In this episode, Dr. Bobek and Dr. Wasson discuss large maxillary transverse corrections in orthognathic surgery, covering how their comfort with expansion magnitude has evolved over time and what strategies they use when the plan pushes the limits of what a segmental Le Fort can reliably achieve.

Topics covered in this episode:

- How comfort with large maxillary expansion develops over a surgical career

- The difference between bony expansion on a 3D plan vs intermolar expansion and why that distinction matters

- Flat palatal vault as a key risk factor for large transverse corrections

- Step by step approach to a large segmental Le Fort expansion including mobilization, palatine release, and progressive stretching

- Having multiple backup splints ready and how to use them intraoperatively

- Mandibular midline osteotomy as a backup plan and when it actually makes sense

- Bone grafting the segmental gaps: what materials to use and why grafting is hard to argue against

- Palatal splints: design considerations, relief adjustments, and how long to leave them in

- SARPE vs segmental Le Fort: what the existing stability data actually shows and why the common teaching may be backwards

- DOME, MARPE, and MSC expansion: what we still do not know about long-term stability

- When SARPE is clearly the right answer and when segmental Le Fort is the more direct path

📬 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 discuss the tension between simple and complex surgical treatment planning in orthognathic surgery, including how their thinking has evolved with experience and what the right balance looks like in practice.

Topics covered in this episode:

- How virtual surgical planning has opened up new possibilities for complexity, and whether that is always a good thing

- Single-piece vs segmental maxilla: when segmenting adds real value and when it adds risk without proportional benefit

- Single jaw vs double jaw surgery: how to weigh small gains against added complications, particularly nerve risk in younger patients

- How training environment shapes a surgeon's default approach to planning, and how that evolves over a career

- The role of the orthodontist in shaping surgical complexity and how communication between surgeon and orthodontist influences the final plan

- Involving patients in treatment planning and how patient priorities should influence surgical decision-making

- Why some of the highest-volume experienced surgeons tend toward simpler plans and what that signals

- Complexity relative to experience: what feels advanced in one practice is routine in another

- The online patient community and how internet-driven expectations around speed, custom hardware, and outcomes affect real clinical conversations

- Mandibular midline osteotomy, genioplasty, and other procedures that vary widely in how routinely they are incorporated

📬 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 revisit the topic of gimmicks and misleading claims in oral and maxillofacial surgery, this time through the lens of how to identify snake oil in practice, whether you are a patient trying to navigate options or a clinician trying to stay grounded.

Topics covered in this episode:

* What snake oil actually means in a modern surgical context and how it differs from well-intentioned but unsupported practice

* The difference between inadvertent misinformation and deliberate misrepresentation

* How marketing and internet presence can create the appearance of expertise that may not reflect clinical reality

* Red flags practitioners can use to identify questionable techniques or products: lack of transparency, absence from specialty conferences, claims of universal success, and vague reproducibility

* Stem cell injections, expansion devices, mewing, and other interventions discussed through a skepticism lens* How AI is changing the way patients find subspecialists and evaluate treatment options

* Arthrocentesis as a first-line TMJ treatment: where it fits and where it does not

* The role of networking with colleagues in maintaining healthy clinical skepticism

📬 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 discuss what patients and practitioners should actually know about having surgery at the hospital, including some things that might be counterintuitive.

Topics covered in this episode:

- How hospital culture around jaw surgery varies dramatically between institutions and even between different areas of the same building

- The history of orthognathic surgery at the hospital, from ICU admissions and blood transfusions to the current outpatient era

- Why access to more resources does not automatically mean better care for routine jaw surgery cases

- Staff turnover, familiarity gaps, and what happens when the team has never seen a jaw surgery patient before

- Fragmented post-operative care: medication timing, oral intake, mouth care, and why the patient experience often suffers

- How anxiety in unfamiliar staff transmits directly to patients and families

- Hospital policies, committee structures, and why it can be nearly impossible to change things even when something clearly does not make sense

- Equipment and implant contracts: why you may not get the plating system you trained with

- Hidden cost drivers: OR time overruns, implant costs buried in facility bills, and what patients never see on their EOB

- When the hospital genuinely is the right place to be, and what clinical scenarios warrant higher acuity care

- What patients can do to advocate for themselves and why getting out sooner is usually better

📬 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 are joined by Angie Barker Murphy of Murphy Healthcare Consultants, who has worked in oral surgery compliance and accreditation since 1999.

Angie helped one of the earliest oral surgery practices pursue AAAHC certification for in-office jaw surgery and has since built a consulting practice helping oral surgery offices through the accreditation process.

Topics covered in this episode:

- What AAAHC accreditation is and how it differs from standard dental or oral surgery licensing requirements

- Office-based surgery accreditation vs. the ASC route and when each makes sense

- Whether accreditation can be used to negotiate facility fees with insurance companies

- What the accreditation process actually involves: timelines, site visits, case observation, and documentation

- Staff onboarding, training documentation, and clinical competencies under AAAHC standards

- Common things practices are already doing but not documenting, and common blind spots such as CLIA waivers and medication handling

- The role of a consultant vs. attempting the process independently

- Approximate costs: AAAHC fees, consultant fees, and what to budget

- Ongoing maintenance and reaccreditation every 3 years

- Quality improvement studies and how to make them meaningful for oral surgery practices

- How Dr. Bobek's practice experienced the process and what changed afterward

Murphy Healthcare Consultants can be reached through their website once live, or via the email below.

