Below you will find a letter from Dr. Michael Singer. Due to the length of this letter and necessity for a special reader, the site administrator felt this was the easiest way to view it.
THE BESTHESDA TEMPORMANDIBULAR JOINT AND FACIAL PAIN TREATMENT CENTER
Summary of Treatment
Donnie Fritts presented to the restorative team in Washington, DC with the loss of brain tissue, forehead bone, cheek bones, bone between the eyes, floor of the left orbit, cheek tissue, nose, sinuses, upper lip, and the entire upper jaw secondary to a cancer operation to remove an ameloblastic carcinoma after a biopsy by Dr. George Lee, DDS, confirmed the presence of cancer. The cancer surgery team of Dr. Charles Moore, Dr. Jeff Olson, and Dr. Albert Loskin at Emory University Hospital Center in Atlanta deserve tremendous credit in saving Donnie's life. Dr. Lawrence Davis finished the cancer treatment with radiation and chemotherapy. Donnie is the only person of 16 people in the world to survive this very rare cancer.
In the pretreatment evaluation of Donnie Fritts it was obvious that the single most difficult aspect of restoration and treatment was the bilateral maxillectomy or the devastating loss of the entire upper jaw. To do anything without addressing this issue would be less than adequate and very disheartening considering all that would be required of Donnie. The maxilla is involved in eating, swallowing, breathing, talking, and support of facial tissue. To cover the defect itself would accomplish very little for Donnie and fall far short of his goals. Recognizing and then treating the this problem involved creating a new approach for the restoration of bilateral maxillectomy patients because of the severe loss of bony support as well as radiation therapy and chemotherapy in general which often follows surgical removal of any cancer and renders support from the surgical site useless. An additional issue was the constant daily headaches which further demoralized Donnie. It is only through the total unquestioning dedication of Donnie and the unyielding and ultimate love of Sharon, his wife, that this restoration could have been accomplished.
The maxillofacial prosthodontist is responsible for guiding the restorative team because of his additional understanding of medical restorative techniques, the work of the prosthetist, and his vision of the final result as well as his responsibilty for restoring the maxilla which then provides further support and contour for the remaining facial tissue as well as intergration of the nasal prosthesis. The maxillofacial prosthodontist ultimately shoulders the responsibility for the success or failure of this restorative process.
To this end Dr. Craig Dufresne eliminated the multiple neuromas under the original forehead flap which relieved Donnie of his daily, constant headaches and restored the shape of the forehead with bone putty. Additionally, Dr. Dufresne filled the defect between his eyes with bone and the remaining cheek tissue was further approximated as this would interfere with the design of the new prosthetic mazilla. Critically, Dr. Dufresne recreated the upper lip and later further augmented the lip with injected fat tissue. Ultimately, Donnie will receive a minor plastic surgery procedure under his eyes to remove excess tissue by Dr. Dufresne.
In the interim, Dr. Dorsey Van Horn in Georgia restored the teeth of the mandible with crowns.
Dr. David Ross placed dental implants donated by the 3i Implant Company across the forehead in the supraorbital rim and bone graft done by Dr. Dufresne between the eyes. This procedure was very important as these implants will ultimately support the complex gold subframe, maxillary obturor, facial tissue, and final nasal prosthesis. These implants are remotely located from the defect because of the lack of cheek bones(zygomas), radiation, and chemotherapy which have comprimised the surgical site for use in restoration.
At this point, the foundation for the restorative process is complete. Donnie has undergone nearly 20 operations without question and the dedication of his wife Sharon has been a tremendous inspiration for Donnie.
Dr. Singer, the maxillofacial prosthdontist, will bring the artificial reconstruction to reality by utilizing the foundation established by Dr. Dufresne and Dr. Ross to completely restore the missing upper jaw to full function, a goal previously unattainable in maxillofacial prosthodontics for bilateral maxillectomy patients, and lay the foundation and substructure for the nasal prosthesis. The first problem was expanding the reconstructed upper lip outward to reach the lower lip. Dr. Singer fabricated a tissue expander and over a period of 4 momths the continuity of the upper lip with the lower lip was established. This was important in restoring normal facial contour, speech, eating, and drinking by finally creating a seal with the lower lip. Next, a gold subframe was fabricated and attached to the implants to hold the entire artificial maxilla in place with magnets and provide support for the nasal prosthesis. The obturator was then fabricated that replaces the entire upper jaw and supports the remaining facial tissue in such a way that the nasal prosthesis can easily blend with the existing tissue. using the obturator to create a normal facial contour was a difficult balance between retention for eating and support of the cheeks for normal contour. The base of the nasal prosthesis was constructed so that it also attaches to the gold subframe through clips and magnets and provided the nasal prosthesis with a solid foundation. Dr. Singer's thorough knowledge and experience in fabricating various facial prostheses allowed him to anticipate the needs of the prosthetist and plan various aspects of the final nasal prosthesis.
Because the obturator supported the contours of the remaining facial tissue and the gold subframe provided solid anchorage for the nasal prosthesis through magnets and clips in the foundation of the prosthesis, the actual nasal prosthesis created on the foundation by Mr. bob Barron was greatly simplified. The foundation adds to the success of this prothesis especially by supporting eye glasses and adding stability during facial movement and function.
Finally, at Dr. Singer's suggestion a gold implant will be placed in Donnie's left eyelid to allow the eyelid to completely close over his left eye. This will be done in Georgia by Dr. O'Boyle.
Where no hope of reconstruction was ever given to Donnie and his wife, the offer of hope and promise of the return to normal function is an enormous responibility to undertake by the restorative team for the patient, his wife, and all the people and charities associated with fund raising especially in light of the fact this has never been discussed in the literature before. The restoring team of Dr. Dufresne, Dr. Ross, Dr. Singer and Mr. Barron wish to especially thank all the physicians in Georgia, Dr. Charles Moore, Dr. Albert Losken, Dr. Jeffrey Olsen,Dr. Larry Stephens, Carolyn Wills, Elizabeth Harris,Dr. Dorsey Van Horn, Dr. Phillip Parhem, Dr. Matthew Brock, Dr. Taylor, Dr. Self,Dr. George Lee, Martha Guardina, Dr Lawrence Davis, Yuri Hairston,Susan Yates,Dr. Ledford, Dr. Landry, Dr. Samuel Milton, Peggy Gibson, for their continued support, the Barrett Road Church of God Benevolence Fund, and Sharon, Donnie's wife, for the unrelenting strength and dedication, unselfish care and love they gave through such a difficult and devastating process for Donnie.
Sincerely,
Michael T Singer, DDS, FAAMP, FACP