Everyday Oral Surgery

Today’s guest is the first surgeon I’ve had on the podcast who has a completely hospital-based practice. Many surgeons have concerns about having a practice of this type; if you are one of them, you might have your mind changed today! For Dr. Jackson Morgan, the ever-changing, incredibly rewarding nature of his role as a hospital-based surgeon is exactly what he wanted out of his career. It is not without its challenges, but then again, nothing is, and for Jackson, the positives far outweigh any negatives that may arise. Whether you're interested in pursuing this path or not, you’ll walk away from this conversation with a broadened perspective on the range of possibilities that exist for oral surgeons. Key Points From This Episode:What makes today's guest, Jackson Morgan, different from all the other guests we’ve had on the show.Jackson shares what his professional journey has consisted of. Why Jackson decided to be a purely hospital-based surgeon. Challenges of the route Jackson has chosen. What Jackson’s role consists of, and how he feels about his job. Jackson puts to rest a common fear that surgeons have about hospital-based practice.The variety of ways that Jackson is compensated for his work. Contributions that Jackson has made to the Atrium Health OMS program.  Benefits that Jackson receives through the hospital system. Advice from Jackson to anyone interested in having a hospital-based practice. Why Jackson likes being in academia. Tips from Jackson on how to maintain a balanced lifestyle when working in a hospital-based practice. A rapid fire round with Jackson.Links Mentioned in Today’s Episode:Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720 441 6059

There’s never going to be an anesthesia technique that is 100% foolproof, but the LMA/Sevo technique used by Dr. Paul Rollins and his partners, gets pretty close, according to Paul. Other than a small number of people who have small, or otherwise difficult, airways, the LMA/Sevo approach is safer for the patient, and a more pleasant experience for the surgeon. Amongst other advantages which Paul explains today, there’s less chance of aspiration, laryngospasms, and bronchospasms when using an LMA. Paul also addresses some of the concerns that surgeons have around using Sevo and LMA’s (which include a high cost of entry and the risk of malignant hypothermia) and offers some valuable advice to anyone who is interested in bringing this technique into their practice. We also discuss a book which has a profound impact on both of us, and how getting involved in your community will benefit you at work in ways that may surprise you.Reference ImageKey Points From This Episode:A brief rundown of Paul’s educational and professional career path up until today.The unique element of anesthetic technique that Paul and his partners utilize. Paul explains the benefits of the technique they use.Why Paul and his partners decided not to use narcotics. How working with an LMA differs from working with an open airway. Cases when Paul will do an open airway procedure.What the wake-up looks like after a Sevo/LMA surgery. Why the Sevo/LMA technique is safer than more traditional techniques.Where LMA sits on the emergency airway algorithm. Barriers to using the Sevo/LMA technique. How much Paul and his partners spend on LMAs per year.Advice for surgeons interested in starting to use this technique. Paul addresses concerns that people may have about malignant hypothermia when using this technique.Types of airways which are not suitable for an LMA. How marijuana use impacts the amount of sedative required to put them under. A case where Paul aborted the LMA technique. The book which allowed Paul and I to gain perspective on a lot of things. How socializing outside of work will benefit you at work. Links Mentioned in Today’s Episode:Dr. Paul Rollins —paul.rollins29@gmail.com Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720 441 6059

