Most of us see an oral and maxillofacial surgeon at some point — to remove a tooth or surgically implant a tooth replacement. But a few years ago, an ABC documentary called “Boston Med,” filmed at Massachusetts General Hospital, dramatically spotlighted another major role. Cameras captured Maria Troulis, DDS, MSc, FACS, now chief of the Mass General Department of Oral and Maxillofacial Surgery, removing a bullet from the face of a police officer and repairing his shattered jaw.
The department is Mass General’s smallest, but one of the largest of its kind in the country. Through treatment and research, it aims to save and improve the lives of those with injuries, diseases and cancers above the head and neck, especially those involving the mouth, teeth and jaws.
One of Dr. Troulis’ predecessors as chief, Walter Guralnick, DMD, is celebrating his 100th birthday. On the occasion of this milestone, Dr. Troulis, who became chief in 2015, talks about past advances and offers a look at what’s to come.
Improvements we’ve made include using smaller incisions, for example we can now reconstruct parts of the jaw using a 1.5 centimeter incision instead of 3 to 5 centimeter one.
What problems do patients come to you with?
Our department has a rich history in oral, head and neck health, specifically maxillofacial surgery. This includes repair of both the upper and lower jaws due to tumors and trauma, and surgical reconstruction of the face and jaw. We also treat congenital and temporomandibular joint (TMJ) disorders.
You’ve made pioneering contributions to minimally invasive surgery. What makes it better for patients?
A smaller incision is one type of minimally invasive surgery. Because the incisions are small, patients tend to have quicker recovery times and less discomfort than with conventional surgery — with the same benefits. Improvements we’ve made include using smaller incisions, for example we can now reconstruct parts of the jaw using a 1.5 centimeter incision instead of 3 to 5 centimeter one.
Minimally invasive may also mean doing surgery without an incision, using a natural opening and a narrow scope to remove salivary gland stones.
What are some examples of research going on in your department?
The most exciting research is on the minimally invasive treatment of jaw tumors. Dr. Leonard Kaban, my predecessor and mentor, has committed his career to helping children. One example is trying to prevent debilitating surgical resections to treat benign jaw tumors by instead using additional medical treatments. He has also described the reconstruction and construction of craniofacial deformities.
We have worked hard to reconstruct faces without using bone harvested from elsewhere in body. We’ve been able to generate new bone by gradually stretching existing bone using an instrument called a “distractor.” This is a form of what’s called in vivo tissue engineering.
Are there any measures we should be taking to maintain our oral and jaw health?
A new area of prevention is related to the opioid crisis. Many of our patients have extremely painful facial syndromes. We are looking at alternative therapies to opioids for pain control, such as laser therapy.
We are also looking for blood markers to allow for early detection of recurrent jaw tumors.
Why do you want to launch a Division of Education-Simulation?
This a fun time, with numerous naming opportunities, endowments and others ways to help fund the next generation of physician-scientists and the care they deliver.
We want to use simulation-based training to better teach the material and skills that oral and maxillofacial surgeons need and then assess how well the material has been learned. Using simulators we plan to develop, surgeons will be able to practice a whole procedure before operating on a patient.
What are other pressing department goals that philanthropy could help you reach?
We are seeking endowments to fund labs and research. We need to better understand bone biology and why some tumors only occur in the jaw. We’d also like to better understand osteonecrosis of the jaw, a deterioration of the jaw bone. This sometimes happens to those who’ve undergone lifesaving cancer therapy.
It is my responsibility to continue the great tradition of my predecessors and mentors Drs. Walter Guralnick, Bruce Donoff and Leonard Kaban as we train the next generation of surgeon-scientists. This a fun time, with numerous naming opportunities, endowments and others ways to help fund the next generation and the care they deliver.
To learn more about supporting the Department of Oral and Maxillofacial Surgery’s initiatives, please contact us.