Roethlisberger repairs maximize function, safety

Dr. Evans

Pittsburgh — The techniques used to repair facial fractures suffered by Pittsburgh Steelers quarterback Ben Roethlisberger have facilitated his speedy return to the gridiron for a variety of reasons, experts tell Cosmetic Surgery Times.

Nevertheless, sources express somewhat divided opinions regarding such fixes' long-term strength.

Dr. Genecov

On June 13, Mr. Roethlisberger's motorcycle hit a car that had been traveling toward him and attempting a left turn, according to news reports. The helmetless Super Bowl hero was thrown from the motorcycle into the car's windshield before landing on the pavement, according to the Pittsburgh Tribune-Review.

Dr. Papel

Later that day, Mr. Roethlisberger underwent seven hours of surgery to repair multiple facial fractures, said Daniel Pituch, M.D., one of his surgeons and chief of oral and maxillofacial surgery at Mercy Hospital of Pittsburgh, in a press briefing. Along with a broken jaw, other media accounts say, the quarterback suffered a broken nose and lacerations.

Cutting-edge care

Dr. Gilmore

Dr. Pituch said that, in order to fix Mr. Roethlisberger's jaw, his team used the open reduction and internal fixation techniques, which hold broken bones in place with carefully crafted titanium plates and screws rather than wiring the jaw shut.

Along with sparing Mr. Roethlisberger the nutritional consequences of a liquid diet, Dr. Pituch said, the technology typically allows a more predictable outcome that usually does not require additional major reconstructive procedures.

Before the advent of internal fixation, Gregory R. D. Evans, M.D., says, "The problem we had with all of these injuries was that, when fractured bones healed, it altered the dimensions of the face. Usually the face became a little bit longer, or potentially a little wider."

Dr. Evans is professor of surgery and biomedical engineering and chief of the Aesthetic and Plastic Surgery Institute at the University of California, Irvine.

In Mr. Roethlisberger's case, "Instead of just using the teeth to align the jaws, (surgeons) put the bones into anatomic alignment and held them there with plates and screws," says Gregory Borah, M.D., chief of plastic surgery, Robert Wood Johnson Medical School, New Brunswick, N.J. "In most cases, that's the state of the art for managing facial fractures."

Compared to the "latticework of wires" used around 15 years ago, he adds, "It's the difference between holding two pieces of wood together with a rope or using a piece of sheet metal that's nailed at either end."

The rigidity thereby achieved allows patients to perform force-generating activities such as mouth opening and closing, which help both nutritionally and in permitting aerobic exercises such as running, Dr. Borah adds.

In treating facial fractures, a patient's occupation — and risks related to it — often factor into treatment decisions, experts say.

"We want patients to be healthy, have a safe surgery and return to function as soon as possible," Dr. Borah tells Cosmetic Surgery Times.

But treating pro athletes often involves balancing their desire to return to action with the need to avoid compromising the rest of their careers, Dr. Borah explains.

Conversely, David Genecov, M.D., says, "I try not to let a patient's occupation change the surgical plan."