Oral Surgery Provides New Slice of Life

Orthognathic surgery returns patient’s bite

For much of her life, Jane Schillie had one simple wish — to bite into a slice of pizza. But the Kansas State University faculty member and library curator was prevented from doing this for one reason: Her jaws did not align properly. Only her back teeth came together; her front teeth did not touch. The plain-English term for this condition is an open bite. The scientific name is apertognathia or anterior open bite. Jane says the condition first came to the fore when she got braces at age 13. “They didn’t know a lot about it then. My ortho-dontist at the time tried to use a headgear to pull my teeth together. But because of the open bite I had a lot of difficulty eating, chewing and swallowing. I couldn’t bite into anything properly. My whole goal was to be able to bite into a piece of pizza,” she says with a laugh.

Surgery success

She finally got her wish last year, after Kevin Rieck, DDS, MD, FACS, of Nebraska Oral and Facial Surgery performed a successful — and complicated — operation, called orthognathic surgery, at Bryan Medical Center.

Dr. Rieck came to Lincoln in 2013 after a 13-year career teaching and practicing at the Mayo Clinic in Rochester, Minnesota. David Rallis, DDS, MD, convinced Dr. Rieck to join his practice in Lincoln. In fact, the two had met at Mayo, where Dr. Rieck was one of Dr. Rallis’ mentors.

“I’ve always had great respect for Dr. Rieck,” Dr. Rallis says. “I knew his surgical skills and knowledge would be an asset not only to our practice but to the Lincoln health care community.”

Dr. Rieck was an early adopter of a technology called Virtual Surgical Planning, which he has been using for about five years. He has lectured on VSP for orthognathic surgery nationally and internationally on many occasions, and was invited to speak on this very topic this fall at the International Congress of Oral and Maxillofacial Surgery in Melbourne, Australia.

“We do a CT exam of the face and jaws, and develop a surgical plan using specialized 3-D computerized protocols,” he explains. “Utilizing this technology, we can plan out the entire surgery virtually and then have patient-specific splints fabricated to be used in the surgery to help reposition the jaws to the desired position.”

Jane required 19 months of orthodontic work beforehand, to ensure that her teeth were aligned where they should be over the stable bony base. Finally, she underwent surgery in 2014.

Several bone cuts

“Jane’s upper jaw required bone cuts to divide it into halves so that the width deficiency could be corrected,” Dr. Rieck says. “These segments of the upper jaw were wired into the prefabricated surgical splint. Then the upper jaw was repositioned and secured once again with multiple titanium bone plates and screws. The surgical splint wired to her teeth was left in place for six weeks for added stability. Historically, patients’ jaws had to be wired together for six to eight weeks after this procedure. Modern fixation techniques allow us to avoid this, and patients can open and close their jaws immediately after the procedure.”

This was not Jane’s first experience with the procedure, but she believes this surgery has been more successful. She had the surgery at Mayo while in her 20s, but experienced some gradual relapse due to changes in her lower jaw and teeth.

Jane says, “Over the years I started having so much difficulty again — eating, chewing food, talking— that I felt like I was going to choke when I ate. So, there was a lot of discomfort and anxiety about eating.

When Jane, now in her 50s, realized she would need to have a second surgery, she went back to Mayo, and that is where she met Dr. Rieck. She and her parents — her father is a retired physician — were impressed with him, not only with his knowledge, but with his demeanor.

Follows surgeon to Lincoln

“We walked out of the appointment and said ‘That is the most professional doctor we have ever met.’ He was that impressive. I could not have done better than Dr. Rieck,” Jane says.

She wasn’t thrilled about going through the surgery again, but she wanted the situation corrected.

“When I learned Dr. Rieck had come to Lincoln, there was no question that I would follow him there,” she says.

In fact, patients from around the country continue to seek him out for specialized care. Oral and maxillofacial surgeons are experts in mouth, face and jaw surgery.

In addition to cases like Jane’s, Dr. Rieck and his colleagues evaluate, diagnose and treat a variety of conditions. These range from removing wisdom teeth to placing dental implants for single missing teeth or for complex rehabilitation. Frequently they must augment the jaws to improve the bony foundation for implant placement.

Other special procedures include pathology in the face and jaws, ranging from oral or skin lesions to large cysts or tumors. They also deal with surgical aspects associated with the TMJ, facial trauma and facial cosmetic surgical procedures. Dr. Rieck’s interests include complex implant reconstruction of the jaws, orthognathic surgery and facial cosmetic surgery.

Jane liked that Dr. Rieck spent a lot of time with her, answering all of her questions. She also appreciated the working relationship he had with her orthodontist in Kansas, Curtis Hayden, DDS. The two doctors worked in tandem to create a plan for Jane’s pre- and post-surgery care. She notes that upon seeing the results, Dr. Hayden stared at her for a very long time and remarked that he’d seen a lot of people who had this surgery and he’d never seen results like hers.

Jane also was very happy with her experience at Bryan Medical Center and the staff here.

“Bryan was a wonderful experience,” she says. “The postoperative instructions were very thorough, and all of the hospital staff were lovely. I stayed in the Women’s and Children’s Tower, and it was gorgeous.” She also appreciates how the staff kept her family informed every step of the way during the approximately five-hour operation.

Dramatic changes

Today, her life has changed dramatically.

“For one thing, I can bite through a piece of pizza,” she says with a grin. “I actually texted Dr. Rieck a photo of the first slice of pizza I had after the surgery and said, ‘Check out this bite!’

“But seriously, Dr. Rieck is my hero. He’s modest, but without a doubt, he changed my life. I have confidence. I can eat without fear.”

Wish fulfilled.