📬 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 discuss CT superimpositions in orthognathic surgery: what they are, when they are useful, and why more surgeons are not routinely doing them.

Topics covered in this episode:

- What superimposition means in the context of jaw surgery outcomes and how it differs from just reviewing a post-op CT

- Uses beyond outcome review: condylar hyperplasia monitoring, assessing post-surgical changes, and evaluating growth

- Superimposing pre-op to post-op vs. plan to executed result and why the latter is harder to access

- What the data actually shows when you overlay your plan against what happened in the OR

- How mandible splits, Dalpont positioning, proximal segment seating, and inferior border shape look on superimposition vs. what surgeons assume

- Accuracy of stock vs. custom hardware in AP advancement and what that means for planning

- The case for doing this routinely in residency and early practice

- Revision surgery: why superimposing pre-op, post-op, and the new plan together is one of the most useful tools in that consultation

- Managing patient expectations in revision cases using imaging data

- Practical barriers: software access, planning company file ownership, and how long it actually takes

📬 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 start with a brief clarification on the transmucosal pterygomaxillary disjunction technique from last week, then move into a discussion on what they actually add to a standard MMA beyond the double jaw surgery itself.Topics covered in this episode:- Transmucosal pterygomaxillary disjunction: a quick visual clarification with imaging- Nasal work during MMA: septoplasty, turbinate management, bone grafting at the piriform aperture, and where each host has landed on how much to do- The difference between nasal work done during a LeFort vs. a formal standalone septoplasty- Chin surgery and genial tubercle advancement: when to add it, how far forward is too far, and sequencing- Carrying the tubercles with the chin as a single piece vs. separating them as two segments- Troubleshooting tubercle fixation when things do not go as planned intraoperatively- Tonsils and tongue reduction at the time of MMA: why both hosts avoid combining these- Segmental LeFort as an airway adjunct independent of occlusal indications- Mandibular widening with midline osteotomy combined with MMA- How patient goals and surgical planning conversations shape the final treatment algorithm📬 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 try something a little different, taking turns presenting hot takes and arguing opposite sides. The discussion surfaces useful clinical nuance along the way.

Topics covered in this episode:

- Aligners vs traditional braces for surgical orthognathic cases: bracket safety in the OR, setup efficiency, post-op relapse, and whether provider comfort is driving the preference for braces

- Sagittal split osteotomy cut depth: whether 3D imaging and known nerve position justifies taking saw cuts deeper than just through cortex, and where that might prevent bad splits

- Mandible fixation after BSSO: the case for always using a plate and positional screws together, hardware removal rates, and how each host approaches fixation based on movement size and bone quality

- Transmucosal pterygomaxillary disjunction vs traditional technique: where the approach came from, the theoretical benefits, and whether the concerns about blood supply and mucosal tears hold up in practice

📬 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.

#OrthognathicSurgery #JawSurgery #OMFS #OralSurgery #AlignersVsBraces #DownFracturePodcast #TalkingJaws #BSSO #SagittalSplit #ClearAligners #SurgicalOrthodontics #MedicalPodcast #DentalPodcast #JawSurgeryDebate #HotTakes

In this episode, Dr. Bobek and Dr. Wasson discuss overcorrection in orthognathic surgery, covering how their thinking on the topic has shifted with experience and what they currently do in practice for different jaw movements.

Topics covered in this episode:

• Anterior open bite overcorrection and when segmenting the maxilla is worth considering
• Class 2 correction: whether leaving patients tight still makes sense
• Class 3 correction and how much AP overcorrection is reasonable
• Transverse overcorrection in maxillary widening cases and dental vs. skeletal relapse
• Vertical overcorrection in maxillary augmentation cases
• Asymmetry correction and the risks of overcorrecting to the opposite side
• The impaction-to-advancement ratio and why both hosts have moved away from it
• Accuracy of virtual surgical planning and what superimpositions tend to show
• Custom hardware and whether it changes the relapse picture
• How dental relapse and skeletal relapse differ and why that distinction matters for planning

📬 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 are joined by Dr. Moe Hakim, an oral and maxillofacial surgeon based in Arlington, Virginia. Dr. Hakim's practice focuses on TMJ surgery and orthognathic surgery, and he has been publishing on arthroscopic outcomes and PRF in the TMJ space.

Topics covered in this episode:

• Whether open joint surgery still has a place in contemporary TMJ practice
• Arthrocentesis vs. arthroscopy: are they equivalent, and when does it matter
• Level 3 arthroscopy and discopexy: indications, outcomes, and why Dr. Hakim does it less than he used to
• PRF for painful clicks and crepitus: how he uses it and what his outcomes look like
• The disc displacement obsession and why disc position may matter less than we think
• Acute vs. chronic closed lock and how the duration changes the surgical approach
• The role of orofacial pain specialists in the TMJ care pathway
• Regional and institutional variation in how TMJ surgery is perceived and practiced
• Why "surgery is a last resort" framing is worth examining

Dr. Hakim's Instagram: @thetmjandjawsurgeon

📬 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.