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John M. Le

@dr.john.m.le

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Board certified OMS
Head and Neck Oncologic and Microvascular Reconstructive Surgery
UAB Faculty
@uab_omfs
@uabomfsresidency
@uabschoolofdentistry
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Taking advantage of the complimentary headshots at the annual AAOMS meeting in Seattle, WA. #AAOMS2026 #UABOMFS taken in Seattle, Washington by @dr.john.m.le
8
16 days ago
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Osteochondroma of the Mandibular Condyle: Resection & TMJ Reconstruction This case demonstrates the significant facial and occlusal changes that can result from an osteochondroma of the mandibular condyle. The patient presented with a large right condylar osteochondroma causing progressive mandibular asymmetry and a significant malocclusion with negative anterior overjet. Treatment included resection of the condylar tumor, reconstruction with a custom TMJ Concepts total joint prosthesis, and a contralateral sagittal split osteotomy to improve mandibular position and occlusion. Due to the vascularity surrounding the tumor, the internal maxillary artery was embolized preoperatively to reduce the risk of intraoperative hemorrhage. During postoperative follow-up, the prosthetic joint was found to be dislocated and was successfully reduced manually under intravenous sedation. The postoperative imaging demonstrates appropriate reduction of the joint as well as significant improvement in the patient’s anterior occlusion. The primary goals of surgery were to remove the tumor, reconstruct a functional TMJ, and improve the mandibular and occlusal relationship. Additional orthodontic treatment may be helpful for further refinement of the dentition, while residual symphyseal asymmetry could be addressed electively in the future if desired. This case highlights the multidisciplinary considerations involved in managing complex TMJ pathology, combining tumor resection, vascular planning, total joint reconstruction, and orthognathic surgery to restore form and function. #uabomfs taken in Birmingham, Alabama by @dr.john.m.le
0
a month ago
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When Cancer Biology Outpaces Our Best Efforts This PET/CT image tells a difficult story about the aggressive biology of advanced oral cavity squamous cell carcinoma. This patient initially presented with advanced oral cavity cancer and underwent ablative surgery followed by fibula free flap reconstruction. Unfortunately, their postoperative course was complicated by wound-healing difficulties and an early in-field recurrence. Their disease subsequently progressed to the point of causing a life-threatening internal carotid artery hemorrhage, requiring emergent endovascular stenting to control the bleeding and save their life. Despite additional systemic therapy with chemotherapy and immunotherapy, as well as radiation therapy, the cancer continued to progress. This PET/CT demonstrates the extraordinary extent of the metastatic disease, involving multiple distant sites including the lungs and numerous osseous structures—the thoracic spine, humerus, sternum, scapula, ribs, pelvis, and femur. Cases like this are some of the hardest parts of caring for patients with head and neck cancer. As oncologic and reconstructive surgeons, we can perform extensive resections, reconstruct complex defects, restore form and function, and work alongside our colleagues in radiation and medical oncology to deliver increasingly sophisticated multidisciplinary treatment. Yet sometimes, despite everything we do, the underlying biology of the cancer remains more aggressive than our ability to control it. Images like this are a humbling reminder that a technically successful operation is only one part of the battle against cancer. They also reinforce why continued research into tumor biology, early detection, targeted therapies, immunotherapy, and novel treatment strategies is so important. It is heartbreaking when our best efforts are not enough. But I remain optimistic about the progress being made in cancer research and hopeful that continued advances will allow us to better understand, control, and one day overcome diseases like this. Until then, we keep operating, researching, collaborating, and doing everything we can for the patients who entrust us with their care. #uabom taken in Birmingham, Alabama by @dr.john.m.le
2
a month ago
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Function is one of the most important goals of reconstruction. This modified barium swallow study is from a patient who underwent segmental mandibulectomy for mandibular cancer followed by reconstruction with an osteocutaneous fibula free flap. During a modified barium swallow study, contrast material allows us to evaluate the different phases of swallowing under fluoroscopy and, importantly, determine whether material enters the airway. In this clip, the patient is able to swallow a liquid bolus without evidence of aspiration. For patients undergoing major oral cavity cancer surgery, successful reconstruction is about much more than restoring the continuity and appearance of the mandible. Our goal is to reconstruct the defect in a way that facilitates recovery of essential functions—including speech, mastication, oral competence, and safe swallowing. Speech-language pathologists (SLPs) play an integral role in this recovery, evaluating and treating speech and swallowing dysfunction throughout the patient’s postoperative course. Their expertise is an essential component of the multidisciplinary care of patients undergoing treatment and reconstruction for head and neck cancer. #uabomfs #uabheadandneckoncology #uabSLP taken in Birmingham, Alabama by @dr.john.m.le
2
a month ago
