WEBVTT

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All right , just whenever . All right ,

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uh , my name is Grant Dickerson , a

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specialist . I'm a part of 277

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FA Second striker brigade combat team .

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I was down here on the border mission

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and drank something cold , went to the

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doctor , the dentist , and then they

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did an X-ray on my teeth . Grant came

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in here with a referral from the

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dentist asking to evaluate unusual dark

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uh lesion that's seen on the X-ray .

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Immediately , we took another imaging

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in the clinic called the CBCT which is

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a three dimensional uh CT scan

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essentially . And we saw a very large

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expansile pathology or growing tumor .

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As a mom , when I heard the word tumor ,

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I was just in shock . I think I

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was um just scared and afraid that

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it could be cancer . First reactions uh .

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Of course , everybody always goes ,

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worst case , um . But uh we worried

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and we just said let's work through the

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process , see where we end up . What

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Grant had um is something called the

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central giant cell granuloma , so a

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non-cancerous tumor in his lower jaw .

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It forms within the bone and then grows .

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It destroyed 2/3 of his mandible or

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lower jaw . So from a readiness

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perspective , if Grant would have been

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hit in the face at all , uh , he would

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have probably broken his jaw .

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Somebody can come in with an oral

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cancer , a benign tumor , uh , facial

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trauma , a congenital anomaly , some

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type of pathology or change to the

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upper jaw or lower jaw . Traditionally ,

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that would entail the upper lower jaw

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being removed . And then it possibly a

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transplant from the leg bone or another

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source to rebuild the upper or lower

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jaw . This procedure would not have

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been all done in one day . They might

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have part of the surgery done today and

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then might not get teeth for 18 months

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to 2 years later . Jaw in a day , as I

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say to my 5 and 7 year old little girls ,

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is when we take the leg bone and put it

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in the face bone . Really the , the big

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difference between jaw in a day and

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traditional , uh , reconstruction in

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the US and globally . Is that you get

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your dental rehabilitation immediately .

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So the bone , the teeth , and your

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function , so your speech and

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swallowing all come back that same day .

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So it takes 2 years of treatment into 1

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day . The primary goal

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for number one for Pati Dickerson was a

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return to duty . He wanted to continue

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to serve his country and he wanted to

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return to the job that he had left

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behind in Fort Carlson . And so after a

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long discussion , we consented him for

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the one time , one surgery to restore

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everything . Today my role really

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started really before the surgery ,

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before the patient was ever on the

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operating table itself . All the pre-op

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appointments , all the planning was

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done virtually on video communication ,

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we're able to gather . Intraoral photos ,

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intraoral scans of the patient's teeth ,

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as well as a CBCT for the patient , uh ,

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and using that information , we can

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actually virtually plan the surgery ,

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the implants , and the teeth before the

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patient ever comes into the OR .

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Reconstruction has a couple of phases .

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Phase one is you prepare the tissue to

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bring up to the head and neck , so we

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call that the harvest . So for instance ,

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in the leg , we'll prepare the fibula .

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Making an incision on the leg ,

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isolating the part of the bone that we

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want to move , making the cuts so it's

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totally mobilized . So that's all the

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harvest . The next step is rebuilding

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it into what it's going to look like .

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So for a fibula , we'll actually make

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all of the bone cuts in the leg and

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rebuild it into the shape of a jaw

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before we bring it up to the head and

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neck . The next step is the inset , and

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that's where we take our rebuilt jaw

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and we use metal plates to connect it

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to the patient's mouth so that it fits

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in place if we're bringing up skin that

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also may be sewing the skin in , um ,

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to rebuild the uh the defects . And

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then finally we do the microvascular

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anastomosis , which means we connect

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the blood vessels together with tiny

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little sutures under a microscope . So

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all those are different phases of

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reconstruction and they're sort of done

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in sequence . Reconstructive success is

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finite . I did a procedure , I got a

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good outcome , patient OK , moving on .

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You can see how it creates silos . But

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if your outcome is longitudinal in

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process , and it is as audacious as

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restoring the overall health of a

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patient . Rather than myopic of one

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procedure , that is how we restore form ,

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function and purpose . It's more than

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just plugging a hole or closing a

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wound . Uh , we really do need to

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restore all these very complex

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functions . So it's more than removing

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the cancer and telling them that

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they're cancer free . The goal is to be

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able to tell them . They're cancer free

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and that they're gonna be able to eat

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or that they're not gonna drool the

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rest of their life or that they can

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speak to their loved one . The focus is

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not the procedure , the focus is the

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patient . That's the difference between

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reconstruction , a single finite

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outcome , and restoration , which is a

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comprehensive restoration of one's

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health , especially for our war

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fighters so they can get back in the

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fight . So as much as I would like to

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do it here , it takes a surgeon who has

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a specialized training in doing

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microvascular surgery , and it also

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requires the support staff to be

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knowledgeable and to be able to manage

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a patient like that after the surgery

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in recovery in the ICU uh

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monitoring the health of the flab , and

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etc . So ultimately , I , I chose to

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refer a patient out . He reached out

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and did the biopsy and did the initial

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work up and we worked as a team between

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the team in Colorado and the team in

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San Diego we actually were able to be

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so collaborative between the army and

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the navy and the entire military health

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system that we did all the planning all

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the virtual surgical planning all . All

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the fabrication of the 3D printed

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titanium and guides all before Grant

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even showed up . The fact that , you

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know , we are now able to work between

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Army , Air Force , Navy , that's all

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part of the Defense Health Agency and I

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think that's good for us surgeons and

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doctors to be able to take care of

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patients . My hope for Grant with this

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John in a day surgery is that he keeps

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going with his career . He wants

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nothing more than to be in the army ,

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to be a soldier . The the soldier

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aspect of it for Grant , it's what he's

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always wanted . The fact that Grant ,

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after 30 days following his surgery ,

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is able to function at this level and

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to be able to speak and and walk , um ,

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I think it's amazing . Yeah , I have no

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doubt that he's gonna fully recover in

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a short amount of time . And be able to

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do the job that he loves . A diagnosis

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of a benign tumor and removing 2/3 of

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someone's lower jaw is a devastating

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diagnosis . There's no way to get

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around that . But our hope for our team

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is that his diagnosis , his experience ,

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his recovery is just a chapter in his

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life and not his story . What the

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future holds for grant is limitless .

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He'll do He'll do me .