surgeon CRAFTS NEW JAW

With Bone Transplant

Unlike the song in which the leg bone is connected to the ankle bone, Verna Scoular’s leg bone is connected to her jawbone. In fact, part of her leg bone is her new lower jaw.

A painful and persistent bone infection was destroying Scoular’s lower jaw when Dr. Ryan Smart proposed crafting a new jaw from a portion of her fibula, a small leg bone. The Essentia Health oral and maxillofacial surgeon also transplanted a portion of skin and tissue from Scoular’s thigh to replace the floor of her mouth and chin.

Scoular had struggled for 10 months with rare complications and infections from dental implants. She met Smart after she came to the Emergency Department at Essentia Health – Fargo unable to swallow and nearly unable to breath due to infection and swelling. When treatments and antibiotics couldn’t clear the bone infection, Smart turned to reconstructive surgery to replace her jaw and preserve her ability to swallow, speak and breathe normally.

“When I first saw Dr. Smart, he said he could help and I said somebody has got to,” recalls Scoular, who is 63 and lives in Valley City, North Dakota. She had been taking over-the-counter and prescription pain medications to try to get relief. Infections would seem to respond to antibiotics and then return, even with help from an infectious disease specialist who worked around Scoular’s drug allergies.

When Smart proposed the complex surgery, Scoular wondered how she’d be able to walk if a portion of her leg bone was removed. Smart explained the fibula is not the weight-bearing bone in the lower leg and that it would heal.

“Dr. Smart said God gave us extra parts,” Scoular recalls. “I thought if he can make a straight bone into a jaw, he’s one heck of a person.” hile most patients stay in the hospital for seven to 10 days, Scoular stayed nearly a month due to complications from skin grafts that didn’t want to heal properly. While she and her husband, Dean, were discouraged, they stuck it out. “Dr. Smart explained that my body was not accepting what he was doing and all we could do is keep trying,” Scoular says. “He’s got such a terrific bedside manner and he explains things so clearly that you know he’s talking to you, not around you or above you.”

To reduce the amount of time in surgery, Smart teamed up with Dr. Alan Bruns, an Essentia Health ear, nose and throat specialist. While Bruns surgically removed the lower jaw, Smart removed a precisely measured portion of Scoular’s fibula and a flap of skin and tissue to transplant. He shaped the leg bone into a new jaw using a rigid titanium form custom-crafted from CT images of Scoular’s own jaw and skull. The skin flap became the floor of Scoular’s mouth and her chin. Tiny vessels feeding the bone and the tissue had to be connected to keep blood flowing to them.

“Verna is a strong lady and she persevered,” Smart says. “I never gave up on her and I asked her not to give up on me.”

“Dr. Smart came in on Mother’s Day morning to do a surgery on me,” Scoular says. “I told him, ‘We’ve got to quit meeting like this. You should be home with your wife and family.’”

“This is a complex procedure and we do anything we need to,” Smart says. “It’s a lot to put people through. We stick with them and don’t get discouraged, and we coach them to not get discouraged, too.”

Smart explains the surgery can help people with oral cancers, trauma, gunshot wounds and facial abnormalities. “This surgery restores aesthetics and function,” he explains. “The goal is to make people feel whole again. We want them to have a fully functioning jaw and to live a normal daily life.”

Scoular and Smart say she has fully recovered. “Dr. Smart saved my life,” Scoular says, “Without his help, I would not be standing here today.

To Make An Appointment

with Dr. Ryan Smart, call 701-364-8900. You’ll find the Oral and Maxillofacial Surgery Department in the Essentia Health – 32nd Avenue Clinic at 3000 32nd Ave. S. in Fargo.

ere in the Midwest,

the season of fall is almost considered a holiday. It just happens to be the favorite time of year for many, and it’s not hard to understand why. The weather is cool and light, the leaves and colors are ever changing, and hot beverages and stews are back on the menu boards. While fall is a favorite time of year for many of us, it also tends to be a very busy time. Consider it a time of transition as school is back in session, football season is about to officially kick off, and if you live in a farming or gardening community, it’s a time of harvest.