Apr 15, 2024 | admin
Eric R. Carlson, DMD, MD, EdM, FACS is a Board-Certified Oral and Maxillofacial Surgeon who specializes in Head and Neck Oncologic and Reconstructive Surgery. He is also an accomplished researcher and educator. We interviewed him for Head and Neck Cancer Awareness Month.
How did you become passionate about head and neck oncologic surgery?
My interest in oral/head and neck oncologic surgery began at an early period in my career. As a dental student at the University of Pennsylvania in the early 1980's, I received exemplary instruction in oral and general pathology by a very passionate teacher, the late Dr. Edward T. Lally. Dr. Lally illustrated important and very complex concepts in pathology in a comprehensible fashion. He was approachable and happy to bestow his knowledge on nascent learners.
My interest in oral cancer was continuously fostered throughout dental school and during my residency program in oral and maxillofacial surgery at Allegheny General Hospital in Pittsburgh, Pennsylvania. I completed a fellowship in oral/head and neck tumor surgery at the University of Miami under the direction of Dr. Robert Marx, one of the pioneers in surgical training in our subspecialty. Dr. Marx provided didactic education as well as technical surgical training in his fellowship program that was only one of two fellowship programs in the United States in the late 1980s. Dr. Marx inspired me to do what he did so well.
My passion for our subspecialty discipline had its origins in exceptional teaching and mentoring and I am grateful to those individuals who recognized my career interests and supported them at an early time in my career. These individuals have made all the difference in my career that remains very stimulating nearly 34 years after it started.
What percentage of your practice today is oncologic?
My nearly 34 year career to date has seen a gradual increase in my time commitment to oral/head and neck oncologic surgery. During my 22 years at the University of Tennessee, I have been fortunate to develop a practice that now comprises an allocation of effort of 80% benign and malignant tumor surgery with 75% of that work effort devoted to malignant disease. I take call for the maxillofacial trauma initiative in my academic medical center, and that effort rounds off my clinical time commitment.
It has been my experience that community private practice members of our specialty embrace the presence of a trained oncologic surgeon in the academic center, thereby realizing a case load that grows each year. Fulfilling the three A’s in one’s oncology practice – ability, availability, and affability is the key to success and remaining busy. Accepting invitations to speak at local general dental meetings and hygiene meetings as well as our specialty’s state, regional, and national meetings represents a great practice builder.
What makes your work rewarding?
Early in my career, I received excellent performance/task modeling in simultaneously becoming a clinical surgeon, teacher, and researcher. To that end, my career has been very gratifying due to my ability to leverage my clinical practice to the education of oral and maxillofacial surgery residents and oral/head and neck oncologic surgery fellows, as well as to the development of translational research in salivary gland surgery, oral squamous cell carcinoma, and odontogenic cysts and tumors.
It has always been important to me to be part of something bigger than myself. The ability to help patients with these diagnoses, and the satisfaction in observing their successful progress is second to none. My work results in personal and professional relationships with patients and their families. It is common for me to remain in close contact with the next of kin of patients who do not survive their malignant diagnoses.
Finally, our niche subspecialty remains relatively small at this time such that opportunities exist to collaborate with kindred spirits on personal and professional levels.
“Participation in our subspecialty is truly a labor of love…There is an endless supply of glory in our work in taking care of cancer patients, and I consider the professional ‘wins’ to be far more exciting than personal free time.”
How has this line of work affected you personally?
Providing care to patients with oral/head and neck cancer requires sacrifices in one's personal life. It has become infinitely clear to me that a practice primarily devoted to oral cancer patients results in there being no beginning or end to the work day or work week. The “call schedule” is not an absolute concept in that I consider myself to always be on call when in town.
One must anticipate the unanticipated during in-patient and out-patient care. Keeping one's finger on the pulse literally and figuratively represents self-preservation and peace of mind. Participation in our subspecialty is truly a labor of love. The concept of work-life balance must be humbly examined and redefined and wellness constructs must be developed and upheld.
