Down Fracture- A Podcast for Talkin' Jaws

Drs. Wasson and Bobek
  • 5.0 (7)
  • Education
  • Updated Semiweekly

Standing firmly somewhere between the worst and best jaw surgery podcasts of all time, we bring you Down Fracture, A Podcast for Talkin' Jaws. Down Fracture is intended for Oral & Maxillofacial Surgeons and other healthcare professionals interested in learning about jaw surgery. Topics will include Orthognathic surgery, TMJ surgery, Obstructive Sleep Apnea Surgery, and more. This podcast is hosted by Drs. Bobek and Wasson whose practices are limited to Orthognathic, TMJ, and OSA Surgery.

  1. Aug 25

    Grace and Positive Self Talk in Jaw Surgery

    In this episode, Dr. Bobek and Dr. Wasson talk about how surgeons evaluate themselves when an outcome is not what they planned. They cover where critical appraisal stops being useful and starts being punishment, why both of them are harder on themselves than on other surgeons, and how surgical training builds the habit in the first place. Topics covered in this episode: - Whether you are harder on yourself or on the surgeons whose revisions you inherit - The duality of doing the work well and accepting that it could be better - Why complications are difficult to discuss openly, with colleagues and with patients - Evaluating a case where the occlusion, airway, and midlines are all correct but numbness persists on one side - Dr. Wasson's rule: do not beat yourself up unless you can name something to do differently next time - MMA at roughly 86 percent surgical success, and what the other 14 percent means for the surgeon - The distinction between a failed outcome and a failed surgeon - A case that checks every box, full sensory recovery and good occlusion and aesthetics, with an AHI of 7 down from 40 - How the healthcare system defaults to assigning blame to an individual - Going from panoramic films and cephalograms to cone beam imaging, and how more visibility invites more self-criticism - How rarely attendings comment on a good outcome, and what that trains into residents - Doing the wrong thing and getting the right answer, and the reverse - Where the real complications get discussed, and the role shame plays in keeping them quiet - The opposite failure mode: rose-colored glasses, and the surgeon who has never had a non-union - Wisdom from retired surgeons, including why SARPE asymmetry may not be worth agonizing over

  2. Aug 18

    Rewriting the TMJ Treatment Algorithm With Dr. Gary Bouloux | Down Fracture Podcast

    In this episode, Dr. Bobek and Dr. Wasson are joined by Dr. Gary Bouloux, chair of oral and maxillofacial surgery at Emory University. Dr. Bouloux chaired the AAOMS special committee that produced the 2024 TMJ management guidelines, and he represented the specialty at the FDA and National Academies meetings on temporomandibular disorders that preceded them. He performs roughly 300 arthroscopies a year and is currently on the committee revising those guidelines. The discussion covers where the treatment algorithm has moved, why the guidelines skew toward total joint replacement after failed minimally invasive surgery, and the manufacturing bottleneck that has left Australia and New Zealand without a viable custom device. Topics covered in this episode: - The FDA meeting with patient advocacy groups and why it was a difficult starting point - How the National Academies report and its recommendations led to the AAOMS guidelines - What is being updated in the current revision, and what has not changed - Biologics: why steroids underperform, and the case for hyaluronic acid combined with injectable PRF - The practical side of making IPRF in an office, and the reimbursement problem - Why the guidelines move from arthrocentesis or arthroscopy toward total joint rather than open arthroplasty - New data suggesting a single prior arthroplasty is the covariable most associated with worse total joint outcomes - Arthroscopy at roughly 70 percent success, and what to do with the 30 percent who fail - The pediatric exception, and how weak the disc plication literature actually is - Where the term IPD came from and why disc position moved out of the center of the diagnosis - Unilateral versus bilateral surgery, and whether the contralateral joint should be replaced at the same time - Coronoidectomy, fat grafts, and heterotopic bone in joint replacement - Two manufacturers, a 23-week turnaround, and what happened to the Australian market - Whether KLS Martin and 3D printed devices can bring real competition - How many joints a year it takes to stay competent, and what the orthopedic literature says 📬 Questions or topic suggestions: downfracturedpodcast@gmail.com The Down Fracture Podcast is for informational and entertainment purposes only and does not constitute medical advice. All opinions expressed are solely those of the hosts and their guests. #DownFracturePodcast #TalkingJaws #JawSurgery #OMFS #OralSurgery #TMJ #TMJSurgery #TMJReplacement #Arthroscopy #Arthrocentesis #TMD #OrofacialPain #MaxillofacialSurgery #PRF #TotalJointReplacement

