Golpar: First thing I remember, I just heard an impact. I didn’t even know I got hit. I felt the car rolling and next thing I know I was laying on the dashboard of the SUV. I was looking straight at the windshield, and I knew I was going to go through it.
Narrator: One night in November, Golpar Gotti’s SUV was struck from behind. She was thrown through the windshield and hit the pavement of a busy Chicago expressway face-first. Golpar had multiple fractures in her skull, cheekbone, and jaw. Her eye sockets were shattered. Bone fragments had penetrated her brain.
Dr. Steinburg: She broke just about every bone you can break in your face. Fortunately in her case there was no brain injury whatsoever. We can’t say that about every case.
Narrator: Dr. Mark Steinburg was one of the first doctors called in to assess the extent of Golpar’s injuries. He is an Oral and Maxillofacial Surgeon, and a key member of the trauma team at Loyola University Medical Center. In a single fifteen hour operation, Dr. Steinburg and his team reconstructed Golpar’s battered head and face.
Dr. Steinburg: We were able to anatomically reduce the fractures. In other words, line up the bones nicely, then hold them together with small metal plates and screws. What you are seeing where are the metal plates are, that is her forehead. You can see that there are many broken bones. It’s like a jigsaw puzzle.
Golpar: I was very surprised knowing that by coming to Loyola an OMS could conduct the whole thing during one procedure.
Narrator: In fact, the American College of Surgeons requires that all Level 1 trauma centers have OMSs on call, and in many states, OMSs perform the majority of emergency surgery for injuries to the face, jaws, mouth, and teeth. They are also trained in corrective jaw surgery, as well as a wide variety of reconstructive and cosmetic surgery.
Dr. Joseph: Orthognathic surgery is a surgical treatment to correct jaw and facial deformities. It is deformities that may be acquired, they may be from an auto accident, they may be developmental, they may be from a birth defect.
Narrator: Just what is an Oral and Maxillofacial surgeon, and what does it take to become one? Since the early 1900’s, Oral and Maxillofacial surgeons have been pioneers in trauma and reconstructive surgery.
Dr. Leathers: Oral and Maxillofacial surgery has a long and illustrious history dating back to the first orthognathic surgery which was performed in 1849.
Narrator: OMSs have also treated soldiers and civilians from the time of the Civil War through the First and Second World Wars, Korea, Vietnam, and even up to the present day world conflicts. Training to become an Oral and Maxillofacial surgeon is rigorous, with a minimum of four years of dental school and four more years of post-doctoral hospital-based surgical training. Working with a wide variety of medical specialists, OMSs are trained in trauma management, reconstructive surgery for congenital and acquired defects, and other areas including general surgery, elective cosmetic surgery, internal medicine, and anesthesiology. Their dual background in dentistry and medicine, combined with their residency training, make them uniquely qualified to treat conditions, defects, injuries, and cosmetic aspects of the mouth, jaws, face, teeth, and associated structures. In fact, OMSs perform procedures including extracting impacted teeth, placing dental implants, and reconstructing faces, cheeks, noses, eye sockets, and foreheads.
Dr. Cichon: The uniqueness of the Oral and Maxillofacial surgeons are their ability to restore function, their ability to maintain aesthetics in these patients, helps to alleviate some of the most devastating parts of the trauma patient and that’s what they see every day when they go into the mirror.
Narrator: OMSs also administer outpatient general anesthesia, making them unique from any other specialty in the medical and dental fields outside from anesthesiology. As a result of this training, and their ongoing commitment to safe and self-regulation, OMSs have an unsurpassed record of safety and cost-effective patient care.
Dr. Pogrel: The modern anesthesia team consists of the Oral and Maxillofacial surgeon, trained assistants, state-of-the-art resuscitation equipment, state-of-the-art anesthesia equipment. In fact, general anesthesia is given many thousands of times a day by Oral and Maxillofacial surgeons in their private office, and their safety record is actually without equal.
Narrator: OMSs are also trained to remove benign and malignant tumors. The dark area on this x-ray indicates a large tumor in the lower jaw. After removing it, an OMS rebuilt the jaw, using extensive bone grafts, and dental implants to replace missing teeth.