The oral surgery profession is heavily dominated by men, and therefore, being a woman in this field can be difficult. In today’s episode, we’re joined by Dr. Jaclyn Tomsic, an oral surgeon who didn’t let any of the hostility she experienced as a resident stop her from achieving her dreams. Today, Jaclyn works four days a week in private practice, and one day a week in the Case Western OMS program where she tries to give to residents what she wishes she had had when she was in their position. Jaclyn also has a large following on Instagram, and the goals she hopes to achieve through this platform are an increased visibility of the oral surgery profession and an increase in the number of women working in this field. For female listeners, this episode will inspire you to continue on the oral surgery path, even though it may be difficult at times. And for male listeners, this episode will open your eyes to the experiences of your female colleagues, and get you to rethink some misconceptions you may hold. Key Points From This Episode:How Jaclyn spends her working hours.Jacyln’s educational background. Why Jaclyn was drawn to the practice she now works in. Enjoyment that Jaclyn gets out of working with residents. The growth and evolution of Jacyln’s very popular Instagram account, and what she hopes to achieve through it.Factors that inspired Jaclyn’s decision to go the oral surgery route.Challenges that Jaclyn experienced as a female oral surgery resident. Drive and determination that got Jaclyn through the hostility she experienced in residency. Jaclyn’s hopes for the future of the oral surgery field. How Jaclyn’s experience as a resident in general medicine differed from her oral surgery residency experience.Obstacles that women face in the field of oral surgery. Misconceptions that people have of female oral surgeons. Advice from Jaclyn about how to deal with people who try to put you down.What Jaclyn wishes she had done differently as a resident.  The high attrition rate of students during my residency, and the reasons that oral surgery residents drop out. Why oral surgery residency is so tough.Value in having a balance between private practice and academia as an oral surgeon. A rapid-fire round with Jaclyn. Links Mentioned in Today’s Episode:Dr. Jaclyn Tomsic on Instagram — https://www.instagram.com/doctorjacci/?hl=enDr. Jaclyn Tomsic Email — Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720 441 6059

“No worldly success can compensate for failure in the home.” Alongside the fact that we are all oral surgeons, another commonality that I have with the two guests on today’s show is that we all went (or are currently going) through our oral surgery residency with at least one child. Dr John Tannyhill is the Director of Harvard’s School of Dentistry Oral Surgery Program and Dr. Michael Baron is an oral surgery resident at Mount Sinai, and they are here to share advice about maintaining a healthy work-life balance. There is no one-size-fits-all approach, and there will always be compromises that have to be made, so the key is to communicate openly with your significant other. We discuss important factors to take into account when deciding whether a residency program is “family friendly” or not, how some institutions accommodate for the unique income trajectory of oral surgeons, and why residents with families are likely to be more efficient than those without. For all of us, our “why” is our family, and we couldn’t do what we do without them, which is why we all recommend less (or no) moonlighting; there are so many other ways to get rid of your debt without sacrificing time at home! Key Points From This Episode:Michael and John share what their professional paths have looked like, and how these intersected with their family lives. Factors that contribute to making oral surgery programs “family friendly.”Compromises that you are likely to have to make in order to achieve a work-life balance.The importance of communicating with your significant other. A story about an interaction that Michael had with a landlord in Boston. Challenges of finding affordable housing as an oral surgery resident. The unique income trajectory of oral surgeons, and how banks accommodate for this.Ways that some programs prioritize oral surgeons who have families. How hospitals look after their residents in terms of health insurance.Health insurance options for students.John and Michael’s experiences of medical school compared to residency.A difficult time I went through during my residency and the support that my wife gave me during this time.Michael shares a story which highlights how difficult it can be to balance work and family life. Why residents with families are usually more efficient with their time than those without. The pros and cons of moonlighting, and why none of us would recommend it. Value in having conversations with previous residents. Changes that have occured in residency programs over the years. Support that Michael is receiving in his residency program. A rapid fire round with John and Michael.Links Mentioned in Today’s Episode:Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720 441 6059

