Air Force dental team helps patients 'face' the world

  • Published
  • By Sue Campbell
  • 59th Medical Wing Public Affairs
The members of the 59th Dental Training Squadron here have a unique service they provide their patients. They help reconstruct their faces.

The Maxillofacial Prosthetics Department at MacKown Dental Clinic here employs a team that deals with the rehabilitation of patients with acquired and congenital defects of the head and neck region. They are one of only a few dental teams in the Department of Defense that creates prosthetic body parts such as eyes, ears and noses.

"We help wounded warriors who were injured on the battlefield, and also medical patients who have lost facial features due to disease, such as cancer," said Col. (Dr.) Joe Villalobos, the program director of Maxillofacial Prosthetics. "Facial prosthetic devices are an essential part of restoring their physical and psychological well being."

Patients are referred to the team from various medical departments at nearby Wilford Hall and Brooke Army Medical Centers, such as plastic surgery, otolaryngology, radiology/oncology, ophthalmology and the burn center. Dr. Villalobos works closely with each person to determine what he or she wants and needs.

"Normally, burn patients have already undergone many months of treatment, amputees have endured numerous surgeries and rehabilitation, and cancer patients have undergone surgery, received radiation and/or chemotherapy," Dr. Villalobos said. "The service we provide puts the final touches on returning them to a semblance of how they looked before their injury or illness."

Often most important to the patient is the restoration of function -- speech, chewing and swallowing -- in cases where injury or cancer to the mouth or jaws has occurred, he said.

The team's first step frequently starts in the stereolithography lab at MacKown Dental Clinic.

Stereolithography is a rapid prototyping method that allows the fabrication of anatomically-accurate, three-dimensional epoxy and acrylic resin models created from various types of medical data. There are numerous data formats that can be assimilated, some of which include those from computed tomography, magnetic resonance imaging and optical scanners.

"I can take a CT scan of a burn patient's head and create an exact replica, so our anaplastologist can build replacement ears and noses that will fit perfectly," said Dave Carballeyra, the stereolithography lab supervisor. "This technology is also used to incorporate dental and craniofacial implants to enhance the doctors' diagnosis and treatment planning."

The team's anaplastologist then works to create facial prosthetics for the patient.

Anaplastology is the art and science of restoring a malformed or absent part of the human body through artificial means, and Nancy Hansen is the only certified clinical anaplastologist in the DOD.

"Our patients are going through the traumatic experience of missing anatomical features," Ms. Hansen said. "We get to see them blossom because they are given hope."

Ms. Hansen said she begins by making an impression of the area of the missing anatomy.

Prosthetic noses, ears, jaws, even eyes can be made with silicone or hard resin. Many steps are taken to give the prosthesis a realistic look.

Then, the prosthesis is attached to the patient by various means, such as by surgically placing titanium implants into bone so that an ear can be magnetically attached, or by using adhesives that fasten the prosthesis to the face or head.

The prosthesis will be tried on and adjusted until it meets the patient's needs and comfort," Ms. Hansen said. "We are always a resource for them and they can always come back to us for follow-up treatment."

Another mission of the department is education.

"The 12-month 59th Medical Wing Maxillofacial Prosthetics Fellowship Program provides a one-of-a-kind comprehensive experience, promoting interservice jointness," Dr. Villalobos said. "Heavy clinical emphasis and technological proficiency provide our current fellow, U.S. Army Maj. Thomas Gunnell, the training needed to function as an educator, specialty consultant and expert clinician for medical centers throughout the DOD."