Ali Cook of The Wednesday Watch and Dentistry Today spoke with Thomas Balshi, DDS, PhD, of Prosthodontics Intermedica at the Institute for Facial Esthetics in Fort Washington, Pa, about an extraordinary case. Dr. Balshi and his team helped a small boy from Africa get a new nose and facial structure after a hyena attack. You can view the interview transcript is below.
How did you get involved with this case?
This procedure emanated from Geisinger Health System in Northern Pennsylvania, a maxillofacial surgeon, Dr. Robert Pellecchia, referred the patient to our center. The patient, as you know, came from Ethiopia after being attacked by a wild hyena. The hyena took one bite out of the 6-year-old’s face, removing his nose, the entire pre-maxilla, and the posterior section of the maxilla as far back as the first molars.
Can you give us an overview of the procedure?
When Sisay first came to us, he had a very very small silicon, out-of-the-box nose that was given to him when he landed in New York. It was being held on with some adhesives, but it was out of proportion. It was very small compared to his face, and so we began looking at what we had to work with.
Dr. Pellecchia, and one of his residents, Joseph Pierce, put some implants into [the patient’s] facial skeleton: one between his eyes, and then one around the first molar region of what was remaining of the maxilla. The one between the eyes was an extraoral craniofacial implant. (They used to be made by Nobel Biocare, and they’re now being made by Cochlear Implants, the people that make the hearing aid implants.) So that went between the eyes: a very short implant, about 4 mm in depth, and it has a flange. The one on the left side was also an extraoral craniofacial implant, and the one on the right side… they couldn’t stabilize the craniofacial implant; they ended up using a NobelActive Implant in that area.
So he came to us with the implants already in for several months, and now we were at the point where we have to uncover the implants and then begin to build the framework: taking impressions and making master casts. So we uncovered the framework; all three implants appeared to be firmly integrated, so we proceeded with making the impressions.
What was unique about this case?
What’s unique about this procedure is the fact that he’s only 8 years old, and still growing. When we do craniofacial reconstructions, or prosthetic reconstructions for instance for cancer patients, they’re usually older patients, and they have mature cranial development. We don’t anticipate any real continued growth of their skeleton. But with an 8-year-old boy, obviously, we’re going to see a lot of growth in the next decade. So our major concern was, even if we were able to get implants to integrate in the bones of the face, how were we going to use them, and what could we do to keep them in place while the rest of the cranium expands and continues to grow?
What can other dentists learn from this procedure?
I think we can use many of the different products that are available to us in dentistry off-label. The Cendres+Métaux overdenture bar, for instance, was developed to hold teeth in place on implants—2 implants or 4 implants—but we learned to adapt things we have around us, with modification, and make them work in a way in which they were never intended or dreamed of being used.
As prosthodontists, we constantly think of ways to correct defects in the human being: we’re trained to replace teeth, we’re trained to replace jaws, we’re trained to replace missing components intraorally and extraorally. So I think prosthodontics generally think out of the box and think about creative and inventive ways to take what we have at our fingertips and make it work.
What an interesting case. Thank you so much for your time today, Dr. Balshi.