Robert M. Brody, MD
For cancer patients requiring surgery on the mandible or maxilla, the recovery process has traditionally been lengthy and challenging, often involving multiple procedures. However, a skilled and multidisciplinary team of specialists at Penn is revolutionizing care by streamlining this process into a single, comprehensive operation.
Jaw-in-a-Day, an innovative procedure available at Penn Medicine for more than 5 years, is providing patients undergoing mandible or maxilla surgery with the immediate restoration of their smiles and a dramatic improvement in their quality of life. These patients may have benign conditions (such as an ameloblastoma), infections, or trauma requiring complex reconstruction. In addition to these benign conditions, many individuals with head and neck cancer require surgery to remove significant portions of their upper or lower jaw, either as part of their curative treatment or to address complications arising from the side effects of their therapy.
These surgeries involve removing the diseased portion of the jawbone, including the teeth anchored in it. Consequently, patients may face challenges such as difficulty chewing, speaking, and significant changes to their physical appearance. Recovery can be lengthy and complex, as many are unable to use traditional dentures after surgery. For these patients, the only way to restore teeth is through the placement of dental implants and a custom-fabricated prosthesis that functions like a denture. However, this process can take months or even years to complete and, in some cases, may not be feasible at all.
Reflecting upon these concerns, head and neck surgeon Robert Brody, MD, notes the stress that patients endure as they’re going through treatment.
“They’re already coping with the side effects and stresses of having cancer, and now they have this substantial change in their appearance and function,” he says. Dr. Brody is an Assistant Professor of Otorhinolaryngology—Head and Neck Surgery at the Perelman School of Medicine at the University of Pennsylvania.
Available at Penn ENT, Jaw-in-a-Day transforms the challenges of treatment into a single streamlined procedure, combining tumor removal and jaw reconstruction with the same-day placement of titanium dental implants. These implants anchor custom-designed teeth that closely replicate the patient’s natural dentation, restoring both function and appearance in just one surgery.
“Jaw-in-a Day involves the use of a free flap,” Dr. Brody says. “This is a surgical technique that involves transferring a section of tissue—often including skin, muscle, or bone—from one part of the body to another, along with its blood supply.
Free flaps are commonly used to reconstruct large sections of bone and soft tissue removed due to cancer, infection, or trauma. In the mandible or maxilla, the fibula-free flap is considered the gold standard. This approach uses bone from the fibula to rebuild the jaw’s structure while also providing soft tissue coverage to restore both form and function.
In Jaw-in-a-Day, dental implants are placed directly into the free flap or other areas of the jaw using a specially designed surgical guide created through virtual surgical planning. This process involves analyzing the patient’s unique scans to develop a one-of-a-kind guide tailored specifically to their anatomy, ensuring precise and personalized reconstruction.
Jaw-in-a-Day — A multidisciplinary effort
Jaw-in-a-Day requires an enormous amount of coordination among several specialties. Head and neck surgeons, oral surgeons, prosthodontists, speech and language pathologists, and various technicians involved in the fabrication of dental prostheses contribute to the planning beforehand. On the day of the surgery, they’re supported by an extensive staff comprised of nurses and surgical assistants.
“It’s a very team-intensive enterprise, and we’ve really refined it at Penn ENT,” Dr. Brody says.
Penn ENT: A history of transformative innovation in facial reconstruction and dental rehabilitation
Jaw-in-a-Day was conceived about a decade ago, but remains a specialized procedure available at only a few centers due to the high level of expertise, coordination, and experience it demands. At Penn Medicine, the multidisciplinary team involved in Jaw-in-a-Day surgeries works collaboratively under one roof, enabling seamless planning and execution of this complex process. Dr. Brody, who performed Penn’s first Jaw-in-a-Day surgery seven years ago, notes that the institution’s integrated approach has been instrumental in its success. Since then, approximately 20 of these transformative surgeries have been performed at the Hospital of the University of Pennsylvania.
Dr. Brody explains that the expertise gained from performing Jaw-in-a-Day procedures enhances the team’s ability to handle all types of jaw and rehabilitative surgeries with greater precision and efficiency. This unique level of collaboration also has a downstream effect, streamlining less-intensive procedures—such as those involving dental implant placement over several months—by the same highly experienced specialists.
The Jaw-in-a-Day procedure relies heavily on advanced technology and meticulous precision to achieve optimal outcomes. Using cutting-edge virtual surgical planning, patient-specific guides and the patient’s dental prosthesis are custom-designed and printed before the operation. These guides are critical in every step of the process, from the precise resection of the affected jawbone to harvesting the fibula for reconstruction. In the operating room, these guides ensure the accurate placement of the free flap, the integration of titanium dental implants, and the proper alignment of the prosthesis or denture. This level of precision allows the team to restore both function and aesthetics in a single surgery, ensuring each component is exactly measured and positioned to fit seamlessly.
“Everything needs to be perfectly in place for the teeth to sit exactly where they should,” Dr. Brody says. “You can’t have a deviation of even a millimeter.”
The Jaw-in-a-Day procedure typically takes 10 to 12 hours to complete, but recovery times vary depending on the reason for the surgery. Dr. Brody estimates that functional recovery may take at least three to six months for patients with benign conditions, although initial healing can occur within two weeks. For patients with oral cancer, recovery of function often takes longer—typically six to eight months—due to additional treatments such as radiation and chemotherapy. However, the cosmetic benefits, including the restoration of teeth and a natural smile, are achieved immediately, allowing patients to proceed with the next phase of their cancer treatment without delay or restrictions.
Ultimately, Dr. Brody believes Jaw in a Day represents a “significant leap forward in maxillofacial reconstruction and dental rehabilitation.” He adds: “It’s a quicker, more efficient solution for patients who want to recover as quickly as possible after their treatment.”