Jaw in a Day

Alysha Wynn began the morning of April 26 by reading the Bible. She prayed for a good outcome as medical staff prepared her son, James, for an eight-hour surgery to remove an advanced tumor from his face and reconstruct his jaw.

Doctors diagnosed the 17-year-old from Memphis with the tumor months earlier. “I saw his jaw started getting big, but I thought maybe something had bitten him,” his mother says. She was shocked to learn a tumor was causing the swelling on the right side of his face.

Fortunately for James, the tumor was not cancerous, and he never complained of any pain. However, the tumor was destroying his facial bones and causing his teeth to shift. It had to be removed, and the Wynns soon learned his doctors planned to do so through a unique surgery that would make history in their state.

“I had mixed emotions because it was a first-time thing,” Alysha says. “It was my first time even hearing about this kind of surgery.”

The surgery is called Jaw in a Day, and James was the first patient in Tennessee and the Mid-South to undergo it. Performed by a multidisciplinary team of surgeons from the UT Health Science Center, the procedure involved removing the tumor, building the facial bones, eye socket and jaw out of Wynn’s leg bone, and installing dental implants and prosthetic teeth—all within one day.

This groundbreaking surgery has significant advantages for the patient, chiefly a substantially shortened treatment timeline that enables quicker recovery.

“Traditional methods could take several months, sometimes even years, to complete. In contrast, this procedure enables patients to receive a functional jaw in just one day,” said Anas Eid, chief of facial plastic surgery in the UT Health Science Center College of Medicine and leader of the Jaw in a Day surgery team.

The accomplishment was years in the making, starting when Eid formed a team that included experts in facial plastic surgery, head and neck surgical oncology, and oral and maxillofacial surgery. The team meets regularly to discuss cases involving complex facial reconstruction resulting from disease, trauma and congenital defects. Each surgeon can present a case for help to create a treatment plan that addresses all concerns.

“It also helps surgeons appropriately stage surgeries in which multiple services are involved and, furthermore, allows surgeons to plan for combined cases in which surgeons will provide care under one operating room visit when appropriate,” says Associate Professor and Program Director Brett Wilson, who led the oral and maxillofacial surgery team in the Jaw in a Day surgery. “This can prevent patients from unnecessarily assuming the risk of general anesthesia multiple times. All of this just results in patients getting ideal and efficient treatment.”

In James’s case, timing was on his side. He arrived as a patient when the surgeons felt confident they were ready to perform the surgery for the first time. They confirmed he was a good candidate—considering factors such as his overall health, dental health and the cause and extent of the jaw problem—and then began the extensive planning process.

The planning began on the computer. Using James’s CT scans, the surgeons created 3D models of the skull and the leg bone and essentially performed the surgery virtually.

“This allows us to plan the ideal placement of each component and use multiple patient-specific materials, including guides to help with tumor removal, orientation and positioning of the fibula, and orientation of the dental implants within the fibula. It also allows us to have custom, 3D-printed titanium hardware that helps ensure everything fits together seamlessly,” Wilson says.

Using the computer models, the team 3D printed a life-size model of James’s skull to use during surgery. They also built custom cutting slots to guarantee precise cuts while recreating the pieces of the jaw. Lastly, they designed and fabricated custom prosthetic teeth that matched Wynn’s natural jawline and bite.

On the day of the surgery, teamwork proved key.

“This surgery involves multiple steps from multiple surgeons that essentially build on one another,” Wilson says. “Each surgeon has to execute their part to set the next surgeon up for success, so the stakes can be high for everyone involved to bring the entire plan to fruition.”

In an operating room at Methodist University Hospital near the UT Health Science Center campus, Burton Wood, assistant professor of head and neck surgical oncology, first removed the tumor. The surgeons then removed the maxilla, or upper jaw, and the orbital floor, the bottom of the eye socket, since the tumor had damaged those bones. The reconstructive team meticulously cut James’s fibula to create the shape of the face and jaw.

While the bone was still connected to the leg via blood vessels, the team fixed the fibula onto a 3D-printed model of Wynn’s skull, allowing Wilson and Jeffrey Brooks, professor and chair of the Department of Oral and Maxillofacial Surgery, to place dental implants into the bone. Eid and his team then removed the fibula from the model and attached it to James’s face, using a microscope to connect the blood vessels and ensure the bone’s survival. Finally, Wilson and Brooks attached the prosthetic teeth to the dental implants.

“This surgery is akin to constructing a face from LEGO pieces. Every piece is meticulously designed and cut to fit perfectly in the end,” Eid says. “The surgery concluded without any complications.”

Alysha says she cried happy tears when she learned her son’s surgery went smoothly. “I was surprised by how good he looked, even though he was still kind of swollen,” she says. “They kept texting me throughout the whole thing saying, ‘OK, he’s fine,’ just to keep me updated. I’m just thankful that he actually went through it and came out.”

Thanks to the shortened recovery time of the single-day operation, James went home less than a week after the surgery and reintegrated into his normal life more swiftly than with traditional methods. While he has had some bad days, he says he is feeling well, and from the outside, the only sign of what he has gone through is a small scar above his lip and a scar on his leg.

Since treating James, Eid, Wilson and John Gleysteen, associate professor of head and neck surgical oncology, have completed a second Jaw in a Day surgery. In this case, the patient had a lower jaw tumor that required reconstruction of most of the lower jaw and lower teeth. That surgery was also successful, which the team credits to their unique collaboration.

“The key factor that contributed to the success of this kind of surgery is the collaboration between surgical services at UT Health Science Center,” Wilson says. “We have an immense amount of collegiality between our departments, which ultimately results in our patients receiving the highest level of care.”

The team of surgeons agree that this procedure represents a significant leap forward and encourages them to continue to push the boundaries of what is medically possible. Additionally, they say this accomplishment underscores the quality, innovation and dedication of each member of the team to provide the best and most up-to-date care for patients.

“In the state of Tennessee, this achievement sets a new benchmark for head and neck reconstructive procedures,” Eid says. “Our institution takes great pride in being a pioneer in this area, contributing significantly to the improvement of health care services in our state.”