Down Fracture- A Podcast for Talkin' Jaws

In this episode, Dr. Bobek and Dr. Wasson are joined by Dr. Shahid Aziz, an academic oral and maxillofacial surgeon in New Jersey. Dr. Aziz spent twenty years on full-time faculty at Rutgers and now leads the development of an oral surgery department and training program at Hackensack Meridian Health. He trained at Harvard and at Columbia under Dr. Steven Roser, performs over 200 orthognathic cases a year, and founded Smile Bangladesh in 2005, a nonprofit that has now run 34 cleft and orthognathic surgical missions to Bangladesh. The conversation covers how the organization was built and funded, what it takes to make room for that work inside a surgical career, and what mission surgery has taught him about how he practices at home.Topics covered in this episode:- How Smile Bangladesh started, from family connections and a first mission of five people in January 2006- What each mission costs, how it gets funded, and who keeps it running between trips- The OMS Foundation scholarship that helps residents cover travel for global surgery- Solving the logistics: in-country instrument storage, what still has to be carried in, and industry support for plates, screws, and virtual planning- Why visas, not willingness, are the barrier to bringing Bangladeshi surgeons to train in the States- Negotiating four to five weeks of global surgery into an employment contract rather than spending vacation on it- Choosing global surgery over becoming a board examiner, and how he thinks about that tradeoff now- Going back to non-custom technique abroad: positional screws for a double jaw, bending plates, and wire- Why he still has splints made and takes vertical measurements even on custom plate cases- Residents who have never seen a freehand genioplasty or done model surgery- Managing post-operative follow-up through local surgeons he has trained, with video calls and messaging- Inside his orthognathic fellowship, and where the fellows have gone- Why fewer residents choose orthognathic surgery, and how debt and reimbursement drive that- Patients arriving with specific millimeter requests from social media, and airway complaints with negative sleep studies- Reviewing every virtual surgical plan with the patient before signing off, and what he does when the trust is not there- How the measure of a successful case shifted from function and recovery to the measurements themselves- Getting hospital privileges and staying involved in maxillofacial trauma- Family first, and the one thing he says he would do differently📬 Questions or topic suggestions: [email protected] Down Fracture Podcast is for informational and entertainment purposes only and does not constitute medical advice. All opinions expressed are solely those of the hosts and their guests.

In this episode, Dr. Bobek and Dr. Wasson are joined by Dr. Suzie Bergman, DDS, FTMJF, a general dentist in Vancouver, Washington, Adjunct Associate Professor at Pacific Northwest University School of Dental Medicine, Fellow of the TMJ Foundation, and Visiting Research Scholar in Neurological Surgery at OHSU. Dr. Bergman is also a TMD patient: a jaw injury at 19 led to two open joint procedures and, eventually, bilateral custom total joint replacement. She joins the podcast the week after speaking at the TMD IMPACT meeting, an initiative of the NIDCR and the TMJ Association.This podcast is produced for oral and maxillofacial surgeons, orthodontists, and other clinicians. The hosts discuss clinical reasoning that depends on training and experience, applied to specific scenarios, and nothing here is a treatment recommendation. The discussion assumes a clinical background and is not a substitute for an individual evaluation with your own surgeon.Topics covered in this episode:- Dr. Bergman's own history: 35 years from injury to bilateral joint replacement, and what she would do differently- Who should be the quarterback for TMD care, and why primary care and ENT do not want the job- Whether general dentists are the practical answer or the wrong pathway entirely - Dr. Wasson's proposed model: surgeon, physician assistant, and physical therapist, and why Dr. Bergman calls it an oversimplification- Splints: an average of four to five per patient, and what the evidence supports- Why the TMJ is the only joint not managed by orthopedics, and how dental billing shapes care- Orofacial pain: 14 programs nationally and a geographic desert in the middle of the country- Arthrocentesis for acute closed lock and the cost of delaying referral- Physical therapy with TMD-trained PTs, and the harm from untrained ones- The "money joint," profitable dogma, and whether colleagues are too polite to say so- Total joint replacement outcomes today vs the proplast era, and what most dentists still believe- TMJ Connect and Dr. Bergman's map of surgeons, orofacial pain specialists, and physical therapistsFind Dr. Bergman on Instagram at @drsuzberg.📬 Questions or topic suggestions: [email protected]*The Down Fracture Podcast is for informational and entertainment purposes only and does not constitute medical advice. All opinions expressed are solely those of the hosts and their guests.*

