Is surgery first orthognathics the future or a shortcut with real tradeoffs? In this episode, Dr. Bobek and Dr. Wasson dig into one of the most debated topics in surgical-orthodontic treatment: whether jaw surgery should come before braces, and when it actually makes sense to do it.

This episode gives you a frank look at how two oral and maxillofacial surgeons actually think about this in practice.

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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.

In this episode, Dr. Sam Bobek and Dr. Michael Wasson are joined by Dr. Vince Maxim Lucero, a pediatric and oral and maxillofacial anesthesiologist with over 40 years of experience, trained at Yale, the University of Washington, and the Hospital for Sick Children in Toronto. They cover how anesthesia for jaw surgery has evolved over the decades, including blood pressure management, hypotensive anesthesia techniques, the A-line debate, post-op nausea prevention, nasal intubation tips, surgeon-anesthesiologist communication, and what it actually takes to run outpatient orthognathic surgery safely.

Topics discussed:

— How anesthesia drugs and monitoring have changed since the 1980s

— Why outpatient jaw surgery works (and when it doesn't)

— The A-line debate: is it necessary?

— Managing blood pressure without just cranking the gas

— Post-op nausea: TXA, scopolamine patches, NG tubes, and more

— What anesthesiologists wish surgeons understood

— Building a surgeon-anesthesiologist relationship that actually works

---Disclaimer: The Down Fracture Podcast is intended for healthcare professionals and is for informational and educational purposes only. Nothing discussed in this episode constitutes medical advice, clinical guidance, or a standard of care. Clinical decisions should always be made in consultation with qualified medical professionals and with consideration of individual patient circumstances. The views expressed are those of the hosts and guests and do not represent any institution or employer.

In this episode, Drs. Bobek and Wasson discuss moving the maxilla posteriorly.

In this episode, Drs. Bobek & Wasson discuss the differences between marketing and gimmicks in jaw surgery. Multiple contemporary topics and procedures are discussed with an attempt to assist the listener in determining which category each falls into.

In this episode, Drs. Bobek & Wasson discuss MMAw, or Maxillomandibular Advancement with Widening to treat Obstructive Sleep Apnea (OSA).

In this episode, Drs. Wasson & Bobek discuss ideas or concepts presented in the literature that we feel are not good ones (or as the kids say-"no bueno.")

In this episode, Drs. Wasson & Bobek discuss provider wellness including causes of burnout and what can be done to address it. Kind of. You know how it goes with us.

In this episode, Dr. Wasson & Bobek discuss whether the type of mandibular fixation causes condylar resorption. We also celebrate a US hockey gold medal extravaganza.

In this episode we again discuss ethical considerations in jaw surgery practice. We may also discuss Sam's love of The Biebs.

In this episode, Drs. Wasson & Bobek discuss some ethical questions in jaw surgery. There may also be some pro-Seahawks talk and some old man sayings sprinkled in.