Jaw-in-a Day: Process Improvement and Outcomes.
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OBJECTIVE: Describe the evolving institutional experience with Jaw-in-a-Day reconstruction and evaluate the functional, oncologic, and surgical outcomes of an efficient and reproducible model that can be used for both benign and malignant cases. STUDY DESIGN: Retrospective case series. SETTING: Tertiary academic referral center and an affiliated private practice. METHODS: A retrospective review of Jaw-in-a-Day reconstructions performed between January 2023 and January 2024 was conducted. All patients undergoing fibula or scapula free flap reconstruction with immediate dental implantation and provisional prosthesis were included. Operative times and prosthetic workflows were compared by prosthesis capture method (in situ vs at the head) and team composition (single vs integrated two-surgeon teams). Outcomes measured were operative time, flap and implant survival, perioperative complications, Functional Oral Intake Scale (FOIS) scores, and prosthesis use. RESULTS: 33 patients (median age 66; range 13-83) underwent Jaw-in-a-Day reconstruction, 20 malignant disease cases, and 13 benign or traumatic cases. Fibula free flaps were used in 32 cases and scapula in one. Median operative time was 12h19m. Prosthesis capture in situ trended toward shorter operative and prosthetic times but did not reach significance. The two-surgeon approach significantly reduced operative time by 4h24m (P < .001) and prosthodontic time by 2 hours (P = .01). All flaps survived. Implant survival was 97%, with three failures in 2 patients. At 12 months, 32 patients used definitive prostheses and median FOIS was 7. CONCLUSION: The Jaw-in-a-Day surgical approach is feasible for benign and malignant reconstruction with high flap and implant survival. Early institutional adoption shows a learning curve, but efficiency improves with process refinements, particularly a two-surgeon workflow.