Quick Review #280 - #surgery #surgeon #doctorgallagher #oralsurgery #oralsurgeon #omfs #dentist #dentistry #dental #orthognathic #lefort #bsso #bleeding

- 8.17.25

Bleeding during a Le Fort I osteotomy, particularly at the pterygomaxillary junction, is a high-yield oral boards topic and a common intraoperative challenge. Frequent sources are the descending palatine artery (arterial) and the pterygoid venous plexus (venous).

Anatomy & Mechanism:

The descending palatine artery, a branch of the maxillary artery, travels through the greater palatine canal, emerging at the posterior hard palate. It lies close to the posterior maxillary wall and is vulnerable when separating the maxilla from the pterygoid plates. The pterygoid venous plexus is located around the lateral pterygoid muscle and produces slow, dark venous oozing rather than pulsatile bleeding.

Recognition:

A) Arterial bleeding: Bright red, pulsatile flow; rapid accumulation in the field.

B) Venous bleeding: Dark, slow ooze; diffuse origin.

Immediate Management:

1. Direct Pressure – Apply firm pressure with gauze or sponge at the bleeding point.

2. Suction & Visualization – Clear the field to localize the source.

3. Hemostatic Agents – Surgicel, Gelfoam, or Floseal for diffuse venous ooze.

4. Electrocautery – Bipolar cautery for focal arterial injury, avoiding nerve injury (e.g., V2 branches).

5. Packing – If uncontrollable, pack the area temporarily and assess for stability.

6. Escalation – For severe or persistent arterial bleeding, consider intraoperative ligation or postoperative embolization of the maxillary artery via interventional radiology.

Prevention:

1. Keep osteotomes oriented correctly during posterior maxillary cuts.

2. Avoid excessive posterior force that risks the greater palatine canal.

3. Use virtual surgical planning to anticipate anatomy and avoid injury zones.

Tip:

Try to identify whether the bleed is arterial or venous—management and urgency might differ. Mention both possible sources in your oral boards answer, but highlight the descending palatine artery as the more common significant arterial injury in Le Fort I procedures.

References:

1. Bartlett, S., Ehrenfeld, M., Mast, G., & Sugar, A. (n.d.). Approach to the Le Fort I level of the midface in cleft lip and palate patients. In E. Ellis III (Exec. Ed.) & D. Buchbinder (Gen. Ed.), AO Surgery Reference: CMF – Congenital Deformities. AO Foundation. Retrieved August 14, 2025, from https://lnkd.in/dvQj9tr3

2. Miloro, M., Ghali, G. E., Larsen, P. E., & Waite, P. (2022). Peterson’s Principles of Oral and Maxillofacial Surgery (4th ed.). Springer.

3. Abubaker, A. O., Lam, D., & Benson, K. (2016). Oral and Maxillofacial Surgery Secrets (3rd ed.). Elsevier.

4. ChatGPT. 2025

#podcast #dentalpodcast #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentist #dentistry #oralsurgery #dental #dentalschool #dentalstudent #doctorlife #dentistlife #oralsurgeon #doctorgallagher

Top 4 Topics:

- Inside the Oral Surgery Board Exam: HOW TO CRUSH THIS EXAM

- The Hidden Value of Board Certification: Why It Protects Patients and the Future of Surgery

- Life as an Oral Surgeon: Balancing Trauma Cases, Family, and 2AM Emergencies

- Mentorship, Medicine, and Motivation: The Stories That Shape Surgeons

Dr. Jenzer and Dr. Figueroa let me share their emails, here, so you can contact them directly with additional questions and to sign up for their OMFS Oral Board Exam Review Course - see you there on October 9th!

[email protected]

[email protected]

Link to sign up for the course: https://stlomfsreview.com/

Quotes & Wisdom:

On preparation & mindset

“This test is about half knowledge, but it’s half preparation — being able to verbalize quickly, concisely, and move through a case. That’s a skill we don’t practice enough.” — Andrew Jenzer (17:54)

On repetition & efficiency

“If you come out of a residency, you already know this stuff. The key is organizing it and verbalizing it quickly and efficiently, because there’s a time component. If everyone had unlimited time, 99% would pass.” — Aaron (18:57)

On facing the challenge

“When I was nervous before the exam, I reminded myself: this is all stuff I’ve seen, I currently do, or have done. They just want to know I can do it safely. That mindset helped me calm down and let the answers flow.” — Aaron (36:18)

