麻豆视频Cancer and Dental Specialists Help Man Regain Function, Speech After Oral Cancer Surgery
Little did Matthew Keeling know what was ahead of him when he felt a bump on the roof of his mouth.
“It ultimately ended up being stage four adenoid cystic carcinoma,” the 39-year-old said. “I underwent 20 hours of surgery where my upper right teeth, most of my palate, and parts of my upper jaw were removed.”
Surgeons used part of Matthew’s fibula and its surrounding skin and muscle to make a flap that covered the spaces where his teeth and jaw once were. To help ensure they remove all the cancer, surgeons work to clear the margins around the tumor. In Matthew’s case, that resulted in a surgical hole in his mouth.
“Matthew had a very aggressive cancer that typically requires not just surgery, but radiation, which is a double-edged sword,” explained Dr. Weitao Wang, who specializes in otolaryngology and plastic surgery at the 麻豆视频’s Wilmot Cancer Institute. “The radiation can eradicate microscopic tumor cells and decrease the chances of the cancer from recurring, but it can also damage the surrounding tissues.”
Just a few weeks after his surgery, Matthew began a regimen of 30 radiation sessions.
“Unfortunately, the radiation caused parts of the flap to fail, and it created two large openings in my repaired palate,” he said.
Matthew’s palate was reconstructed with the skin from the leg while his cheek bones were rebuilt with the fibula bone. The skin had pulled apart from his native palate as he continued through radiation. This resulted in a communication between his mouth and the back of his nose, which can have significant functional implications. The hole can cause voice quality to sound very nasally, and it can also cause food and liquid to come out the nose when eating or drinking.
“We had a heart-to-heart discussion about the option to perform another tissue transfer procedure to close the hole in his palate,” Dr. Wang said. “He had been through so much that another surgery was daunting. Instead, we decided on obturator rehabilitation that could both effectively cover the hole and provide dental function, while avoiding a significant surgical recovery.”
Dr. Wang referred Matthew to Dr. Carlo Ercoli, Prosthodontics chair at Eastman Institute for Oral Health, to create a custom obturator—a prosthesis to replace his missing teeth and palate.
 
An example of an obturator, designed to replace bone, teeth and tissue after surgery. |
Dr. Ercoli, who has produced several obturators for patients treated at URMC, took a mold of Matthew’s mouth and began the process. “As the tissue continues to heal, getting a perfect fit can be a moving target at first,” Dr. Ercoli said.
They went through several iterations over a few weeks, including input from speech therapy.
“Only when Dr. Ercoli was completely satisfied that the fit was as good as it could be, the obturator was finalized,” Matthew said. “He genuinely didn’t want me leaving with anything less than the best possible prosthetic he could provide me.
“The obturator is an amalgam of metal, ceramic, and plastic so working with it can’t be easy,” continued Matthew, who works in a chemistry lab in Cortland, NY. “Considering how unusual the shape of my mouth is now, I can’t help but appreciate the level of experience and spatial intelligence that such an adjustment would need. And Dr. Ercoli nailed it!”
Since the bone in the area was too radiation damaged for an implant, Dr. Ercoli carved a series of shallow shelves on Matthew’s remaining upper teeth to hold the obturator firmly in place.
“I thought my life was fine before the obturator – I could mumble through most conversations and eat most foods,” Matthew said. “But since receiving the obturator, I can’t emphasize enough how much things have improved.”
While microvascular free tissue transfer has revolutionized head and neck reconstruction, there are still many limitations, Dr. Wang explained. “It is really a blessing to have Dr. Ercoli’s expertise to offer this quality of obturator reconstruction for our patients to really try to get them back as close as possible to things before treatment.”
Matthew says he can clearly communicate with everyone now.
“I can order food at the drive-thru again,” he said. “I don’t dread phone calls. I can eat with both sides of my mouth. And, I had the confidence to fly across the country and visit my nieces for the first time in two years.”
Matthew says the obturator actually feels like it’s part of his mouth.
“Dr. Ercoli even matched the color so you can’t distinguish the obturator from my other teeth,” he added. “With the obturator now, my life is about 99% back to what it was before everything.”
“Collaboration is key for providing comprehensive care to our patients,” said Dr. Ercoli. “Together, we can anticipate and manage oral health issues that frequently arise from cancer treatments. Our primary goal is to greatly enhance quality of life as well as prevent possible complications.”
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