jaw tumor surgery in Alabama.”
As for Bacon, the recovery process is ongoing; but she has learned a lot throughout the process.
“I learned that, in order to get through a surgery like this, you need a lot of faith and a strong support system,” Bacon said. “I know without a doubt that God carried me through and gave me a peace that I won’t understand. I’m forever grateful that I was led to the surgical team at UAB who went out of their way to lead me through this journey with exceptional care.”