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The Sidney Kimmel Comprehensive Cancer Center

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Anaplastology is the art of restoring a malformed or missing part of the human body via artificial means. At Johns Hopkins, certified clinical anaplastologist Juan Garcia, a trained medical artist, directs a program creating custom prosthetic facial parts, including eyes, ears and noses, for head and neck cancer patients whose original facial features may have been damaged or missing due to radiation or surgery. The devices, generally made of silicone, are designed to match and blend into the remaining anatomy in form, color and texture. They can be affixed either with adhesives or by implanting a bar and magnetic retention plate to the face, so the devices can be magnetically attached.

Designing the prosthetics involves several steps:

  • First, Garcia takes a custom impression of the affected area of a patient’s face.
  • Next, he sculpts a form. Most sculpting is done on a patient to match as closely as possible.
  • Then, he creates a mold into which pre-tinted silicone matched to the patient’s skin tone is placed. The silicone is placed in a series of layers to mimic the multiple layers of natural skin.
  • The patient is called in for a fitting, at which point the device may trimmed to fit the anatomy comfortably and discreetly. Patients are sent home with instructions on caring for the device.

Garcia works as part of a multidisciplinary team with facial/plastic surgeons and the Division of Dentistry to coordinate reconstruction. The devices are covered under most insurance plans, including Medicare, and are considered durable medical equipment.

To read an article from Johns Hopkins magazine about Garcia’s work, click here.

For more information or to schedule an appointment, call the Art as Applied to Medicine Facial Prosthetics Clinic at 410-955-3213.

Dental Implants

In the past two decades the use of dental implants has progressed from the extreme to the conservative. Initially the implants developed in Sweden by Dr. Bränemark years ago were used in patients missing all of their teeth. Now the same principles are applied to replacement of a single tooth, multiple teeth or an entire arch of teeth with the same high degree of success. Depending on the condition of your mouth and your desires, our specialists can recommend the type of treatment right for you.

Some head and neck cancer patients need to have part of the jaw removed during surgery, affecting speech and function. To aid these patients, Johns Hopkins has a dental implant team composed of a maxillofacial prosthodontist and an oral surgeon. The team generally evaluates patients to design their prosthetics before they undergo jaw removal surgery, then coordinates with surgeons to implant titanium screws in facial bones at the same time as jaw removal surgery. Two months later, after the jaw has healed, patients return to the team so they can place attachments to the screws that can hold an individual tooth, a bridge or full denture.

At Johns Hopkins Hospital Dental, we provide implant placement surgery as a routine aspect of patient care. In many cases, an oral surgeon and prosthodontist are the ideal specialists to provide the dental implant surgery as well as the restoration. The success of the restoration depends on the implant placement, and our multi-disciplinary approach ensures restoration of ideal form, function, and esthetics.

The Johns Hopkins team also is starting to employ new technology enabling image-guided prosthetics. The team is using new computer software to view three-dimensional computed tomography (CT) images of a patient’s jaw and design the implants through the program, resulting quicker treatment that is the most efficient and accurate as possible.

For more information or to schedule an appointment, call 443-997-6467.

Surgery – “Free flap” Procedure

Another method of reconstructing missing parts of the face following cancer treatment involves transplanting tissue from one part of a patient’s body to face, known as a “free flap” surgery. The goal as much as possible is to return the patient’s appearance and function to how they looked and worked before cancer treatment. Dedicated facial plastic and reconstructive surgeons at Johns Hopkins can transfer bone, skin or muscle to repair almost any defect of the face for an aesthetically pleasing and funcional result.

For example, these surgeons can take a straight bone from the leg and reshape it into a new jaw for patients who lose their jaw from cancer. Working with the dental team, implants can then be placed in the new jaw bone and teeth restored. They also use bone from the leg or shoulder blade to rebuild the cheek bones, the eye socket and palate when these areas are remove for cancer. Other reconstructions include making a new tongue and swallowing tube for patients with tongue and throat cancer. Through microsurgery techniques, the surgeons also can restore facial movement in patients with facial paralysis by repaiing damaged facial nerves or transplanting nerve and muscle from other parts of the body. In most cases, the transfers can be done in a single surgery, though some patients may need to return for follow-up procedures. In the future, as technology improves, the facial plastic and reconstructive surgeons at Johns Hopkins may be able to offer highly selected patients facial transplants from donors as a means of reconstructing massive defects of the face.

For more information or to schedule an appointment, call 410-502-2145.