In this episode, Dr. Bobek and Dr. Wasson take on a question both of them hear regularly in consultation: whether patients should undergo maxillary expansion (MARPE, MSE, DOME, EASE) before maxillomandibular advancement for obstructive sleep apnea. They cover who they think expansion is for, what is and is not established about nasal airway change compared with segmental Le Fort, and the cost, time, and surgical trade-offs of doing both. Dr. Wasson also shares a six-week post-operative MMAW case with intermolar and nasal base width measurements.This podcast is produced for oral and maxillofacial surgeons, orthodontists, and other clinicians. The hosts discuss clinical reasoning that depends on training and experience, applied to specific scenarios, and nothing here is a treatment recommendation. The discussion assumes a clinical background and is not a substitute for an individual evaluation with your own surgeon.Topics covered in this episode:- Who is a clear expansion patient, who is a clear MMA patient, and why the middle group is hard- Cost and time: roughly $10,000 to $30,000 and a year or more before jaw surgery- Whether MARPE widens the nasal airway more than a segmental Le Fort- Widening the nasal aperture by tilting segments in a three-piece Le Fort- How prior expansion changes the Le Fort: scar tissue, blood supply, and resistance to advancement- When expansion first makes sense: the anxious patient and the tongue-space complaint- Whether expansion followed by MMA is any better than MMA alone- Whether surgeons are going along with expansion to keep patients and referrals happy📬 Questions or topic suggestions: [email protected]*The Down Fracture Podcast is for informational and entertainment purposes only and does not constitute medical advice. All opinions expressed are solely those of the hosts and their guests.

In this episode, Dr. Bobek and Dr. Wasson talk about how surgeons evaluate themselves when an outcome is not what they planned. They cover where critical appraisal stops being useful and starts being punishment, why both of them are harder on themselves than on other surgeons, and how surgical training builds the habit in the first place. Topics covered in this episode:- Whether you are harder on yourself or on the surgeons whose revisions you inherit- The duality of doing the work well and accepting that it could be better- Why complications are difficult to discuss openly, with colleagues and with patients- Evaluating a case where the occlusion, airway, and midlines are all correct but numbness persists on one side- Dr. Wasson's rule: do not beat yourself up unless you can name something to do differently next time- MMA at roughly 86 percent surgical success, and what the other 14 percent means for the surgeon- The distinction between a failed outcome and a failed surgeon- A case that checks every box, full sensory recovery and good occlusion and aesthetics, with an AHI of 7 down from 40- How the healthcare system defaults to assigning blame to an individual- Going from panoramic films and cephalograms to cone beam imaging, and how more visibility invites more self-criticism- How rarely attendings comment on a good outcome, and what that trains into residents- Doing the wrong thing and getting the right answer, and the reverse- Where the real complications get discussed, and the role shame plays in keeping them quiet- The opposite failure mode: rose-colored glasses, and the surgeon who has never had a non-union- Wisdom from retired surgeons, including why SARPE asymmetry may not be worth agonizing over

In this episode, Dr. Bobek and Dr. Wasson are joined by Dr. Gary Bouloux, chair of oral and maxillofacial surgery at Emory University. Dr. Bouloux chaired the AAOMS special committee that produced the 2024 TMJ management guidelines, and he represented the specialty at the FDA and National Academies meetings on temporomandibular disorders that preceded them. He performs roughly 300 arthroscopies a year and is currently on the committee revising those guidelines.The discussion covers where the treatment algorithm has moved, why the guidelines skew toward total joint replacement after failed minimally invasive surgery, and the manufacturing bottleneck that has left Australia and New Zealand without a viable custom device.Topics covered in this episode:- The FDA meeting with patient advocacy groups and why it was a difficult starting point- How the National Academies report and its recommendations led to the AAOMS guidelines- What is being updated in the current revision, and what has not changed- Biologics: why steroids underperform, and the case for hyaluronic acid combined with injectable PRF- The practical side of making IPRF in an office, and the reimbursement problem- Why the guidelines move from arthrocentesis or arthroscopy toward total joint rather than open arthroplasty- New data suggesting a single prior arthroplasty is the covariable most associated with worse total joint outcomes- Arthroscopy at roughly 70 percent success, and what to do with the 30 percent who fail- The pediatric exception, and how weak the disc plication literature actually is- Where the term IPD came from and why disc position moved out of the center of the diagnosis- Unilateral versus bilateral surgery, and whether the contralateral joint should be replaced at the same time- Coronoidectomy, fat grafts, and heterotopic bone in joint replacement- Two manufacturers, a 23-week turnaround, and what happened to the Australian market- Whether KLS Martin and 3D printed devices can bring real competition- How many joints a year it takes to stay competent, and what the orthopedic literature says📬 Questions or topic suggestions: [email protected] Down Fracture Podcast is for informational and entertainment purposes only and does not constitute medical advice. All opinions expressed are solely those of the hosts and their guests.#DownFracturePodcast #TalkingJaws #JawSurgery #OMFS #OralSurgery #TMJ #TMJSurgery #TMJReplacement #Arthroscopy #Arthrocentesis #TMD #OrofacialPain #MaxillofacialSurgery #PRF #TotalJointReplacement