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.

In this episode, Drs. Wasson & Bobek are again joined by Dr. Lou Mercuri to get into the weeds on the TMJ prosthetic materials, metal testing, and current protocols for prosthetic joint infections.

In this episode, Dr. Bobek and Dr. Wasson are joined by Dr. Michael Olson, an otolaryngologist and facial plastic and reconstructive surgeon at Mayo Clinic with a fellowship in sleep surgery. Dr. Olson is one of a small number of ENTs who consistently performs orthognathic surgery for OSA, which makes for an interesting conversation about how the two specialties approach sleep surgery differently and where they overlap.

Topics covered in this episode:

- Why the Stanford Step Protocol developed the way it did and how surgical risk perception has shaped referral patterns

- Who benefits from soft tissue surgery, Inspire, and jaw surgery and how to think about each

- Age considerations for orthognathic surgery vs. airway stimulation

- Inspire tolerance issues and what that means in practice

- Maxillary expansion for sleep apnea: appropriate use vs. overuse

- Residual sleep apnea after MMA and next steps

- Dr. Olson's approach to septoplasty before LeFort

- Nasal congestion management post-LeFort

- Practical notes on ENT and OMFS collaboration in the sleep space

📬 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.

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.

📬 Have a topic or question? Email us: [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.

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.