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One Lesion. Two Biopsies. Two Different Diagnoses. Not all oral lesions are created equal—and not every biopsy tells the whole story. This patient presented with a longstanding left lateral tongue leukoplakia that had previously been biopsied elsewhere. The original pathology demonstrated squamous cellular atypia with candidiasis, and he was treated with antifungal therapy. Unfortunately, the lesion persisted. At evaluation, the lesion demonstrated obvious clinical heterogeneity—areas varied in thickness, texture, and appearance. Rather than relying on the previous biopsy, we performed additional biopsies from separate regions of the lesion. The results were revealing: ➡️ Superior border (previous biopsy): Squamous cellular atypia with candidiasis ➡️ Anterior border: Persistent squamous cellular atypia ➡️ Inferior border: High-grade epithelial dysplasia The most dysplastic portion of the lesion was not where the original biopsy had been performed. Clinical Pearl A biopsy only represents the tissue that is sampled. When evaluating heterogeneous leukoplakia, erythroleukoplakia, or other oral potentially malignant disorders, one biopsy may underestimate the true pathology. The areas that appear: • thicker • verrucous • nodular • ulcerated • erythematous (red) • indurated should be sampled separately, as they often harbor the highest grade of dysplasia—or even invasive squamous cell carcinoma. This case reinforces an important principle in oral oncology: Treat the lesion, not just the pathology report. Careful clinical examination should always guide biopsy site selection. Early recognition and appropriate sampling remain some of the most important steps in preventing progression to oral cancer. #uabomfs #uabheadandnecloncology taken in Birmingham, Alabama by @dr.john.m.le
4
3 months ago
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This past year flew by! Congrats to our fellow @morgan_ari for being phenomenal! We all will miss you dearly… #prayersup #uabomfs #uabheadandneckoncology taken in Wine Loft Birmingham by @dr.john.m.le
2
4 months ago
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New headshot. 📸 #uabomfs #uabschoolofdentistry taken in Birmingham, Alabama by @dr.john.m.le
10
5 months ago
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I had a great time at the ONE AO meeting in Tampa. It was an outstanding multidisciplinary gathering that brought together orthopedic, veterinary, and craniomaxillofacial surgeons, all aligned in advancing education, research, and clinical outcomes. I had the opportunity to attend excellent lectures by speakers including Benjamin Hall, Mun Choi, Frank Renouard, along with a distinguished panel of experts in their respective fields. The future of AO North America is very promising and I’m excited to be apart of it. I also had the opportunity to catch up with a friend and future orthopedic trauma surgeon. #AONA #AOCMF #ONEAO2026 taken in Grand Hyatt Tampa Bay by @dr.john.m.le
1
6 months ago
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This patient presented with a gingival mass that had been present for nearly two years. He was unable to seek care during that time due to caregiving responsibilities for his terminally ill mother. His medical history is significant for multiple comorbidities, including coronary artery disease status post PCI, type 2 diabetes mellitus, hypertension, history of left ventricular thrombus, heart failure with preserved ejection fraction, and prior bilateral lower extremity thrombi status post thrombectomy and right lower extremity fasciotomy. He also has a significant smoking history of over 20 years at two packs per day and currently smokes one pack per day. An incisional biopsy of a large ulcerative mandibular mass demonstrated poorly differentiated adenocarcinoma with extensive necrosis. While primary adenocarcinomas can arise from minor salivary glands within the oral cavity, there was a strong suspicion for metastatic disease, particularly from a pulmonary primary given his smoking history. A CT neck and CT chest were obtained for staging and evaluation of distant disease. Imaging of the neck demonstrated a large oral cavity mass with multiple bilateral necrotic lymph node metastases. CT chest revealed a large mass occupying the majority of the right upper lobe with extension to the right hilum and associated paratracheal lymphadenopathy. PET imaging further demonstrated bilateral adrenal metastases. Given the extent of metastatic disease, the patient was referred to thoracic surgery for tissue confirmation of the lung primary, followed by multidisciplinary tumor board discussion to guide palliative management. #uabomfs #uabheadandneckoncology taken in Birmingham, Alabama by @dr.john.m.le
8
6 months ago
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This was another complex facial trauma case. The patient initially presented following a severe motorcycle accident with multiple orthopedic injuries and significant intracranial trauma. He was intubated in the field. On evaluation, he was found to have extensive panfacial fractures, including a laterally displaced right TMJ dislocation positioned superior to the zygomatic arch. Management was delayed due to the severity of his intracranial injuries, postponing both orthopedic and maxillofacial intervention for over two weeks. An initial attempt at operative fixation was made at day 7 post-injury but had to be aborted due to elevated intracranial pressures. At that time, we were at least able to reduce the right TMJ. He was ultimately cleared and taken back to the operating room for tracheostomy and definitive fixation. Given the delay, there was significant fibrous tissue formation at the fracture sites, making reduction particularly challenging. Surgical access was obtained through a combination of coronal, transconjunctival, transoral, and transcervical approaches to address bilateral NOE, right ZMC, Le Fort, and mandibular fractures. Occlusal management was further complicated by the patient’s baseline dentofacial anatomy, with a constricted anterior maxillary arch and a relatively wider posterior mandible, making reproducible occlusion difficult to establish. The mandibular fractures were anatomically reduced, and maxillomandibular fixation was applied based on the most stable and reproducible occlusion achievable intraoperatively. Overall, an excellent multidisciplinary effort. Our fellow and resident did an outstanding job managing a highly challenging case. #uabomfs #facialtrauma taken in Birmingham, Alabama by @dr.john.m.le
67
6 months ago
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Now available as an early online publication in JOMS. When feasible, placement of implants at the time of fibula free flap mandibular reconstruction is associated with a higher rate of successful prosthodontic rehabilitation. #uabomfs taken in Birmingham, Alabama by @dr.john.m.le
3
7 months ago
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I’m excited to share that I am now a board-certified oral and maxillofacial surgeon. I’m incredibly proud to be part of this specialty and look forward to continuing to provide excellent care to my patients while contributing to the education and training of our trainees. #aboms #boardcertified #diplomate taken in Birmingham, Alabama by @dr.john.m.le
42
7 months ago
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