By Brian B. Farrell, DDS, MD, FACS
Patients and their families become expectedly anxious the moment they hear the words “may need surgery,” which is especially true during an appointment that started out as a routine dental visit.
When we outline treatment options and initiate discussions for a plan moving forward, their eyes widen and they sit further back in their chair. The decision to proceed with a combined orthodontic surgical treatment plan is a big one for families weighing benefits, risks, logistics of life, finances, timing, you name it…
My first experience with orthognathic surgery was observing it on my college roommate. I subsequently spent weeks listening to the blender pureeing a diet to keep him sustained. What I remember most about “our” experience was his inability to get a toothbrush to the inside of his mouth while wired together during healing. The experience left an indelible impression and likely is the impetus to follow in the surgeon’s footsteps, as he was my father.
The correction of dentofacial deformities through orthognathic surgery is an essential service delivered by an oral and maxillofacial surgeon. It is my focus and passion: helping people be happy and pleased with what they see. Corrective jaw surgery to establish a sound skeletal foundation is the basis for facial balance, proportion, and symmetry, and subsequently allows our orthodontic colleagues to generate a stable, reproducible occlusion. The functional detriments of a distorted bite such as dysphagia, speech articulation, and temporomandibular joint dysfunction are commonly improved with the establishment of an efficient occlusion. Esthetic benefits through reorienting the skeletal scaffolding to support the overlying soft tissue are lifelong.
I was fortunate to rotate offsite through my current practice as a resident during the summer rush. I quickly appreciated the machine and pace necessary to support and maintain a broad scope in oral surgery through days filled with corrective jaw surgery, temporomandibular joint replacement, and complex reconstruction. Bustling offices addressing dentoalveolar procedures illustrated the power of having strong support around as a surgeon sets out on their path: experienced mentors, supportive partners, knowledgeable assistants, diligent coordinators, and a motivated administration.
When deciding where to relocate upon graduation, drawing on the experience and mantra of “who wouldn’t want to live in the Carolinas?!?” the pull was strong to return. The decision was quickly confirmed with the opportunity to shape a practice that met my professional goals and expectations.
Osteotomies to reorient the facial skeleton remain technically similar to those devised by the pioneers of jaw surgery decades ago. The evolution within the field of orthognathic surgery has come through a renaissance including rigid fixation, digital planning, and delivery in an office setting.
The extent of jaw surgery within our practice has allowed the opportunity to remain in constant contact with industry and play a role in simplifying data collection for digital planning, push engineer establishment of the occlusion away from stone models, and champion the rejuvenation of surgical techniques that were infrequently used due to complexity. We are proud to have been on the forefront in the development of techniques and advances in technology to improve surgical efficiency, accuracy, and outcomes.
Confidence and trust are earned from the initial consultation, preoperative preparation, surgical result, and guidance through the postoperative period via education, experience, and empathy. The model has allowed the delivery of repeatable, best results for thousands of patients over the years. It is the mindset and diligence of our team (surgeons, coordinators, assistants) that keep the focus on striving for the highest quality patient care and experience that will continue to foster confidence from orthodontic referrals, families, and patients.
To navigate healthcare’s ever-changing landscape, as well as ensure the value and volume of corrective jaw surgery, we gained AAAHC accreditation and shaped the delivery orthognathic surgery in an office setting. An in-house anesthesiologist has allowed most of the orthognathic surgery, temporomandibular joint surgery (arthroscopy and open arthrotomy) and reconstructive surgery to be performed within our office, benefiting cost containment and efficiency. Our model of orthognathic surgery within an office environment has become a medical/surgical tourism destination locally, regionally, and nationally for the management of dentofacial deformities. Our team has frequently hosted visiting surgeons over the past 15 years as they attempt to learn and replicate the model.
Learning should continue, daily. The hybrid model that is the privacademic multispecialty practice that encompasses surgeons, fellows, residents, prosthodontists, oral medicine specialists, and anesthesia providers is a platform like no other. The amalgam of experienced providers that ranges from conservative management to restorative rehabilitation to surgical care all working together ensures learning and care is constant.
The fellowship has allowed extensive exposure to diagnosis, interdisciplinary treatment planning, surgical work up, and post-surgical management. Vast experience within the operating room aided in refining surgical techniques, maximizing efficiency and instilling proficiency with corrective jaw surgery, temporomandibular joint surgery, and full arch implant reconstruction. The experience garnered during their rotation is not limited to clinical. The administrative rigors of practice, such as communication with referrals, navigation of insurance submission, data collection and scheduling, journal review, and presentations complement the clinical exposure to make it a well-rounded experience.
Surgeons finishing residency interested in garnering more exposure and experience should be commended, not criticized for the perception they didn’t learn it during training. A fellowship will increase one’s exposure to patients that possess dentofacial deformities, temporomandibular dysfunction, craniofacial anomalies, esthetic concerns, and head and neck cancer ablation and reconstruction.
The period as an apprentice under talented teachers and mentors will aid to slingshot junior surgeons forward, only strengthening the specialty of oral and maxillofacial surgery.
The volume of major surgical cases has steadily increased year to year as recent surgical logs illustrate over 500 major orthognathic, TMJ, and reconstructive procedures staffed by our collective team. The fellowship, in its 15th year, continues to reach new heights through the dedication of those teaching and the talented fellows that want to be their best for their future patients.
Brian B. Farrell
DDS, MD, FACS
Dr. Farrell lectures throughout the country on orthognathic surgery and techniques for providing safe efficient corrective jaw surgery in an outpatient setting. He is an active partner in the Orthognathic Surgery Fellowship program at the Carolinas Centers for Oral & Facial Surgery.