First-ever surgery to remove an aggressive tumor and construct a new a jawbone and jaw hinge in one day performed at Legacy Good Samaritan Medical Center.
Philip Chastain – Before and After.
August 25, 2020, Portland, OR – Philip Chastain, 53, flew from Charleston, South Carolina, to Portland to get the lower left side of his face reconstructed in one day. Chastain suffers from a recurrent ameloblastoma, a rare, aggressive, benign tumor that kept growing out of his left jawbone. The bulging tumor eventually destroyed his jaw. Chastain read an article in his local newspaper about an oral and maxillofacial surgeon named Baber Khatib, M.D., DDS, who performed a Jaw-in-a-Day® procedure on several patients.
Dr. Khatib was on KATU news with Phillip Chastain. His case is unique in that it was the first Jaw in a Day with simultaneous TMJ reconstruction on the West Coast according to 3D Systems.
“I met Dr. Khatib before he left South Carolina for Oregon,” said Chastain. “His treatment plan made me feel comfortable, so I knew I was going to Oregon to get this done.” Ameloblastoma is a rare head and neck tumor. If left untreated, it can grow and cause severe facial deformities and loss of teeth, making it difficult to eat or talk. “It psychologically impacted me because it changed my appearance,” said Chastain, a single father. Chastain was treated twice before by conventional methods; however, the tumor returned and extended to his skull base.
Using the fibula (calf bone) to repair a jaw has been around for many years. What makes this innovative is now surgeons can reconstruct the patient’s jaw and screw in a new set of teeth all in one day. Chastain’s case had an added complexity; he needed a new temporomandibular joint, the hinge that connects the jawbone to the skull, and this would be the first one performed in Oregon. “The Jaw-in-a-Day® procedure saves time and multiple trips to the operating room,” said Dr. Khatib. “Traditional treatments for ameloblastoma typically involve several reconstructive surgeries over one to two years.”
Intraoperative view of Chastain’s surgery. Dr. Khatib is checking the bite at the leg and the final fit of the teeth and TMJ reconstruction in the mouth before final closure.
Dr. Khatib, who specializes in head and neck microvascular reconstructive surgery, says the procedure is unusually complex and requires a team of specialists in the operating room at the same time. His partner, Dr. Ashish Patel removed Chastain’s jaw and the tumor. Dr. Khatib used a custom three-dimensional printed articulated model he designed to ensure the patient had a balanced bite, and his new joint functioned smoothly. He used the model to create a symmetrical and functional jawbone while simultaneously replacing teeth with dental implants and a prosthesis in one surgery. At the same time, the bone was still being perfused by vessels in the leg. In addition to reconstructing his bite with the fibula, teeth, and implants, Dr. Khatib rebuild his temporomandibular joint.
According to James Busch, with 3D Systems, the virtual planning company used for the Jaw-in-a-Day® procedure, this was the first time the procedure included a temporomandibular joint reconstruction on the West Coast.
Before photo – 1. Tumor 2. Bony resorption by tumor 3. Extension to skull base
The 10-hour surgery required a one-week hospital stay. “Patients can get back to their daily lives sooner,” said Dr. Khatib. Just days after the surgery, Chastain was back at home in South Carolina with only a small scar on his leg and jaw.
Dr. Baber Khatib’s planned reconstruction – Virtual Surgical Planning
“I’m looking forward to getting back to running as soon as possible, and I’m planning on doing a pretty strenuous 100-mile solo hike late next spring in the mountains of North Carolina. It was such a relief to find Dr. Khatib.”
Legacy Health is Oregon’s only locally owned nonprofit health-care organization with nearly 12,000 employees. Legacy includes Legacy Emanuel Medical Center, Randall Children’s Hospital at Legacy Emanuel, Legacy Good Samaritan Medical Center, Legacy Meridian Park Medical Center, Legacy Mount Hood Medical Center, Legacy Salmon Creek Medical Center, Legacy Silverton Medical Center, Legacy Laboratory Services, and Legacy Research Institute. Legacy also includes over 100 Legacy Medical Group primary care and specialty care clinics. Based in Portland, Oregon, Head and Neck Surgical Associates (HNSA) is the Northwest’s most highly specialized medical and surgical practice. With expertise in head and neck, oral, maxillofacial, and facial cosmetic surgeries, HNSA is comprised of a unique group of board-certified physicians that attended both medical and dental school.