Down Fracture- A Podcast for Talkin' Jaws

In this episode, Dr. Bobek and Dr. Wasson are joined by Dr. Timothy Neal, an oral and maxillofacial surgeon who trained at UT Southwestern in Dallas and stayed on as the program’s first trigeminal nerve repair fellow under Dr. Zuniga. Dr. Neal runs his own nerve clinic, handles repairs for the head and neck reconstruction team, and recently co-authored a JOMS study on nerve tape.Topics covered in this episode:- Nerve tape: how the nitinol hooks and porcine submucosa wrap work, what the JOMS data showed, and concerns about removing it once placed- Connector-assisted repair for gaps under 5 mm vs interpositional allograft for longer defects- Why direct repair has largely fallen out of favor, including axon alignment and chorda tympani fibers in the lingual nerve- What to do if you transect the IAN during a sagittal split without nerve tape or microsurgical training- When to perform an intraoperative repair relative to fixation in a BSSO- Referral patterns at UT: roughly 600 nerve referrals over 6 years, about 6% from jaw surgery, often older MMA patients- Defining post-traumatic trigeminal neuropathic pain using allodynia, hyperpathia, and hyperalgesia- Timing data: pain-free rates of about 60% when surgery happens within 200 days of injury, 12% beyond that, and none past 300 days- Functional vs complete sensory recovery, and how that distinction shapes patient messaging after BSSO- MR neurography for localizing injuries, and practical barriers like hardware scatter and braces- Cut and cap vs decompression and wrapping for neuropathic pain, where Dr. Wasson and Dr. Neal report different experiences- Whether wrapping the exposed IAN during a sagittal split could reduce compression injury- Articaine for inferior alveolar blocks: what the literature says vs what the panel sees in practice- Compression, interferences, and fixation choices (bicortical screws, plates, custom hardware) as possible contributors to injury📬 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 talk about the mandibular osteotomies that most surgeons rarely perform. They cover where the inverted L and the vertical ramus osteotomy still have a place, how total joint replacement absorbed many of the indications that used to belong to the L, and whether the sagittal split gets reached for by default more often than it should.Topics covered in this episode:- Why a surgeon can finish residency without seeing an inverted L or an IVRO- How joint replacement outcomes changed the case for the L, including what the longer-term data shows- The indications that remain: ramus morphology, lengthening, and the multiply operated patient- Aesthetics at the angle, and where an implant beats an osteotomy- Where the inverted L workflow breaks down, from condyle seating to pre-drilled holes- Why the L does not reliably avoid numbness, despite what patients are often told- Non-unions, grafting choices, and why hardware removal is its own problem- Whether the IVRO should be offered more often for mandibular setbacks- Late non-unions that stay hidden behind strong fixation- The subcondylar osteotomy for a healed fracture with a persistent malocclusion📬 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 #OrthognathicSurgery #BSSO #IVRO #RamusOsteotomy #TMJReplacement #SurgicalTechnique #MaxillofacialTrauma #VirtualSurgicalPlanning #MedEd #residentlife

In this episode, Dr. Bobek and Dr. Wasson talk about the decision not to operate. They start from the AAOMS indications paper updated in 2025, which both find useful as a reference point and limited in practice, and spend most of the episode on the judgment it does not cover: readiness, timing, support, and the patients whose expectations will not be met by a technically successful result.Topics covered in this episode:- Why a list of indications does not invert into a list of contraindications- Three kinds of patients at the first visit, and which one is hardest- The patient who agrees with everything, and why that is a warning sign- Clicking as a primary motivation, in orthognathic and TMJ cases- The third molar analogy, and how the threshold changes with age- Social reasons to wait: insurance, family circumstances, school, a new business- BMI thresholds and age limits, and how much they actually hold up- How to tell someone they are not ready, and why being direct often helps📬 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. Zubad Newaz, an orthodontist whose airway-focused practice runs across offices in New York, Vermont, and Florida, with a large share of patients treated at a distance. He completed a radiology residency before orthodontics, and has built the practice around a centralized diagnostic role so he can follow each case closely through treatment rather than splitting his time between offices.The conversation covers how remote coordination actually functions between an orthodontist and a surgeon, where skeletal expansion fits relative to jaw surgery, and how both sides of that referral relationship see the same patient differently.Topics covered in this episode:- Running one treatment plan across four locations, and why a local orthodontist doing the orthodontics often works best- Aligners, fixed appliances, and which long distance patients need a provider on the ground- Monitoring expansion remotely with local CBCT and intraoral scans, and where the touch points fall- Why airway-aware orthodontic practice has moved close to mainstream in the last few years- Dr. Wasson revisiting his assumption about patients who expand with one provider and finish with another- The three groups now offering expansion, and who is best positioned to oversee it- Using space from expansion as currency for later segmental osteotomies- The asymmetries that show up with expansion, including yaw from uneven pterygomaxillary release and septal base drag- Why diagnosing what is still tethered during expansion is harder than it looks- Device choice between FME and custom MARPE, and why the field is trending toward smaller expansions than in 2022- Mandibular midline distraction, bone loss around the lower centrals, and mitigating it with SFOT- Expanding the mandible during surgery instead of staging a separate distraction- A tiered way of framing options for patients: teeth only, skeletal expansion, then jaw surgery- How often expansion patients go on to need jaw surgery, and how often a case could be made for it- What counts as a small, moderate, and large expansion when measured as skeletal yield rather than device activation- Why skeletal relapse is lower than expected once expansion is held through re-ossification- Whether to expand before MMA when a patient will have both, and why surgeons who only do single piece surgery shape that answer- A rhinomanometry finding on where nasal airflow actually comes from, and what it might mean for mid-face expansion📬 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 talk about what a surgeon owes a patient during a consultation. They cover the position you are put in when a patient arrives with a treatment plan you disagree with, how to say so without undermining the referring provider, and what patients can reasonably expect from an hour in a surgeon's office.Topics covered in this episode:- Why a consultation becomes a tightrope when the patient was referred for something you would not recommend- Lower stakes in dentoalveolar practice: second molar implants, third molar referrals, grafting materials- Taking the role of the bad guy so the referring provider keeps the relationship- Why picking up the phone usually reveals a miscommunication rather than a disagreement- How fast patients now relay your opinion back to the referring office, often before you can call- Patients arriving with a specific request and expecting it executed, and what that asks of trust- The cost of expansion before MMA, and the obligation to say plainly what it buys- Asking a patient directly what their actual motivation for treatment is, and why they sometimes cannot articulate it- Cases where bite, airway, and aesthetics align, and cases where correcting one works against another- How much information is the right amount in a consult- Giving a contrasting opinion when the patient has already been told otherwise online- Why disagreeing with a plan is the service being asked for- Judgment calls versus errors, and why a bad outcome from sound reasoning is not a mistake- Research presented at the national meeting on pre-operative expectations predicting dissatisfaction- Whether calling yourself a specialist in a condition carries an obligation to stay current on treatments you do not perform- Conversion rates and billable chair time, and why both hosts refuse to track them- Red flags from the patient side: absolutes, assembly line consults, and minutes with the actual surgeon📬 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.