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Bill Klaproth (Host):  Maxillofacial prosthetic rehabilitation and reconstruction is for patients with defects or disabilities due to disease, trauma or congenital anomalies. Oral prosthetics are then used to replace missing areas of bone or tissue and restore function such as swallowing, speech and chewing. And here to talk with us about ECMC Oral Oncology and Maxillofacial Prosthetics is Amanda Colebeck, a Maxillofacial Prosthodontist at ECMC. Amanda, thanks so much for your time. So, let’s start with this. can you explain what you do as a Maxillofacial Prosthodontist?

Amanda Colebeck, DDS, MS (Guest):  Absolutely. And thank you so much for the opportunity to discuss my profession. So, Maxillofacial Prosthodontists, I’m trained in the treatment of patients that have defects or disabilities that were present when they born or developed due to a disease or a trauma. Prosthetics are often needed to replace missing areas of bone, tissue, restore oral functions such as swallowing, speech and chewing and in other instances, prosthetics for the face or the body could be indicated for cosmetic or psychosocial reasons in the cases where a patient may have had a facial structure removed due to a trauma or a surgery.

So, every day I see patients that have some type of head and neck acquired surgery, chemoradiation therapy after affects, traumatic injuries or congenital birth defects for a reason that they would be seeing me for any type of prosthetic for the mouth or the face.

Host:  Got you. So, you are often needed then to replace missing areas of bone or tissue. As you said, people sometimes are born without these areas or because of an accident.

Dr. Colebeck:  Exactly. So, born without it would be like a cleft palate situation. An accident could be anything – at ECMC we see a lot of patients that have had motor vehicle accidents or trauma from gunshot wounds that could be involved as well in terms of why they would be missing something.

Host:  Sure, so how are patients referred to you for this care?

Dr. Colebeck:  So in our setting, we are very lucky to share a clinic with head and neck surgeons, dental oncologists, medical oncologists and there is also speech pathologists. So a lot of time, patients are directly referred to us when the patient has had a lesion of the mouth and they are referred here for a biopsy; if that biopsy comes back positive, then a head and neck surgeon would be seeing the patient to discuss the surgery and we get pulled in in a prosthetic would be needed.

Say the patient was having part of their hard palate removed or a part of the lower jaw removed we get called in to not only start talking about a prosthetic but talking about how that’s going to be held in the patient’s mouth. Very often we utilize oral implants in order to have the prosthetic be attached to something if there is any bone remaining in the jaw that we would be reconstructing or we work with the surgeon then they will transplant bone to the jaw or the face and then we are able to actually help in the reconstruction by placing implants and providing a prosthetic right away and then as the patient heals we can modify that prosthetic to however it needs to be for the patient’s form and function.

Host:  Wow, this is really interesting. So, as you talking about these prosthetics; what are some examples of prosthetics that you provide to your patients. I’m just trying to envision these.

Dr. Colebeck:  So, for instance, we’ve had patients that had part of their hard or soft palate removed and, in that case, there are prosthetics that are basically attached utilizing the patient’s own teeth if they have them. If not, we do utilize those oral implants like I mentioned. And it’s basically a form in an acrylic with usually a metal substructure that replaces the part that is missing. And in patient’s like lower jaws, the surgeons will often transplant bone actually from their legs and the fibula, transplanted to the patient’s jaw and we can place implants into it and then reconstruct more of like a dental rehabilitation. Not dissimilar to what patients would undergo with any type of implant and oral prosthetic on top of that for chewing, for swallowing function to really be restored.

And in addition, we also create silicon prosthetics when facial structures are missing. So, we can actually color and tint silicon to look like the patient’s skin tone. And in the case of like an eye missing, we can incorporate what’s called an ocular prosthetic that’s an acrylic eye that can really give a lifelike appearance back to the patient, so they don’t have to feel like that have to hide themselves or be embarrassed to go out into public. And we can really rehabilitate them in that sense.  

Host:  So, it sounds like many of these things are custom designed. Is that correct?

