AndreaLSmith
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AndreaLSmith32 karma
The most difficult palate cases are the kids who have had failed surgeries. With today's techniques, we can surgically close most cleft, but if a surgery fails sometimes you can't operate again, they are left with strange wounds, and they need to wear an appliance (like a retainer with a tail) to close off their palate. It's difficult to see kids struggle with those kinds of problems.
One of the most unique was a woman from another country who had agressive cancer and was not expected to live. Instead of a traditional appliance, they actually wired a denture into her facial bones as a temporary jaw until she passed away. Well, she was pretty tough and beat the cancer. She came to the US several YEARS later with this horrid, infected mess of a denture that caused destruction of her facial bones, so much so that pus was oozing out of her face (sorry to be graphic). We got the denture removed and made her a new appliance to eat and speak with. It was difficult beacuse when her tissues healed it was so scarred that she didn't have lips or and upper jaw. It's amazing to see how far someone can come.
AndreaLSmith28 karma
Once in residency there was a woman who had lost her entire face to an animal attack. She had one eye, a lower lip, and chin. The rest of her face had been skin grafted and was pretty amorphous. That was difficult and interesting to make because there was nothing normal surrounding the area to match the facial prosthesis to. I had never seen or made anythig that extensive. It was also interesting because she had looked somewhat like me before the accident, so we took an impression of my face as a starting point for her prosthesis.
AndreaLSmith26 karma
So, even though I've only seen half of the first season before cancelling my HBO in protest of cable injustice (big mistake on my part), I have seen pictures, and it is fairly accurate.
They used to make prosthetics out of very thin pieces of tin or other metal that we meticulously painted. They would suspend these appliances from glasses or strings around the head. It's actually quite remarkable what they could do.
AndreaLSmith26 karma
Well, since my dad decided that I was not allowed to go to art school and my high school job was a dental assistant, I decided to become a dentist. I loved art and science and through dental school I learned about Maxillofacial Prosthetics, which for me is the most artistic thing dentistry had to offer. You get to sit with people and scult their face, and help them in the process!
AndreaLSmith45 karma
Probably that last one, but here is another. There was a man who had many recurrences of cancer, he lost the roof of his mouth and also his eye. We made him an oral appliance to close the palate and also an eye appliance to cover the defect in his face. To keep the in better we attached the two (inside his head) with a magnet!
It's fun when you have a patient with a good sense of humor, this gentleman could lick his eyebrow by putting his tongue up through his palate and into his eye socket from below!
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