Dental Oncologists Restore More Than Teeth

Playing golf, having cookouts and taking a summer drive up to Gatlinburg, Tenn., are a few of Darrell Hensley's favorite things.

As Hensley soon discovered, however, these activities would take a backseat to his battle with cancer.

To his surprise, a persistent "stopped-up nose" would take him on an emotional six-year journey, including a stop at M. D. Anderson in 1992.

Near his home, Hensley underwent several surgeries to remove a skin cancer growing inside his right nostril. "But it just kept coming back," Hensley recalls. "Then I was referred to M. D. Anderson."

It takes multidisciplinary team to reconstruct lives

His doctor at M. D. Anderson said Hensley's upper lip, roof of the mouth and upper jaw had been affected and that extensive surgery to remove most of his mid-face was the only option.

"It took me awhile to realize what he was saying," Hensley says. "Then it hit me hard. My wife and I were scared to death."

Fortunately, a highly specialized group of surgeons, as well as an "artist," were on hand to help.

As a team, "we decide if the defect is such that we can handle it with prosthetics only, or if reconstruction is also needed," says Rhonda Jacob, D.D.S., a professor in M. D. Anderson's Department of Head and Neck Surgery.

Often it's a marriage of the two, as in Hensley's case.

"Our goal is to rehabilitate the entire oral cavity," Jacob explains, "and that includes restoring not only the missing anatomy, like the upper and lower jaw, but also the functions that go with them such as speech, chewing and swallowing."

Affected structures replaced with bone and tissue

An advance that has revolutionized prosthetic rehabilitation is microvascular surgery. It involves transferring bone and tissue from the leg and other areas of the body, to replace the structure that has been removed. Dental implants can then be placed into the reconstructed bone.

The implants serve as an anchor for facial prostheses both inside and outside the oral cavity. Prostheses can be attached to the implants and/or adhered to the skin by special adhesives, says Jack Martin, D.D.S., M. D. Anderson's section chief of Oncologic Dentistry and Prosthodontics in the Department of Head and Neck Surgery.

With the combination of microvascular surgery, implants and prostheses, just about all structures of the oral cavity, including the jaw and tongue, can be restored.

Hensley optimistic about "what all they could do for him"

After performing surgery to remove the tumor and completing radiation therapy, Hensley's surgical team set out to repair his facial defect.

Plastic surgeon Gregory Reece, M.D., used one of Hensley's leg bones to reconstruct the hard palate by contouring the bone to fit the length of the defect.

Although bone can be taken from different parts of the body, surgeons usually use a portion of the fibula bone-the smaller of the two leg bones-to reconstruct a mandible or maxilla (lower or upper jaw), Reece says.

This approach allows them to leave the parts of the fibula that comprise the knee and ankle joints undisturbed so the patient can still walk shortly after surgery.

Implants enable facial prosthesis to be added

During another surgery, Jacob and Reece placed implants in the bone. Vertical implants were positioned to help stabilize an oral prosthesis. Also inserted were horizontal implants that would affix to an external bar to help retain the nasal prosthesis Hensley would eventually receive.

Many patients receive an intraoral as well as a facial prosthesis, which not only restores appearance, but also function and oral continuity, says James Lemon, D.D.S., a professor in M. D. Anderson's Department of Head and Neck Surgery, who is responsible for all of the facial prosthesis fabrication at M. D. Anderson.

Jacob says that since Hensley's reconstruction, improved computer technology has made it possible to create 3-D models of the patient's facial defect. This allows the medical team to better plan the size and shape of replacement bone needed for large tumors of the jaw.

Down to the last freckle: "artists" create life-like prostheses

Peggy Wesley, an anaplastologist, told Hensley his prosthetic nose would be ready in a week.

Wesley, along with her colleague Pattii Montgomery, makes new eyes, noses and ears lost to cancer. Making a prosthesis, she says, involves creating an impression of the face and area of the surgery. The resulting hard model is used as a base for a wax sculpture of the missing body part.

Final molds are made with the wax sculpture as a guide. Then, a custom-mixed silicone matching the patient's base skin tone is injected into the mold and allowed to set. When the mold is opened, the silicone nose is ready to be fitted, trimmed and painted to match the patient's skin tone.

When Hensely's new nose was securely in place, "it was fantastic," he recalls. "One of the first things I did was go out for dinner and eat a steak. It was pretty good."