A Radical New Technique

If an American dentist were to say to his patient, "I'm going to break your jaw," he might confidently expect to lose the patient. Yet, last week 500 of the most eminent U.S. oral surgeons* sat on the edges of their chairs at Washington's Walter Reed Army Medical Center, as a respected Swiss practitioner described his radical, jaw-splitting procedures for correcting severe malformations. When Zurich's Dr. Hugo Obwegeser had finished a presentation that took most of three days, Cornell Uni versity's Dr. Stanley Behrman stated flatly: "American oral surgeons have never been so impressed, and I think that all over the country they will try his methods."

Inside Only. Dr. Obwegeser's research in "the geography of the mouth" and his resulting new methods are not for the average youngster suffering from a "bad bite." He will still need conventional orthodontics and have to wear braces. Jawbone surgery is mainly for people who have stopped growing.

Sometimes it is needed by the aged to permit the successful fitting of dentures; but more often it is needed by the many young adults who have the chinless "Andy Gump" profile commonly associated with a severe case of "buck teeth," a jaw that sags too far, or marked malformation or misplacement of either jaw.

Most U.S. oral surgeons have operated from outside the mouth, through the neck, usually cutting through the jaw bone to shorten or lengthen jaws. The procedure is likely to leave a scar and carries the risk of damaging a nerve, thus causing facial paralysis, and it does not permit the free repositioning of parts of the jaw. Only occasionally have U.S. surgeons operated entirely inside the mouth to move the jaw, something Dr. Obwegeser has made a standard practice. His techniques for moving and repositioning entire segments of bone, with teeth affixed, speedily correct severe defects U.S. surgeons have despaired of treating. Because his operations are performed entirely inside the mouth, his work has the added advantage of leaving no visible scars.

If the lower jaw is too short, Dr. Obwegeser cuts halfway through its rearward, ascending segment, the ramus, on the inner side. On the cheek side, he cuts halfway through the bottom part of the jawbone. Then he divides the bone lengthwise, leaving two pieces with half-thickness ends. He slides these pieces apart, lengthening the jawbone but leaving a space where the lower cut was made. Where nonalignment is too great to be corrected by an operation on the lower jaw alone, Dr. Obwegeser may move all or part of the upper jaw. With remarkable versatility, he can even move it upward or downward, sometimes removing small pieces of bone to achieve the desired repositioning (see diagram) and using the chips to space out the lower jaw. Bone from a receding chin may be removed and replaced at the front.

Disease & Distress. The Austrian-born surgeon has operated on more than 500 patients for a variety of developmental defects and for conditions resulting from injuries. Some of his "before" photographs showed such startling malformations that they distressed even the military surgeons, but the "after" pictures showed astonishingly attractive repairs.

"A man may have a first-class brain, and yet be unable to get a good job because he has an ugly protruding jaw," said the Army's Colonel Robert B. Shira, president of the American Society of Oral Surgeons. "If he has difficulty in chewing, he cannot eat many normal foods. He may develop disease in the mouth because his teeth don't meet properly. And he may get a complex because he doesn't look like other people. The psychological factors are enormously important. Now, with Obwegeser's techniques, we can completely alter the appearance of the face."

*In the U.S., an oral surgeon is a dentist who has taken at least three years of additional, specialized training in the treatment of the jaw and related structures.

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