Dr. Phan, I value your input, and I hope that you will give me your insight on reconstructive surgery for maxillectomy and palatectomy. Thanks!

I have discussed it only with my original surgeon in Shreveport so far. He is renown in the area of head and neck surgery. He is an oral and maxillofacial surgeon (MD/DDS.) He has completed three cases (a pretty low experience rate!) but all of these seem to have been successful.

Hi Colleen,

My area of expertise is in prosthetic reconstruction of maxillofacial defects so surgical reconstruction questions should be left with your surgeon. It is extremely important to know that if you choose to have surgical reconstruction, the results should be the same or better than what you have now. Know what you will gain and what you will loose. Sometimes it is better to put up with a prosthesis but has excellent speech and function rather than surgical repair with less than satisfactory speech. The reason why your surgeon has only three repairs is that in majority of the cases, prosthetic reconstruction has proven to be the most effective treatment option of all. If you send me a picture of your defect and the types of surgical reconstruction that your surgeon is considering, I will offer my best opinion. Better yet, your surgeon should discuss the pros and cons with your prosthodontist also. DP

Hi, Dr. Phan. I thank you for responding in such a thoughtful, professional manner. My surgeon and my prosthodontist work hand in hand on many things, including these reconstructions. At any rate, I will certainly let them have time to "practice" lots more before they operate on me!

I do have excellent speech now, exc. for not being able to secure the appliance well. I think that to do that, I will try the crowns with the attatchment on the back side and see if I can get satisfaction for many of the issues that are bothersome.

My surgeon only began doing these reconstructions during the past year (He is nationally known, but he is also fearless.) To give him credit, my surgery is gorgeous, with no external incisions and no problems with rejections of the alloderm graft.

At the time of my surgery, just 1 yr. and 4 months ago, he said that any consideration of reconstruction would have to wait a long time...years.....to be sure that I didn't have a recurrence. Now, just a year later, he is talking reconstr. He says that the PET scans are so much more sensitive than visual exams that he could pick up any problem with PET before he could see it, and that, besides, he feels that my original lesion is gone and that there is no particular reason to expect that I will have another primary.

I would love to have the opening in my palate closed. I am learning to live with it, and if I can get the appliance to be secure, I will probably be content with that. I do need to explore the issues involved with the surgery, however, so that I can make an informed decision. I am 63, and if I wait too long, then I won't be young enough to feel that it is worth it.

The idea of interfering with my perfect healing, and being in another recovery period voluntarily, and possibly having a rejection...or nerve damage from the surgery..,,or a leg problem from the harvest of the fibula......are daunting considerations. EEK!

I will send you a photo from the internet that shows a picture very similar to my own surgical result. thanks.

Colleen,

Anytime that there is surgical component involved, there is risk. That is why there is consent form to be signed. From reading some of the posts who had underwent the procedures that you are contemplating, it was my understanding that most are happy with the results. However, you should know that each and every oral defect is different and everybody responses differently to the healing process. It is very important to know what you will gain and loose before diving in. It is also important to have a back up plan if the surgery does not turn out the way you expect. Will you be able to go back to where you were before? You need to weight the nuiences of the obturator with the surgical risks and benefits. I certainly would feel comfortable if you seek second opinions with your surgeons and the maxillofacial prosthodontists at well known Medical Centers that deal with oral cancer patients.

Regarding getting anchoring from your teeth, a most important factor that one must consider is the crown to root ratio of the abutment teeth (anchoring teeth). In other words, the height of the crown to what is embedded in the bone itself. A teeth may appear tall and healthy but if the root is short, then it would be a poor candidate for such function. In such situation, a semi-rigid retention mechanism may be employed that allows some micro movements of the retentive mechanism.

If the tooth is a candidate for the attachment, then the tooth would need to be crowned where the attachment is build in. This is done where the metal female or male is casted into the crown's metal structure. With proper design, when the prosthesis is inserted, you will not be able to tell that it is there. When the tooth is properly prepared and with the help of an experienced dental lab technician, a PFM (Porcelain Fused to Metal) will be impossible to tell from a natural tooth. DP