The etiology, diagnosis, and treatment of temporomandibular joint (TMJ) and orofacial pain disorders are frequently challenging, and misdiagnosis and multiple failed treatments are common in this patient population. Today, we are joined by Dr. Louis Mercuri, an experienced oral maxillofacial surgeon, Clinical Consultant for TMJ Concepts, and Visiting Professor at Rush University Medical Center in Chicago, who has practiced in the state of Illinois for many years. Over his career, Dr. Mercuri has obtained research funding, published extensively, and been invited to lecture locally, nationally, and internationally on subjects related to the diagnosis and non-surgical and surgical management of temporomandibular joint disorders (TMD). In this episode, Dr. Mercuri shares some pearls for diagnosing and treating TMD patients, including the tricks and techniques he uses during examination to determine if the condition is intra-articular or extra-articular, how he communicates with unhappy TMD patients, and what resources he provides them with, plus so much more. This is a fascinating and informative conversation about TMD with a foremost expert on the subject, so make sure not to miss it!Key Points From This Episode:Learn about Dr. Mercuri’s dental and surgical training and his current practice setup.Advice for young surgeons who are interested in doing TMJ surgery: learn from others.Complications he has observed in TMD patients, many of which start with misdiagnosis.Diagnosis is key, as is knowing the difference between intra-articular and extra-articular conditions and what operation is required to treat it.Tricks Dr. Mercuri’s uses during examination to determine if TMD is intra- or extra-articular.Why some patients don’t respond to botox and others only feel relief for a few months.Why Dr. Mercuri says you should never operate for pain or promise 100 percent pain relief.The ‘bio-psycho-social’ etiology of TMD and the role that para-functional habits play.What Dr. Mercuri means when he says a well-informed patient is a partner in treatment.The benefits of what he calls a ‘hands in the pocket’ diagnosis.Indications for a total joint replacement, including dysfunction and degenerate changes.Learn more about the custom joint that Dr. Mercuri developed and its benefits.The importance of the social aspect of communicating with an unhappy TMD patient.The resources that Dr. Mercuri provides for TMD patients to take home with them.With the right patient, the right time, and the right equipment, you’ll get a good result!What Dr. Mercuri recommends for the oral surgeon who needs a good counterpart to help with non-surgical procedures.The important distinction that he makes between dentists, oral surgeons, and ‘pain doctors’.Useful medications that Dr. Mercuri prescribes diagnostically, like a low-dose of Elavil.Advice for younger surgeons looking to treat TMD patients: keep up with the literature!Links Mentioned in Today’s Episode:Dr. Louis Mercuri Email — TMJ Concepts — https://www.tmjconcepts.com/Rush University Medical Center — https://www.rush.edu/OMSNIC — https://www.omsnic.com/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720 441 6059

Suturing has a variety of purposes; it helps to quicken the healing process, minimize bleeding, and hold things in place. There are also a number of different categories that sutures fall into, for example, natural, synthetic, resorbable, and non-resorbable. In today’s episode, I’m joined by my brother, Dr. Jake Stucki, for a discussion around the basics of suturing, and some of the suturing techniques that are commonly used by oral surgeons. We go through a number of cases that we have personally dealt with, and explain what informed our decisions around the type of suture we used in each case, as well as some of the mistakes we have made along the way!  Key Points From This Episode:Jake shares a few of the reasons that oral surgeons suture. Problems with doing a loose suture.Conclusions from studies that looked at results when suturing was done versus when it wasn’t.How oral surgeons generally deal with mandibular compared to maxillary third molar sites. The different categories of suture.Why a surgeon would use a non-resorbable suture.When it is a good idea to use fast-gut.A mistake Grant made when suturing a child with severe autism. Squaring the knot; what this suturing technique entails, and how long it can last if done correctly. How to decide how many knots to place and tips for keeping them tight. Advice for dealing with a very large flap. The benefits of switching sides when suturing.Links Mentioned in Today’s Episode:Dr. Jake Stucki Email — jakestucki@gmail.comDr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720 441 6059

