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International Physician Update
| OTOLARYNGOLOGY-HEAD & NECK SURGERY |
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| NOVEMBER 2002 |
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Rebuilding the Face After Cancer Surgery
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| Using a polymer model of the patient's skull, surgeon Patrick Byrne is able to visualize underlying structures he normally would not see in the operating room. |
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The patient had suffered a devastating cancer in her nasal septum. What the cancer had not eroded, repeated operations to rid the disease had. One of her cheek bones and eye sockets were missing, as well as a significant portion of the nasal bone. With nothing to support her eye and nose, they flopped down to her mouth.
“Many of the options that you would normally have to reconstruct the patient’s face didn’t exist here,” says head and neck surgeon Patrick Byrne, M.D. “There was nothing to hold her nose and eye up.”
New materials and surgical techniques, however, are making reconstruction of such severely damaged faces possible. Using three-dimensional CT, for example, Byrne was able to create a plastic polymer 3-D model of the patient’s skull. Using that model in the operating room, he was able to see the exact topography of the patient’s facial bone and cartilage beneath her facial tissues. That gave him precise landmarks to work with when performing micro-vascular surgery and free-tissue transfers, taking bone, muscle and skin from one area of the body to fill the facial defects.
“The model gave us a much more accurate idea of what kind of defect we’re dealing with,” Byrne says. “It also allowed us to more accurately select the best bone graft to use in restoring her face.”
New materials are making a difference, too. Byrne cites a 32-year old woman who had an aggressive cancer of the nasal septum, which he surgically removed. Because the risk of the cancer returning is so high in such cases, normally he’d have to wait a year before rebuilding the septum with rib grafts. That meant the patient would be left with a serious, socially-inhibiting facial disfigurement during that time.
Byrne, however, had a plan that would allow him to reconstruct the septum, while allowing doctors to monitor and treat any cancer spread. First he replaced the septum with a new type of polymer plastic that dissolves in 12 to 18 months. By heating this sheath, he was able to mold it into the shape of the patient’s natural septum. He then attached to this scaffold bone chips, which slowly bond and replace the sheath as it is absorbed by the body. To feed blood supply to the bone grafts, he used a new technique to tunnel forehead muscle beneath the skin to the inside of the nose.
“Usually, when you put a rib graft in, you have blood supply from the septum,” Byrne says. “This is a case where that wasn’t available.”
His approach, Byrne adds, allowed the patient to undergo a full course of radiation therapy, reducing the risk of cancer recurrence, while preserving her appearance. “If we didn’t reconstruct during the initial surgery, she would have been left with a severe deformity for a year,” Byrne says. “That would have been pretty tough for her to go through.”
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