On the value of board certification

“The process makes you a better surgeon and provider. You start to connect things laterally, and it makes you incredibly safe for your patients. That’s why it’s worth it.” — Andrew Jenzer (41:20)

On overcoming fear of failure

“What’s the worst that happens? You fail, you retake it. You’re still an oral surgeon. Don’t let fear stop you from going for it.” — Aaron (42:53)

On teaching & mentorship

“Follow your heart. If you’re passionate about teaching, you can change the trajectory for residents and future surgeons. The world always needs more people willing to mentor.” — Andrew Jenzer (09:49)

On patient safety & exam priorities

“The exam isn’t about knowing every obscure disease. It’s about proving you can safely manage the common conditions — asthma, diabetes — the things you’ll see every day.” — Andrew Jenzer (31:59)

On commitment to the specialty

“There are people before us who fought for us to be in hospitals, to do cancer and cosmetic surgery. Whether or not you do that, board certification preserves the scope of our specialty.” — Aaron (42:53)

Questions:

(03:45) “How did you guys think up the Oral Boards Review Course?”

(04:50) “Was the fellowship one year or two? And what was it like for you personally?”

(09:09) “Where are you guys practicing right now?”

(15:43) “When should someone start preparing for the oral boards — is now too early or too late?”

(23:37) “How should we structure group study sessions to best simulate the real exam?”

(29:12) “Besides starting too late, what are the biggest mistakes people make preparing for this exam?”

Now available on:

- Dr. Gallagher’s Podcast & YouTube Channel

- Dose of Dental Podcast #168

My watch in this episode = Citizen Promaster Diver Day Date

- 8.2025

#podcast #dentalpodcast #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentist #dentistry #oralsurgery #dental #dentalschool #dentalstudent #doctorlife #dentistlife #oralsurgeon #doctorgallagher

📍It’s the 2nd half of 2025, I just graduated residency in Oral & Maxillofacial Surgery in June, now starting to work at All County Oral Surgery in Melville on Long Island, NY. I’ll be an associate surgeon here & working toward a personal goal of becoming a partner one day. Outside of dentistry, I have side projects & companies to bring my passions to life, including mentorship, education, and life strategy, and I obnoxiously share a lot of content on it all as I go hahahaha

👉 Keep an eye out for my weekly TikTok LIVE Q&A Session (usually Sunday evenings) and the monthly Q&A session on Instagram (end of every month). Let me know how I can help you

🌎 *** PreDent Mentor Map is now LIVE, at predentmentormap.org ! *** it’s a free resource for predental students to use for data on every dental school, and to connect with current dental students for personalized mentoring.

🙋🏼‍♂️ If you’re an organization or club at a school and you’d like to discuss a partnership, event or conference, DM me on Instagram or LinkedIn- that is the best way to contact me directly

❤️ MOST importantly: THANK YOU. Mentoring is what got me here, and it is how I’ll help you achieve your dream goals as best I can. You are a MASSIVE part of this journey to me, more than you know

🤠 Sincerely, Brendan @doctorgallagher

🔗 Links to my platforms: https://linktr.ee/doctorgallagher/

#podcast #dentalpodcast #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentist #dentistry #oralsurgery #dental #dentalschool #dentalstudent #doctorlife #dentistlife #oralsurgeon #doctorgallagher

🎙️ Clip from the July 2025, Monthly Insta Story Q&A sessions I do at the end of every month- stay tuned the last week of the month on my Instagram @doctorgallagher 🙌

🔗 Links to my platforms: https://linktr.ee/doctorgallagher/

#podcast #dentalpodcast #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentist #dentistry #oralsurgery #dental #dentalschool #dentalstudent #doctorlife #dentistlife #oralsurgeon #doctorgallagher