In today’s episode we are joined by Dr. Aaron Liddell, a repeat guest on the podcast; because he has so much valuable knowledge to share one episode wasn’t enough! The main focus of our conversation today is fractures. Over the past few years, and particularly since the start of the COVID-19 pandemic, Aaron has noticed an increase in the number of fracture cases that he is being called in to treat. He goes into detail about how the different approaches he utilizes to deal with a variety of fractures, using real world examples of patients he has worked with. Aaron offers advice to any surgeons who aren’t used to working in this particular realm of oral surgery which will help avoid unnecessary long term damage. So for all this and more from our great guest, join us on Every Day Oral Surgery!Key Points From This Episode:Trends that Aaron has noticed in Denver over the past few years.Ways that the COVID-19 pandemic had an impact on the volume of fractures Aaron was called to treat.The best way to avoid fracturing a jaw when taking out a third molar.How Aaron’s approach to taking out third molars has changed over time.An example of a patient who was inappropriately managed by another surgeon, and the damage control that Aaron had to do. Advice Aaron would give to surgeons around dealing with cases that are unusual to them.A strategy that Aaron uses in order to avoid using force when taking out a tooth.Factors which determine the order in which Aaron will deal with mandible fractures if the patient has multiple.How Aaron deals with any fractures situated at the mid-neck level or below. Aaron shares his thoughts about hybrid fixation systems.Approaches to dealing with different types of low condylar neck fractures. When Aaron uses rigid treatments and when he uses non-rigid treatments. Links Mentioned in Today’s Episode:Dr. Aaron Liddell — https://www.coloradooralsurgery.com/meet-us/dr-aaron-t-liddell-md-dmd-facs/ Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720 441 6059

Today, we are joined by Dr. Ian Lehrer, an oral maxillofacial surgeon practicing in Dana Point, California. In this episode, we discuss how to prepare to join a practice after you have completed your residency program. Dr. Lehrer has some valuable and practical tips to share, including the value of keeping in touch with your upper level residents and attending meetings at the American Association of Oral and Maxillofacial Surgeons (AAOMS) and the American College of Oral and Maxillofacial Surgeons (ACOMS). We also touch on contract negotiations and choosing between money, scope of practice, and location, as well as the benefits of joining group practice, proving your worth, and building relationships. Tune in today! Key Points From This Episode:An introduction to Dr. Ian Lehrer, his education, and his practice.How he figured out which practice to join after residency, starting with researching different cities and the practices in each area.The value of keeping in touch with your upper level residents after your residency.Another helpful tip: make sure to attend annual AAOMS and ACOMS meetings.Utilize all the resources that you have available to you, including courses and observerships.Advice for contract negotiations: consider your location and how much leverage you have.Different kinds of contracts you can expect, like an associateship in Dr. Lehrer’s case. Why Dr. Lehrer says defining your location is the most important thing when searching for a job; work where you want to live!Picking out one of three options: money, scope of practice, and location.The benefits of joining a group practice, including learning from the experience of others.Dr. Stucki highlights the importance of having a good work ethic and proving your worth.The value of building relationships; Dr. Lehrer encourages listeners to reach out to him.Rapid fire questions: Dr. Lehrer shares the best book he read this year and non-oral surgery skills that assist him in daily oral surgery.Ending on a note: “You can either go through life and be humble or you will be humbled.”Links Mentioned in Today’s Episode:Dr. Ian Lehrer on LinkedIn — https://www.linkedin.com/in/dr-ian-s-lehrer-865b56ab/Dr. Ian Lehrer on Instagram — https://www.instagram.com/drianlehrer/Dr. Ian Lehrer Email — lehrer@niguelcoastoralsurgery.comNiguel Coast Oral & Facial Surgery — https://www.niguelcoastoralsurgery.com/American Association of Oral and Maxillofacial Surgeons (AAOMS) — https://www.aaoms.org/American College of Oral and Maxillofacial Surgeons (ACOMS) — https://www.acoms.org/Osteo Science Foundation — https://www.osteoscience.org/Man’s Search for Meaning — https://www.amazon.com/Mans-Search-Meaning-Viktor-Frankl/dp/0807014273/Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720 441 6059