  3. Aug 11

    Infection in Orthognathic Surgery: Rates, Antibiotics, and When to Worry

    In this episode, Dr. Bobek and Dr. Wasson discuss infection in orthognathic surgery, including how to define it, how often it actually occurs, and how they each approach antibiotic use around the time of surgery. Topics covered in this episode: - How to define surgical site infection in orthognathic surgery and why the criteria matter for tracking outcomes - Reported infection rates in the literature and what clean contaminated surgery benchmarks look like - The debate around post-operative antibiotic prescribing: who uses them, who does not, and why- How the mandible differs from the maxilla in terms of surgical site infection frequency - When drainage after surgery signals infection vs normal healing - Hardware as a driver of persistent infection and the role of plate and screw fixation vs positional screws - When to remove hardware and how timing affects recovery- True osteomyelitis after jaw surgery: how rare it actually is, how to diagnose it, and how it differs from non-union - Why non-union is more likely than osteomyelitis in the setting of a persistent post-op problem - Antibiotic selection, dosing schedules, and compliance considerations - How patient expectations and clinical reality both shape antibiotic prescribing decisions in practice 📬 Questions or topic suggestions: downfracturedpodcast@gmail.com The Down Fracture Podcast is for informational and entertainment purposes only and does not constitute medical advice. All opinions expressed are solely those of the hosts and their guests.

  4. Jul 29

    Treatment Planning in Large Maxillary Expansions | Techniques, Limits, and Stability in Jaw Surgery

    In this episode, Dr. Bobek and Dr. Wasson discuss large maxillary transverse corrections in orthognathic surgery, covering how their comfort with expansion magnitude has evolved over time and what strategies they use when the plan pushes the limits of what a segmental Le Fort can reliably achieve. Topics covered in this episode: - How comfort with large maxillary expansion develops over a surgical career - The difference between bony expansion on a 3D plan vs intermolar expansion and why that distinction matters - Flat palatal vault as a key risk factor for large transverse corrections - Step by step approach to a large segmental Le Fort expansion including mobilization, palatine release, and progressive stretching - Having multiple backup splints ready and how to use them intraoperatively - Mandibular midline osteotomy as a backup plan and when it actually makes sense - Bone grafting the segmental gaps: what materials to use and why grafting is hard to argue against - Palatal splints: design considerations, relief adjustments, and how long to leave them in - SARPE vs segmental Le Fort: what the existing stability data actually shows and why the common teaching may be backwards - DOME, MARPE, and MSC expansion: what we still do not know about long-term stability - When SARPE is clearly the right answer and when segmental Le Fort is the more direct path 📬 Questions or topic suggestions: downfracturedpodcast@gmail.com The Down Fracture Podcast is for informational and entertainment purposes only and does not constitute medical advice. All opinions expressed are solely those of the hosts and their guests.

  5. Jul 21

    Simplicity in Treatment Planning for Jaw Surgery | When Does Adding Complexity Actually Help?

    In this episode, Dr. Bobek and Dr. Wasson discuss the tension between simple and complex surgical treatment planning in orthognathic surgery, including how their thinking has evolved with experience and what the right balance looks like in practice. Topics covered in this episode: - How virtual surgical planning has opened up new possibilities for complexity, and whether that is always a good thing - Single-piece vs segmental maxilla: when segmenting adds real value and when it adds risk without proportional benefit - Single jaw vs double jaw surgery: how to weigh small gains against added complications, particularly nerve risk in younger patients - How training environment shapes a surgeon's default approach to planning, and how that evolves over a career - The role of the orthodontist in shaping surgical complexity and how communication between surgeon and orthodontist influences the final plan - Involving patients in treatment planning and how patient priorities should influence surgical decision-making - Why some of the highest-volume experienced surgeons tend toward simpler plans and what that signals - Complexity relative to experience: what feels advanced in one practice is routine in another - The online patient community and how internet-driven expectations around speed, custom hardware, and outcomes affect real clinical conversations - Mandibular midline osteotomy, genioplasty, and other procedures that vary widely in how routinely they are incorporated 📬 Questions or topic suggestions: downfracturedpodcast@gmail.com The Down Fracture Podcast is for informational and entertainment purposes only and does not constitute medical advice. All opinions expressed are solely those of the hosts and their guests.

