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Hospital 125th: Recollections of an oral and maxillofacial surgeon

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Oral and maxillofacial surgeon Bruce Murdoch joined Palmerston North Hospital in late 1977.

Here he details some of his experiences.
“In 1977 when I joined the department, Gerry Lane was the visiting dental surgeon and Tom Hookham was the visiting oral surgeon.
“Our department consisted of a ‘broom cupboard’ in the old A&E department in the outpatients’ clinic. Patients were treated in the main theatre where we had instruments for carrying out routine management of facial fractures and dental alveolar problems. All our fracture patients at that stage were admitted and kept for anything up to two weeks with their jaws wired together, as some could not be trusted to look after themselves. They often spent three to four days in the intensive care unit because of the inherent risks with the inter-maxillary fixation.

Bruce Murdoch.

“In 1981 after postgraduate training in the USA I introduced open reduction of facial fractures with internal fixation techniques using AO bone plates. At the time these plates were large and cumbersome but they did the job. The result was that patients were no longer kept with their jaws wired together and could be discharged virtually the next day. One of the problems with jaws wired together and patients going home the next day was that they were issued with emergency wire cutters in case they vomited. Many wire cutters were never returned and we were constantly having to go to Hopwoods hardware store for a fresh supply.
“More seriously, although it was quite nice to have these patients discharged from the ward very quickly with obvious cost savings and to the joy of nursing staff.
“Most of our fracture cases were due to drunken assaults and some of our victims were from very violent backgrounds and difficult for the nursing staff to cope with. If we discharged them with their jaws wired together many of them often cut the wire within a couple of days and the fractures would then become displaced, causing post-operative problems with infections, mobility and a lack of union. This meant they returned later to have major reconstruction with bone grafting and control of sepsis.
“In 1979, we designed and commissioned our new department, which was situated in the old A&E department. It was a breakthrough to have a fully equipped operating theatre commissioned on site so that children with problems requiring general anaesthesia could be treated there.
“Murray Thompson joined our department in the mid-1980s as Principal Dental Officer and later went to Dunedin where he became Professor of Preventive & Paediatric Dentistry.
“Major developments through the early 1980s included the introduction of orthognathic surgery for correction of facial deformities, and osteotomies (cutting of the bone) of the mandible and maxilla were carried out in Palmerston North. We tackled some quite complex cases and in 1988 we introduced micro plating for open reduction and fixation of fractures – this revolutionised the management of these fractures as the plates were much smaller and much easier to place and gave much more accurate reductions.  Most of the cases were mostly ‘day stay’ surgery – this was combined with the overall development and shutting down of a number of beds, and a quantum shift throughout the hospital for day stay surgery, which pleased the bean counters.
“The establishment of a multidisciplinary Head and Neck Clinic for joint management of head and neck oncology improved communication between specialties and particularly the management of our head and neck cancer patients.
“Peter Leung joined the Department in 1991 as another visiting oral and maxillofacial surgeon and when Tom Hookham retired in 1995 we were joined by Guy Lawton. Guy introduced arthroscopic surgery of TMJ (Temporomandibular Joint and Muscle Disorders) and we worked together to do the first CAD cam designed custom made TM joint replacements. I believe we were the first hospital in Australasia to do this. To this day we are still regarded as the gold standard for treating TM joint disease.
“Unfortunately, Guy’s untimely death left us with a deficiency of manpower and Peter and I went back on to a 1 in 2 on call, which meant that we were running at between 150 to 200 acute trauma cases between us a year. Peter retired in 2006.
“Looking back, I always found working with departmental colleagues stimulating and very productive. Particularly I would like to mention Andrew Sutherland and Phillip Marshall, Margaret McDonald, Marilyn Linklater, Mikki Tyler and a series of house surgeons. Professor Ninian Peckitt and Dr Suzi Ramiraz joined the department in February 2007 and brought some new blood and exciting changes.
“It is my belief the hospital needs a minimum of three part-time consultants for oral surgery workload plus a trainee registrar and two house surgeons.
“I retired from the hospital in 2008, cutting back to just a 40-hour week with my private practice at Broadway Surgical Clinic.  I could not believe what a luxury it was to have weekends for doing things and at the time I even contemplated, but failed, to take up golf.”

Read more about the Palmerston North Hospital's 125th Anniversary here.

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