Dr. Elda Fisher, our guest on today’s show, works with a highly disenfranchised cohort. Although transgender people make up 0.6% of the US population, they struggle with a lack of access to the kind of healthcare that Elda specializes in; facial gender affirmation surgery. As Elda explains, maxillofacial surgeons are uniquely qualified to do this type of surgery, and she is hopeful that in the future, there will be a more well-developed connection between them and the patients who are seeking to feminize or masculinize their faces. In this episode, Elda explains the life changing capacity of gender affirmation surgery, and offers examples of some simple strategies that surgeons can use to ensure that there is congruency between their patient’s face and their intended gender. As director of the oral and maxillofacial surgery residency program at the University of North Carolina, Elda also shares what she loves about working in an academic setting, some of the biggest learnings she has had during her time as a teacher, and the qualities that she looks for in potential residents. Key Points From This Episode:Elda’s journey to specializing in gender affirmation surgery. The size of the transgender population in the United States. Challenges to providing gender affirmative care. Why maxillofacial surgeons are so well equipped to do gender affirmative surgeries.Gender affirmation surgeries that are covered by insurance, and those that are not.Why there are a limited number of studies which demonstrate positive effects of gender affirmative surgery. Elda shares some simple strategies that surgeons can use to feminize or masculinize a face.  The number of patients in UNC’s transgender health program.Why Elda has found it particularly rewarding working with transgender patients. How Elda navigates the psychosocial dynamics of gender affirmative surgery. The first step towards performing successful cosmetic surgery and gender affirmation surgery.Primary orthognathic surgeries that Elda does as part of her gender affirmative procedures. Learnings that Elda has had through her position as a teacher.Elda’s strategy for giving feedback to her residents. What Elda loves most about working in an academic setting. Qualities and experience that Elda looks for in potential residents. The life changing and lifesaving potential of gender affirmation surgery.Links Mentioned in Today’s Episode:Dr. Elda Fisher — https://dentistry.unc.edu/people/elda-fisher/ Dr. Elda Fisher Email — elda.fisher@unc.edu Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720 441 6059

Today we are joined by oral and maxillofacial surgeon Dr. Myron Tucker. Dr. Tucker had a private practice in North Carolina for 18 years before he stepped away from full time surgery in 2009. Our guest has had a prolific career on the research side of the business, publishing a number of textbooks and offering his experience to support to students of the science. In our conversation, we get to hear Dr. Tucker's perspectives on building a successful practice, the patience and planing this requires, the benefits of pairing with someone more experienced, and how an open attitude to continual learning is the best stance to adopt. We also talk about why disability insurance is always a good idea, and Dr. Tucker's personal experience of this during his retirement. Listening in, you will get a real sense of a true professional, someone who has stayed invested and engaged in the work he loves, so make sure to join us for this inspiring conversation!Key Points From This Episode:Dr. Tucker's history in the dentistry field and the different positions he has filled over the years. The passion that has kept Dr. Tucker involved after his supposed retirement. Advice about pursuing a career in orthognathic surgery.  The importance of patience when building a successful practice.Common mistakes made by new surgeons; tips from Dr. Tucker for those starting out. The end of Dr. Tucker's career and practice and the lessons he learned going into retirement. Why Dr. Tucker strongly recommends getting disability insurance! The best book that Dr. Tucker has read this year: Say Nothing. Dr. Tucker's passion for woodworking and how this aided his work as a surgeon. The tools Dr. Tucker preferred for tooth extraction!  The love that our guest has for sailboats and being on the water; some of the beautiful boats he has owned. A quote about mistakes that has always resonated with Dr. Tucker!Links Mentioned in Today’s Episode:Dr. Grant Stucki Email — grantstucki@gmail.comDr. Grant Stucki Phone — 720 441 6059Dr. Myron Tucker — https://www.linkedin.com/in/myron-tucker-19ab80127Osteo Science Foundation — https://www.osteoscience.org/Stryker — https://www.stryker.com/Say Nothing — https://www.amazon.com/Say-Nothing-Murder-Northern-Ireland/dp/0385521316The Jackal — https://www.rottentomatoes.com/m/jackal