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Man Takes Second Jaw Reconstruction Surgery Head On

Gary Hoffman and Lawrence J. Gottlieb, MD Plastic and reconstructive surgeon Lawrence J. Gottlieb, MD, right, performed a series of procedures to reconstruct Gary Hoffman's jaw and lower face after a previous surgery done at another hospital failed.

One day in 2003, after suffering from a persistent toothache, Gary Hoffman, 70, shattered his jaw while eating. Though living in Boston at the time, he immediately sought care at a Chicago-area academic medical institution and received a jarring diagnosis -- oral squamous cell carcinoma -- also known as cancer of the mouth. Hoffman underwent radiation and a jaw reconstruction, only to have the cancer return and the reconstruction fail.

While enduring the pain of cancer treatment and a failed jaw reconstruction, Hoffman packed up his life and relocated to Inverness, Ill., a Chicago suburb. Previously, he ran sales operations in a high-tech industry, but his sickness ended his career.

A patient who has had a failed major surgery comes in with a different perspective than a new patient.

That's when Hoffman found the care and expertise of the head and neck cancer multidisciplinary team at the University of Chicago Medicine. Here, his cancer was controlled, if not cured, with advanced treatment including chemotherapy and re-irradiation, and his jaw and lower face were reconstructed by plastic and reconstructive surgeon Lawrence J. Gottlieb, MD, professor of surgery and director of the UChicago Medicine Burn and Complex Wound Center.

Gottlieb, who has extensive experience with complex reconstructive surgery, knew to approach Hoffman's case with additional sensitivity demanded by the initial complications and surgical failure.

"It's always challenging when you're repairing something that was previously done and developed problems," Gottlieb says. "But the thing that really complicates matters is the psychological component. A patient who has had a failed major surgery comes in with a different perspective than a new patient. As a surgeon, I have to be able to explain realistic expectations; there's always a possibility it could fail again. The patient is under a higher level of stress, so you must be more vigilant."

Enduring Revision Surgery

The surgery was a success, but required several follow up procedures to tackle swelling and reshape the affected area of Hoffman's face.

Hoffman's first surgery at UChicago Medicine took place in December 2004, a joint effort by Gottlieb and head and neck cancer surgical colleagues. Hoffman ultimately required his previously reconstructed jaw be replaced with a microsurgical transfer of a bone from his leg, as well as the replacement of the radiation-damaged skin of his lower face and neck with new skin.

"I'm a relatively positive individual," Hoffman says, "but it was a never-ending process. I had to continue to say to myself, ‘How are we going to fix this?' and not give up. That's the issue. You have to stay at it."

The surgery was a success, but required several follow up procedures to tackle swelling and reshape the affected area of Hoffman's face. With the cancer finally defeated and his jaw back in place, Hoffman decided to take a nearly five-year break from surgery to get on with his life.

"You have to get in sync with the patient," Gottlieb says. "Returning to normal cannot always be done in one operation."

Returning to the Operating Room

Hoffman attributes the dedication and care of Gottlieb for helping him get so far past his illness.

When the time was right, late in 2008, he came back to Gottlieb to continue work toward regaining normal form and function of his jaw. The physician and patient worked through several more procedures and by 2011, Gottlieb made a pipe dream become reality: He got Hoffman's jaw to a place where it would accept osseous integrated dental restoration, or dental implants. Hoffman would be able to eat more than just soft food for the first time since his cancer diagnosis eight years prior.

Hoffman attributes the dedication and care of Gottlieb for helping him get so far past his illness.

"Dr. Gottlieb has been so much more than a physician," Hoffman says. "He's been an adviser. He's been available and volunteers to help me on many health issues. He's a good person to talk to and get suggestions from; he's just a very communicative guy."

Achieving Exceptional Care

Today Hoffman stays active with daily rounds of golf and managing his headhunting firm for technology sales recruiting. Instead of worrying about his health, he's preparing for the upcoming marriage of his daughter.

And while Gottlieb performed Hoffman's life-changing reconstructive procedures, the entire medical center staff made a deep impact on his patient experience and his overall healing. UChicago Medicine is different than other medical institutions he's been affiliated with, Hoffman says.

"The totality of the people and the quality is exceptional," he says. "We talk about doctors but having a well-run, organized hospital also makes all the difference."

September 2014