I have realized that academic medical centers embrace our efforts and our cancer institutes depend on our hard work. There is an endless supply of glory in our work in taking care of cancer patients, and I consider the professional “wins” to be far more exciting than personal free time.
What advancements in the field have you witnessed in your career, and what do you foresee in the future?
Advancements in our field have been in two areas: clinical and educational.
From a clinical perspective, the development of rigid fixation in the late 1980s and virtual surgery planning in the 2000s has changed the manner in which we provide care to patients. Precision tumor and reconstructive surgery are now a reality such that I wonder how we successfully accomplished the outcomes that we achieved in years prior to these developments. Targeted chemotherapy, immunotherapy, and IMRT protocols have transformed the non-surgical care of our patients in the neoadjuvant and adjuvant settings. The identification of the cohort of patients whose cancers are HPV associated and attributed has ushered in a prognostically favorable set of cancers that have improved the 5-year survival rate of oral/head and neck cancer from 50% nearly 50 years ago to 60% in 2024.
From an educational perspective, the development of fellowships in our subspecialty discipline, currently nearly 20 in number, has permitted greater access of oral/head and neck cancer patients to fellowship trained members of our specialty. The greater than 100 Commission on Dental Accreditation (CODA) accredited oral and maxillofacial surgery residency programs in 2024, among them nearly 50 dual-degree programs, prepare graduates for fellowship training in our subspecialty. In addition, CODA provides intense oversight of our accredited fellowship programs, thereby ensuring an educationally meaningful experience for fellows that properly prepares them for the rigors of our practices. The American Board of Oral and Maxillofacial Surgery (ABOMS) provides a Certificate of Added Qualification to those accredited fellowship graduates and acceptable alternative pathway candidates, whereby the public is aware of the formidable training of these individuals.
Finally, the practice of all surgical disciplines exists in a data driven world. Our intense scrutiny of the outcomes of our surgical efforts and their publication in our specialty's literature provides evidence-based recommendations for our international colleagues, thereby supporting the education of future fellows and practitioners while also protecting patient safety. Examples of this statement include our surgical management of the clinically negative neck in oral squamous cell carcinoma, our execution of the partial parotidectomy for tumors of the parotid gland, the judicious and non-uniform use of chemotherapy for patients with sarcomas of the jaws, and primary surgical resection of odontogenic tumors, such as the ameloblastoma, with curative intent.
“Aspiring oral and maxillofacial surgeons with an interest in our subspecialty must realize that their career path will involve numerous years of training and experience to practice at a high level. There are no shortcuts...”
Do you have any advice for patients, or aspiring oral surgeons, based on your experience?
Patients should seek oral/head and neck oncologic care from formally trained oral and maxillofacial surgeons whose credentials support evidence-based care and whose clinical efforts are supported by proper resources in pathology, radiology, medical oncology, and radiation oncology.
Aspiring oral and maxillofacial surgeons with an interest in our subspecialty must realize that their career path will involve numerous years of training and experience to practice at a high level. There are no shortcuts to proper training in oral/head and neck oncologic and reconstructive surgery. The end result is a highly gratifying career in our subspecialty.
About Eric R. Carlson, DMD, MD, EdM, FACS: Dr. Eric R. Carlson is Professor and the Kelly L. Krahwinkel Endowed Chairman of the Department of Oral and Maxillofacial Surgery at the University of Tennessee Graduate School of Medicine in Knoxville, Tennessee. He educates residents and fellows in his department, and he focuses his clinical and research activities on benign and malignant tumor surgery of the oral/head and neck region. He is a graduate of the University of Pennsylvania School of Dental Medicine, the University of Miami Miller School of Medicine, and the Harvard University Graduate School of Education. He performed his oral and maxillofacial surgery residency at Allegheny General Hospital in Pittsburgh, his oral/head and neck tumor surgery fellowship at the University of Miami, and his general surgery training at the University of Tennessee Medical Center.