Dr. Steinburg: I think the training that an Oral and Maxillofacial surgeon has makes that person unique in treating facial trauma. Some of the incisions we use, particularly a lot of the intra-oral incisions enable us to hide a lot of the scars quite nicely for the patient.
Dr. Gemelli: The availability of extraordinarily sophisticated techniques for not only restoration but for reconstruction are all part of what the fully-trained and dedicated Oral and Maxillofacial surgeon brings to bear.
Narrator: While known for their trauma expertise, OMSs are also at the forefront of reconstructing congenital and acquired facial defects.
Lauren: Because of the way my jaw fit together, I had an open-bite, and an over-bite. It was causing muscle spams, it was causing a lot of jaw pain, a lot of neck pain. I was having tension headaches. I was having migraines several times a week to the point where I wasn’t sure where one began and one ended. They all kind of ran together.
Dr. Joseph: We leveled her upper jaw. Brought her lower jaw forward, and her chin forward. Her orthognathic surgery was done primarily for functional reasons.
Lauren: I had a slight lisp before, and I think that’s gotten a lot better. Certain things I couldn’t bite through because of the open-bite that I had. I couldn’t bite through lettuce, for example. I could not eat lettuce on a sandwich. Pizza was hard to eat, to bite through the crust.
Dr. Joseph: This patient is back in college, and going on to complete her education. I think that clearly shows the medical necessity of the surgery, and how well she did with the surgery.
Dr. McDonald: I can tell you in some of the patients where I have corrected these kinds of deformities, it is amazing to see them six months later with a new feeling about themselves. You are doing this to correct their bite, or their speech, or their jaw functions, but you can see a real improvement in their psyche as well, and that’s a real neat thing.
Lauren: If I had not done surgery, I don’t’ know how much my life would have been different. I don’t know if I would have had the confidence to do some of the wonderful things that I have done with my life. I think because of the surgery, I have tried to venture out a little more with my confidence then maybe I would have if I had not had the surgery.
Narrator: Patients are also choosing OMSs to perform elective cosmetic procedures of the full facial complex.
Dr. Joseph: Katie was referred in as an orthognathic patient, primarily for her under-bite and protruding lower jaw. But as we had consultation with Katie, we discovered that her real concern was the appearance of her nose. We performed orthognathic surgery to correct her under-bite by widening her upper jaw, by setting her lower jaw back, and in addition, we did a rhinoplasty for cosmetic reasons to re-shape her nose.
Patients will often come to me for elective cosmetic procedures such as rhinoplasty. Marge came to me and elected to have the rhinoplasty and was very pleased with her cosmetic outcome.
Margie: Since I’ve had the surgery done, I no longer have to worry about my profile. I no longer have to worry if someone is going to make a snide remark. I am very pleased with the results.
Narrator: In addition to rhinoplasty, OMSs also perform a multitude of other elective cosmetic procedures to augment chins, foreheads, and eyes, while enhancing the overall appearance of the face as well.
Dr. Joseph: Blepharoplasty is a procedure to re-shape or cosmetically re-contour the eyelids, be it the upper or lower eyelids. Blepharoplasty is performed through an incision inside the lower eyelid. The same type of incision that we would normally make to treat a fracture of the rim of the orbit. You can see how those procedures would add to the Oral and Maxillofacial surgeon’s area of expertise in treating the cosmetic areas as well.
Narrator: Always with the patient’s welfare in mind, OMSs are an essential part of the health care team.
Dr. Joseph: Whether it be a patient at two in the morning going through a windshield, or it be a gunshot room, we’re the ones first on the scene, called by the emergency room. In addition, we are the ones who treat the orthognathic problems, whether it be a child who has a cleft lip or cleft palette deformity, we are the ones that treat those difficult facial problems. This makes us eminently qualified to treat the patients with elective facial cosmetic procedures.
Narrator: Golpar Gotti’s road to recovery began with an Oral and Maxillofacial surgeon. The surgery to rebuild her face left her with full use of her jaws and facial muscles.
Golpar: Overall I feel great. I’m so happy with the outcome. I feel I look like what I looked like before, so I’m very happy. Very, very happy.
Narrator: The American Association of Oral and Maxillofacial Surgeons currently has more than 7,000 members. For more information, contact the American Association of Oral and Maxillofacial Surgeons at 800-822-6637 or visit their website at www.aaoms.org.