Maxillofacial Health, Beauty, and Chi: Andy Gump and the Avatars

Article Outline

• Raising the Chi
• How Can Surgeons Help Their Patients Raise Their Life Force?
• Copyright

This month in JOMS, read about Andy Gump. Both Drs Aziz and Pogrel independently researched this iconic figure and have interesting and remarkably contrasting findings from their research. Also, even if you are pop culture challenged, see the blockbuster movie Avatar. As an oral and maxillofacial surgeon the lessons of both experiences will resonate in your practice and patient management.

In Avatar, the native species, the Na'vi, are impossibly hyperteloric: orbits set so wide so as to contain a voluminous nasal airway. Their muscles of facial expression are so hyperactive that, when combined with an aggressive hissing, they reveal rows of icy blue canines. Yellow eyes, hypoplastic mandibles, and mottled blue green skin would appear to complete the picture of a monster. Yet the Na'vi are compelling in their beauty, because of their obvious health, community life, coherence with their environment, personal relationships, and physical accomplishment, essentially due to their life force, the Chi.

Andy Gump too was impossibly deformed, in this case with an absent mandible and mustache covering a cervical stoma. Like the Avatars, his life force, his Chi made him a witty wry head of his family and curbside philosopher, a browbeaten everyman. Gump was popular mostly because he represented the middle class and was seen as an ordinary man despite his obvious deformity. He was so outgoing he even could demonstrate a meanness and toughness usually reserved for heroic figures like the square-jawed Dick Tracy. And he was gregarious enough to run for President! (At least in the comics.)

Gump and the Na'vi race are so evocative to oral and maxillofacial surgeons because we daily treat patients who are also so obviously different in appearance but for whom their success in coping with their difference is often far less successful. Patients with tumors, trauma, cleft craniofacial deformities, acquired edentulism, skeletofacial deformities, and infection, among other ailments, can experience pain and suffering, but their typical appearances can also result in social withdrawal and, subsequently, compromised clinical outcomes. Only with a strong sense of vibrant self (Chi) in the proper environment can these deficits be overcome.

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Raising the Chi 

Self efficacy is a process that allows individuals to accommodate for their deficits and progress, even thrive, in their environment. It is a process that must come from the self. The pre-eminence of the self in Chinese medicine and martial arts is referred to as the Chi, the life force. The Chi is the power of the inner self. If it is raised, it promotes health, fulfillment, happiness, and success. If it diminishes, it leaves the individual susceptible to illness and injury.

In communities, individuals can raise their life force through various means. Methods include sports such as martial arts, yoga, meditation, attending church services, family activities, raising children, social interactions, building structures, producing and experiencing the arts, laboring, and serving others. Thus the Andy Gumps and Na'vi can nearly burst with Chi and thus blind others and themselves to what might condemn them to stereotyping and marginalization.

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How Can Surgeons Help Their Patients Raise Their Life Force? 

Think about our patients and how their illness or deformity can drain their Chi. How can surgeons' actions help our patients to increase their life force?

Preoperatively and postoperatively, encourage activities of daily living that will promote wellness. The patient who soon after surgery goes out, visits with family, dresses themselves, and cooks for themselves is carrying out a self-fulfilling process of recovery. Patients should appear in public and carry out social engagements such as church, school events, etc as soon as possible after corrective surgery. They will recover sooner and heal better. Occupational therapy for those with persistent deficits is beneficial as well.

Beauty is only skin/bone deep but ugliness is to the brain. Do not categorize patients by their appearance. If the patient is told they are ugly, they will sometimes live that ugliness. Tell the child with a cleft they are beautiful, encouraging their active social engagement. Do not tell a patient with skeletofacial disharmony they have a “deformity.” It is better to objectively state clinical problems such as “You have mandibular hypoplasia, which means that your jaw just stopped growing a little too soon.” If the surgeon refers to “disharmony” and discusses “corrective surgery,” the patient will likely respond more positively. Emphasizing improvements in function and how good form and good function are concordant in the orthognathic patient will help the patient sense that the goal is a balanced improvement, not a panacea for all ills.

Select procedures that will advance that patient's ability to succeed in their community and return rapidly to activities of daily living. While a jaw tumor patient can undergo resection and reconstruction well with vascularized tissue transfer, compare the morbidity and eventual esthetic outcome to transoral endoscopic mandibulectomy, prefabricated bone plate and non-donor site reconstruction, such as transport osteogenesis or BMP-2. Assessing the patient's ability and willingness to select treatment that is best for them will affect their life force and their recovery.

Surgeons should understand that the face is not a window to the soul. Emphasize to orthognathic and other patients that postoperatively their appearance will be healthier, or more vibrant, but do not use terms such as “cuter” or “more popular,” as this would imply that there are deficits preoperatively that relate to the face and not to the inner self.

The real lesson of Andy Gump is not that he was accepted in society despite his deformity; it is that he accepted himself and was in some way successful because of his deformity. The lesson of Avatar is that humans, in finding beauty in other individuals, even other species, can find it in themselves.