  6. Jul 14

    Red Flags, Fads, and How To Know What to Actually Trust in Jaw Surgery

    In this episode, Dr. Bobek and Dr. Wasson revisit the topic of gimmicks and misleading claims in oral and maxillofacial surgery, this time through the lens of how to identify snake oil in practice, whether you are a patient trying to navigate options or a clinician trying to stay grounded. Topics covered in this episode: * What snake oil actually means in a modern surgical context and how it differs from well-intentioned but unsupported practice * The difference between inadvertent misinformation and deliberate misrepresentation * How marketing and internet presence can create the appearance of expertise that may not reflect clinical reality * Red flags practitioners can use to identify questionable techniques or products: lack of transparency, absence from specialty conferences, claims of universal success, and vague reproducibility * Stem cell injections, expansion devices, mewing, and other interventions discussed through a skepticism lens* How AI is changing the way patients find subspecialists and evaluate treatment options * Arthrocentesis as a first-line TMJ treatment: where it fits and where it does not * The role of networking with colleagues in maintaining healthy clinical skepticism 📬 Questions or topic suggestions: downfracturedpodcast@gmail.com The Down Fracture Podcast is for informational and entertainment purposes only and does not constitute medical advice. All opinions expressed are solely those of the hosts and their guests.

  7. Jul 7

    What Patients And Practitioners Should Know About Jaw Surgery At The Hospital

    In this episode, Dr. Bobek and Dr. Wasson discuss what patients and practitioners should actually know about having surgery at the hospital, including some things that might be counterintuitive. Topics covered in this episode: - How hospital culture around jaw surgery varies dramatically between institutions and even between different areas of the same building - The history of orthognathic surgery at the hospital, from ICU admissions and blood transfusions to the current outpatient era - Why access to more resources does not automatically mean better care for routine jaw surgery cases - Staff turnover, familiarity gaps, and what happens when the team has never seen a jaw surgery patient before - Fragmented post-operative care: medication timing, oral intake, mouth care, and why the patient experience often suffers - How anxiety in unfamiliar staff transmits directly to patients and families - Hospital policies, committee structures, and why it can be nearly impossible to change things even when something clearly does not make sense - Equipment and implant contracts: why you may not get the plating system you trained with - Hidden cost drivers: OR time overruns, implant costs buried in facility bills, and what patients never see on their EOB - When the hospital genuinely is the right place to be, and what clinical scenarios warrant higher acuity care - What patients can do to advocate for themselves and why getting out sooner is usually better 📬 Questions or topic suggestions: downfracturedpodcast@gmail.com The Down Fracture Podcast is for informational and entertainment purposes only and does not constitute medical advice. All opinions expressed are solely those of the hosts and their guests.

  8. Jun 23

    AAAHC Accreditation for Oral Surgery Offices With Angie Murphy

    In this episode, Dr. Bobek and Dr. Wasson are joined by Angie Barker Murphy of Murphy Healthcare Consultants, who has worked in oral surgery compliance and accreditation since 1999. Angie helped one of the earliest oral surgery practices pursue AAAHC certification for in-office jaw surgery and has since built a consulting practice helping oral surgery offices through the accreditation process. Topics covered in this episode: - What AAAHC accreditation is and how it differs from standard dental or oral surgery licensing requirements - Office-based surgery accreditation vs. the ASC route and when each makes sense - Whether accreditation can be used to negotiate facility fees with insurance companies - What the accreditation process actually involves: timelines, site visits, case observation, and documentation - Staff onboarding, training documentation, and clinical competencies under AAAHC standards - Common things practices are already doing but not documenting, and common blind spots such as CLIA waivers and medication handling - The role of a consultant vs. attempting the process independently - Approximate costs: AAAHC fees, consultant fees, and what to budget - Ongoing maintenance and reaccreditation every 3 years - Quality improvement studies and how to make them meaningful for oral surgery practices - How Dr. Bobek's practice experienced the process and what changed afterward Murphy Healthcare Consultants can be reached through their website once live, or via the email below. 📬 Questions or topic suggestions: downfracturedpodcast@gmail.com The Down Fracture Podcast is for informational and entertainment purposes only and does not constitute medical advice. All opinions expressed are solely those of the hosts and their guests.

See All (87)

Ratings & Reviews

5
out of 5
7 Ratings

About

Standing firmly somewhere between the worst and best jaw surgery podcasts of all time, we bring you Down Fracture, A Podcast for Talkin' Jaws. Down Fracture is intended for Oral & Maxillofacial Surgeons and other healthcare professionals interested in learning about jaw surgery. Topics will include Orthognathic surgery, TMJ surgery, Obstructive Sleep Apnea Surgery, and more. This podcast is hosted by Drs. Bobek and Wasson whose practices are limited to Orthognathic, TMJ, and OSA Surgery.

Information

You Might Also Like