Top 5 Topics:- From Dental School to Dream Job: The Untold Struggles of Young Surgeons- Work-Life Balance in Surgery: How 3 Days a Week Changed Everything- Private Equity in Dentistry: Threat or Opportunity?- Secrets of a Surgeon’s Success: Networking, Marketing, and Mentorship- The Money Talk: Contracts, Compensation, and Equity ExplainedQuotes & Wisdom:"The hardest transition wasn’t coping with residency — it was realizing there’s no next step after graduation.""Three days a week in surgery makes me more present both at work and at home.""Work-life balance isn’t about working less — it’s about being intentional with the time you have.""Success is defined on a spectrum, and for me it’s not about working endlessly — it’s about not looking back with regret.""Nothing is more effective for marketing than meeting people face-to-face and building genuine relationships.""There’s no one way a surgeon should look or be — I like Cardi B and Doja Cat, and I’m still a board-certified oral surgeon.""Just because someone offers you equity doesn’t mean it’s valuable — you need to know how to assess it.""We need transparency on contracts so new grads can advocate for themselves and avoid being taken advantage of.""Private equity isn’t something to run from — you just have to make sure the deal works for you."Questions:(03:25) What residency program did you go to, and how long have you been out?(06:16) What are you doing now, and how does your current associate position work?(07:50) How did you find your first job after residency?(11:26) What does your typical three-day workweek look like?(14:04) How do you define work-life balance compared to 30–50 years ago?(16:00) Where do you see dentistry and oral surgery heading in the future?(17:29) What were the top three things you looked for in an associate contract?(24:53) How much marketing do you do, and what strategies have been most effective?(35:12) Do you prefer base salary, percentage of collections, or equity — and why?(40:08) How do you evaluate private equity opportunities and protect yourself in contracts?Now available on:- Dr. Gallagher’s Podcast & YouTube Channel- Dose of Dental Podcast #167My watch in this episode = Tag Heuer Aquaracer Calibre 16 Chrono- 8.2025#podcast #dentalpodcast #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentist #dentistry #oralsurgery #dental #dentalschool #dentalstudent #doctorlife #dentistlife #oralsurgeon #doctorgallagher

Top 5 Topics:

- Unfiltered OMFS Training

- Le Fort I + BSSO Explained

- Cephalometric Angles Demystified

- Biggest Surgical Screw-Ups

- Relapse & Complications

*** These are live recordings of my review sessions for the oral OMFS boards that I’ll be taking in January 2025 - I can get answers and concepts wrong! Please comment, DM me, or text me with any corrections, additions, or your own board prep tips on these topics so we can learn from my mistakes. ***

- Wanna sponsor these episodes? Let me know in my LinkedIn DM or Instagram DM.

Questions & Topics:

00:00 – Introduction to orthognathic surgery evaluation: history, facial exam, occlusion.

02:03 – Understanding A and B angles in malocclusion and how they guide diagnosis.

04:02 – Surgical procedure choices for Class II retrognathic mandible.

06:01 – Key post-operative management after BSSO to ensure stability.

08:07 – Critical cephalometric parameters for vertical maxillary excess.

10:12 – Le Fort I impaction techniques and intraoperative accuracy tips.

11:50 – Common complications in orthognathic surgery and their management.

14:07 – Pre-surgical orthodontic preparation: leveling, aligning, decompensation.

16:08 – Relapse prevention strategies after BSSO and Le Fort I.

18:35 – Airway considerations in mandibular advancement surgical planning.

Now available on:

- Dr. Gallagher’s Podcast & YouTube Channel

My watch in this episode = Tag Heuer Aquaracer Calibre 16 Chrono

- 8.2025

#podcast #dentalpodcast #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentist #dentistry #oralsurgery #dental #dentalschool #dentalstudent #doctorlife #dentistlife #oralsurgeon #doctorgallagher

📍It’s the 2nd half of 2025, I just graduated residency in Oral & Maxillofacial Surgery in June, now starting to work at All County Oral Surgery in Melville on Long Island, NY. I’ll be an associate surgeon here & working toward a personal goal of becoming a partner one day. Outside of dentistry, I have side projects & companies to bring my passions to life, including mentorship, education, and life strategy, and I obnoxiously share a lot of content on it all as I go hahahaha

👉 Keep an eye out for my weekly TikTok LIVE Q&A Session (usually Sunday evenings) and the monthly Q&A session on Instagram (end of every month). Let me know how I can help you

🌎 *** PreDent Mentor Map is now LIVE, at predentmentormap.org ! *** it’s a free resource for predental students to use for data on every dental school, and to connect with current dental students for personalized mentoring.

