In our patient population, it’s not uncommon for some Veterans to lose part of the oral cavity or have facial defects due to trauma, head and neck cancer, or both. These patients are normally treated by a dental specialist employed in the VA dental service. A maxillofacial prosthodontist is a dental specialist who provides prosthetic reconstruction for the oral cavity and the maxillofacial region as well.
A typical request to the maxillofacial prosthodontist is to provide an oral prosthesis to patients who are missing parts of their oral cavity, so that they can more easily eat, drink and speak. In cases where parts of the facial area need to be restored – such as a missing nose, ear or eyes – they will also be called on to provide this kind of restoration.
Louis (“Lou”) Matarangolo had part of his maxillary palate and nose removed many years ago due to a facial tumor. As a result, Louis had difficulty talking and eating, and he did not feel comfortable in public. Louis’s reconstruction called for a prosthesis to close the palatal defect and a nasal prosthesis made out of medical-grade silicone to restore the missing nose.
Teamwork was vital to the success of this rehabilitation. It involved a dental specialist as well as dental technicians at Dobbs Labs, Inc. in Hoover, Ala., and a maxillofacial prosthetics technician at the James J. Peters VA Medical Center in Bronx, N.Y.
My job was to provide an accurate reproduction of the defect areas and their surrounding anatomical structures, as well as measurements, so that both the dental and the nasal prostheses could be fabricated. An impression known as “facial moulage,” was taken of the entire face and sent to the prosthetics technician, along with current and past photos of the patient, so that the artificial nose would accurately reflect the patient’s pre-surgery appearance.
The dental laboratory technician created the oral prostheses from the measurements provided on the laboratory prescription. The nasal prosthesis was then waxed up and processed to match the patient’s skin tone and complexion.
After this step, the prostheses were returned to me, and I began the process to fit them to Lou. This involved seeing how they fit when he talked, ate, and smiled – would they stay in place without dislodging? Could he breathe OK? Did he like them?
I took that feedback and gave it to the technicians, and they changed the prostheses to fit his needs.
Sometimes at the delivery visit, pigments have to be applied to ensure the seamless transition between the natural and artificial skin tones. And due to the seasonal changes that affect skin color – tan in the summer, paler skin in the winter – we developed two different nasal prostheses for him.
I find my field of work highly rewarding when I know that my service has such an impact on someone’s quality of life. Practicing maxillofacial prosthodontics allows me to combine medicine, dentistry and art into one. It gives me even more satisfaction when I am able to provide valuable service to those who gave us the freedom we have today. For our returning troops who may have maxillofacial defects sustained by wartime injuries, prosthetic reconstruction provided by VA dental services fills a gap in cases where surgical reconstruction may not be feasible.
My special thanks to the technicians at Dobbs Labs, Inc. for construction of the oral prostheses and to Sarah Wisniewski (maxillofacial prosthetic technician in training) at the James J. Peters VAMC – in Bronx, N.Y., for fabrication of the nasal prostheses.
Photographs taken by Kenneth Holt, medical media photographer, William Jennings Bryan Dorn VAMC.
Dai C. Phan DDS, MS is currently a maxillofacial prosthodontist at the William Jennings Bryan Dorn VAMC in Columbia, South Carolina. He along with his older brother and parents escaped from Vietnam in 1978 as boat people and settled to America in 1980. He was an assistant professor in prosthodontics at the University of Tennessee at Memphis until he started his career in the VA system since 2003. Dr. Phan is an avid mentor for students seeking career in dentistry and frequently lectures in a variety of dental topics. Read about Dr. Phan’s story in the Jan/Feb 2009 edition of Vanguard, page 18.