Oral Maxillofacial Clinic – Putting a smile on the face of tragedy

Spc. Todd Goodman
Landstuhl Regional
Medical Center

***image1***There is more than tooth pulling going on at the Oral Maxillofacial Surgical Clinic at Landstuhl Regional Medical Center. Patients have shown up with fractured faces and missing teeth and left with Hollywood smiles.

“Much of what we do is tooth extraction,” said Lt. Col. Boris Sidow, oral and maxillofacial surgeon. “We also do titanium implants to replace teeth and bone transplants to replace lost jaw bone. We’ve had complex facial fractures where the entire face is basically broken – upper and lower jaw, cheekbones and orbital floor, all broken.”

Those types of injuries are usually the result of improvised explosive devices. When the injury is located above the mouth, such as the orbital floor, the treatment method is a coronal flap. An incision is made at the hairline, and the forehead literally is pulled down over the eyes and nose to reveal the injury. It allows maximum room for the surgeon to maneuver.

“It’s a thing of beauty to do this type of procedure,” said Colonel Sidow. “To make it as if nothing happened is just awesome. I just love it. It’s a beautiful operation.”

Fixing a broken smile also is high on the colonel’s list of favorite things. It involves more than simply inserting teeth, because there is no jawbone to hold teeth. If the teeth are gone for a long enough period of time, the bone that holds the roots in place slowly will disappear. Impact from an IED can remove the jaw bone in mere seconds, which is what happened to Pfc. Arthur T. Newell.

Private Newell was driving on the outskirts downrange when a roadside bomb sent a piece of shrapnel ripping through his jaw. The shrapnel blew out seven of his teeth as it lodged in the rear of his jawbone. To add insult to injury, he had just gotten his braces removed last year.

***image2***“I can’t tell you what it felt like,” said Private Newell. “I’ve never had a pain like it before. I’m just glad Dr. Sidow can put me back together.”

To accomplish this, Colonel Sidow must take bone from the private’s hip and transfer it to his jaw. Without the bone transfer, the replacement tooth would have to be unusually long to compensate for the missing bone. Once the hip bone has been grafted to his jaw, the private must allow the graft to heal for a couple of months before any teeth can be inserted.

Improvised explosive devices and rocket launchers aside, many surgeries performed at the clinic are the result of Mother Nature. Drastic under bites, over bites and open bites are fairly common problems that the colonel is happy to fix. He has hundreds of patient photos showing before and after shots of people whose mouths were transformed for the better.

“I really like to do corrective jaw surgery,” said Colonel Sidow. “This surgery keeps someone who has horrible biting problems from further damaging his teeth as well as changing his appearance. Sometimes the change is so drastic that the patient has to get a new identification card. They just don’t look the same after jaw realignment surgery.”

“It really is incredible to see the difference the surgery makes in a patient’s life,” said Sgt. April C. Scales, clinic NCOIC. “It makes me feel good to help cure their jaw problems and keep them deployable.”

A severely displaced jaw alignment is a big culprit of tooth damage. It causes certain teeth to bear the brunt of pressure, thus wearing them down and causing recession. Also, the person simply cannot chew on his front teeth, making the simplest of tasks difficult.

“Some people have such a displaced jaw alignment that they take a bite of a bologna sandwich and just shear off the bread, leaving the lettuce, tomato and bologna behind,” said Colonel Sidow.
“They may have bit the sandwich using only their back teeth. Something like that should be fixed. And I am happy to take care of it.”