🙋🏼‍♂️ If you’re an organization or club at a school and you’d like to discuss a partnership, event or conference, DM me on Instagram or LinkedIn- that is the best way to contact me directly

❤️ MOST importantly: THANK YOU. Mentoring is what got me here, and it is how I’ll help you achieve your dream goals as best I can. You are a MASSIVE part of this journey to me, more than you know

🤠 Sincerely, Brendan @doctorgallagher

🔗 Links to my platforms: https://linktr.ee/doctorgallagher/

#podcast #dentalpodcast #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentist #dentistry #oralsurgery #dental #dentalschool #dentalstudent #doctorlife #dentistlife #oralsurgeon #doctorgallagher

🎙️ Clip from the July 2025, Monthly Insta Story Q&A sessions I do at the end of every month- stay tuned the last week of the month on my Instagram @doctorgallagher 🙌

🔗 Links to my platforms: https://linktr.ee/doctorgallagher/

#podcast #dentalpodcast #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentist #dentistry #oralsurgery #dental #dentalschool #dentalstudent #doctorlife #dentistlife #oralsurgeon #doctorgallagher

📍It’s the 2nd half of 2025, I just graduated residency in Oral & Maxillofacial Surgery in June, now starting to work at All County Oral Surgery in Melville on Long Island, NY. I’ll be an associate surgeon here & working toward a personal goal of becoming a partner one day. Outside of dentistry, I have side projects & companies to bring my passions to life, including mentorship, education, and life strategy, and I obnoxiously share a lot of content on it all as I go hahahaha

👉 Keep an eye out for my weekly TikTok LIVE Q&A Session (usually Sunday evenings) and the monthly Q&A session on Instagram (end of every month). Let me know how I can help you

🌎 *** PreDent Mentor Map is now LIVE, at predentmentormap.org ! *** it’s a free resource for predental students to use for data on every dental school, and to connect with current dental students for personalized mentoring.

🙋🏼‍♂️ If you’re an organization or club at a school and you’d like to discuss a partnership, event or conference, DM me on Instagram or LinkedIn- that is the best way to contact me directly

❤️ MOST importantly: THANK YOU. Mentoring is what got me here, and it is how I’ll help you achieve your dream goals as best I can. You are a MASSIVE part of this journey to me, more than you know

🤠 Sincerely, Brendan @doctorgallagher

🔗 Links to my platforms: https://linktr.ee/doctorgallagher/

#podcast #dentalpodcast #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentist #dentistry #oralsurgery #dental #dentalschool #dentalstudent #doctorlife #dentistlife #oralsurgeon #doctorgallagher

Top 5 Topics:

- Class III Orthognathic Surgery Case Breakdown

- Preoperative Orthodontic Considerations

- Intraoperative Bleeding Control

- Physical Examination Essentials for Boards

- Post-Op Complication Management

*** These are live recordings of my review sessions for the oral OMFS boards that I’ll be taking in January 2025 - I can get answers and concepts wrong! Please comment, DM me, or text me with any corrections, additions, or your own board prep tips on these topics so we can learn from my mistakes. ***

- Wanna sponsor these episodes? Let me know in my LinkedIn DM or Instagram DM.

Questions/Topics:

00:00 – Case presentation: 22M with Class III malocclusion, −8 mm overjet, SNA 82°, SNB 88°, and concave facial profile.

00:04 – Skeletal diagnosis and surgical plan: Maxillary advancement + BSSO setback, indications, and millimeter movements.

03:25 – Most critical preoperative step before orthognathic surgery & specific orthodontic prep for Class III correction.

06:02 – Intraoperative management of bleeding from pterygoid venous plexus vs. descending palatine artery.

11:37 – Essential preoperative medical workup: Labs, imaging, consultations, and anesthesia considerations.

15:28 – Physical examination checklist: Craniofacial symmetry, occlusal cant, airway, TMJ, and nerve baseline.

21:31 – Correcting a 3 mm mandibular midline deviation & maxillary cant during Le Fort I + BSSO.

24:52 – Post-operative nasal obstruction and mid-face swelling: Differentiating edema from hematoma.

27:10 – Airway management strategies in the immediate post-op period.

29:45 – Importance of rehearsing oral board-style answers for surgical cases.

Now available on:

- Dr. Gallagher’s Podcast & YouTube Channel

My watch in this episode = Citizen Promaster Diver Day Date

- 8.2025

#podcast #dentalpodcast #doctorgallagherpodcast #doctorgallagherspodcast #doctor #dentist #dentistry #oralsurgery #dental #dentalschool #dentalstudent #doctorlife #dentistlife #oralsurgeon #doctorgallagher