Dr. Colebeck:  Yes, everything is pretty much custom made for the patients.

Host:  That is amazing. And then where are these prosthetics being made?

Dr. Colebeck:  So, we are very lucky and proud that we have an in-house laboratory. We work really closely with two maxillofacial laboratory technicians in order to produce every prosthetic that we make for our patients and then we do also utilize outside Buffalo laboratories that can fabricate some of the metal substructures that are required. So, everything is pretty much either within our direct facility or locally made by other laboratories that we utilize in Buffalo.

Host:  So, once the patient then has a prosthetic; what type of follow up care is necessary in what you provide?

Dr. Colebeck:  Yeah, so patients really need lifelong care. Any patient that has had head and neck surgery or undergoes chemoradiation therapy; they are going to need lifelong adjustments of the prosthetics because their tissue is going to change over time and these prosthetics are really used every day for functions of the mouth. So repairs, remakes, they are fairly common. So, when our patients are actively undergoing surgery and their other adjunctive therapies; it’s common for us to see them every few weeks for adjustments and revisions. And then once they are healed and it’s been further out from their cancer or their surgery; we see them anywhere from maybe three to six months up to an annual visit in order to kind of follow up on their prosthetics.

Host:  And I imagine those follow ups are crucial for the revisions and adjustments. Amanda as you talk about this, I’m just wondering how did you decide to pursue this profession?

Dr. Colebeck:  So, I was very lucky that when I was in dental school, I had a faculty Dr. Terrance McLean who is actually my colleague now; he was a maxillofacial prosthodontist and he taught courses and let me shadow him in terms of what he did in his practice and it really inspired me. I love the idea of providing this really necessary form, function esthetic back to a patient and kind of giving them back what they had lost. And I found it very fulfilling to watch him with his patients and see how he could change the lives of the people he was able to treat.

So, training was fairly extensive beyond dental school. It’s four years of dental school, then three years of a prosthodontic specialty and then one year additional of a maxillofacial prosthetics fellowship. But all the training was completely worth it because I really love what I do, and I have a strong passion for it. so, it makes really going to work every day a wonderful experience.

Host:  And thankfully we have people like you doing this type of great work. So, for someone listening to this who is facing this or may be a loved one; what would you say to that person?

Dr. Colebeck:  I would say that – what we tell our patients is that they are going to go through a lot. There’s going to be a hard road of a lot of doctors appointments, a lot of visits, a lot of worry and concern and what we tell patients, when I meet patients is that at the end of it all, I really want to help improve their quality of life, improve their overall form, function, for the rest of their life and that we are really here to help them kind of manage all of the things that happened because of what they’ve been through.

Whether it’s something they were born with, whether it’s something that they had developed a cancer or whether they went through a traumatic experience that left them with a deformity; we’re here at the end of the road to follow patients for the rest of their lives and create these prosthetics that will never replace completely what they lost but get as close as possible in terms of restoring them to a more normal psychosocial ability and form function. So, we try to give them hope in terms of that at the end of the road we’re still here to see them whenever they need us.

Host:  And I’m sure that message of hope is well received and very comforting to patients.

Dr. Colebeck:  Yeah, it’s a really rewarding part of what I can provide to patients that they can – a lot of times with patients it’s not necessarily me providing a form of treatment every time they come in. Sometimes we just have conversations about what they are going through and we’re always trying to make something better, so we always say the first thing we make for you is never the last. So, we will always make revisions and adjustments as necessary to work with how the prosthetic is working with you and really make it specific to what the patient’s needs are.

Host:  And again, I’m sure that’s very comforting for patients to hear that. Amanda this has been great. Thank you so much for your time.

Dr. Colebeck:  Thank you so much. I appreciate you.

Host:  That’s Amanda Colebeck a Maxillofacial Prosthodontist at ECMC. And for more information or to book an appointment call 716-898-1461, that’s 716-898-1461 or you can visit www.ecmc.edu. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is the True Care Healthcast from Erie County Medical Center. I’m Bill Klaproth. Thanks for listening.