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Melanie Cole (Host): Welcome to UAB Med Cast. I'm Melanie Cole, and I invite you to join us as we look at maxillofacial prosthetics practice in profile.

Joining me is Dr. Michael Kase. He's an Assistant Director of the Advanced Education in Maxillofacial Prosthodontics and Dental Oncology Fellowship at UAB Medicine. Dr. Kase, it's a pleasure to have you join us again. This time we're talking about specifically your field. Can you tell us a little bit about the subspecialty of maxillofacial prosthetics and dental oncology? Tell us about this exciting field.

Michael Kase, DMD (Guest): Sure. Well, thanks for having me again. I really enjoy being on these interviews with you. So the subspecialty of maxillofacial prosthetics and dental oncology is again, it's the subspecialty of dentistry. So we go through, you know, four years of dental school, but then you have to do a three-year residency in graduate prosthodontics and people always ask me, well, what's that? So the best way I can explain it would be your general dentist might do two or three crowns, a prosthodontist they'll do 28 crowns. So it's a full mouth rehabilitation. So you have to get that fundamental knowledge in your system before you can move on and then do the subspecialty fellowship, which is a one-year program.

And that's for maxillofacial prosthetics and dental oncology is usually combined in it because to treat all these patients in the maxillofacial prosthodontic world, the dental oncology side of things, you can't separate it from each other. It's just kind of inherent. And basically what maxillofacial prosthetics is is, replacing parts of the body that are lost to cancer, to traumatic events, or even congenital aspects of certain syndromes.

So we make eyes, we make ears, we make noses, we make interoral prosthetics called obturators, which essentially plug a hole or obdurate what might be between the oral cavity and the nasal cavity. So patients can eat without food or drink coming out their nose and speak intelligibly as well. So that's the biggest outline I can give of the prosthetic side of things.

And we do even branch into other things such as fingers or if patients have defects in their neck, we might make a prosthesis that plugs the hole in the neck. I believe this coming week or so we have a patient coming in that needs a toe. So we make all sorts of prosthetics. And then the dental oncology side of it is going to be treatment and management of patients that are undergoing therapies such as radiation or medical oncology or IV bisphosphonate drugs, such as that. So we see a wide array of patients.

Host: Well, you certainly do. And I'd like you to expand just a bit because it fascinates me that you do, there is so much, it's so comprehensive from speech pathology and head and neck cancers and didactic training and oncology and dentistry, as you said, and prosthetics, I mean, really there's so very much. Tell us a little bit about, is it a crowded field, Dr. Kase?

Dr. Kase: No, it's not. It is a very, very small number of people. And I always like to say that once you're in this field, you pretty much know everybody because I would have to say in the entire country, there's probably 200 people that are trained to do this. And I would honestly say that probably a third of that actually do the practicing.

A lot of people might do this fellowship and go into purely academics. Or they might do this training and then go into private practice and do an obturator here and there, just in case it comes across their table. But as far as people that practice in this manner, like I do, probably about a third of those that greater pool of 200.

So it's a very, very small number of people. I am the only one, essentially the only one in the state that does this in Alabama here. We have Dr. Sudi as well, who works with me in the dental school, but, he's kind of at retirement state. So it's pretty much myself and the fellow that do all the work here for all these patients in the state of Alabama.

Host: Well, you're a busy man. So one of the things I personally know about you having interviewed you is the way you work so well with other subspecialties. And then there's a lot of them. We've done panel interviews with oral surgeons and medical oncologists. And tell us a little bit about what that's like for you working with such a broad range of other subspecialties and how important that multidisciplinary approach and the multimodal approach that you use for many of the procedures that you tackle.

Dr. Kase: Just right off the bat, I'll say that I love it. I love working with everybody here at UAB. Everybody that I work with every, every department is just wonderful and excellent clinicians and just great people to begin with. So it makes my day better just working with everybody that I work with, but it's also very, very comprehensive for the patient.

I mean, instead of patients having to go from one hospital to the other hospital, seeing a private practitioner outside; they get everything done in-house, at UAB. So the patient comes through and whether it comes through our oral oncology department and oral surgery, or through ENT they'll see the surgeons first and we'll kind of triage the patient and figure out what they need.

And then everybody involved in the treatment ends up seeing the patient beforehand. So we get this huge comprehensive treatment plan, and that's just hugely beneficial for the patient. So, you know, the patient needs radiation. They come see me for a pre radiation evaluation. If the patient is going to have maxillectomy, they come see me for impressions for an obturator prosthesis, or if they are going to need an auriculectomy, they'll come see me for evaluation for an ear prosthesis and, and so forth.

And then it gets even more intricate because the different surgeons I work with all do different aspects of the care. So some may place implants in the mouth, some may place implants in the temporal bone. So, this multi-disciplinary approach we have is just hugely beneficial to the patient, for the efficient yet comprehensive workflow.

Host: And it's quite obvious that you do love it. And I hear you talk about the people that you work with. So really what an interesting field that you're in, what do you personally offer these patients in terms of care. Can you tell us a little bit about your practice within maxillofacial prosthetics and dental oncology at your office? Tell us about your team and what you're doing special to go above and beyond.

Dr. Kase: Well, I believe in some of the other podcasts I've done with you, we've discussed the multidisciplinary clinic I have with Dr. Moreland and Dr. Yang and Christina, our PA. That's one way where we work together and kind of a microcosm of the last comment I made regarding greater UAB, we see the patient and offer this comprehensive care model where they get their treatment plan ahead of the therapy and they know what to expect as they go through it.

But I also get patients come to me they may be from an outside hospital, somewhere up in Huntsville, or I see patients from Georgia, from Mississippi, from, from Florida that need my care. So they may come to me after having surgery and then I have to kind of get them up to speed in terms of, the prosthetics they need.

So if they come to me after having had a maxillectomy, well, then I have to get them an obturator prosthesis to help them with their speech, their swallowing, and function to get them back to a more normal state. But we also do a lot of treatment planning. So the patient comes in let's say they have their ear removed an auriculectomy.

Well, we talk to the patient about the different ways we can have an auricular or an ear prosthesis, retain itself to the patient, whether it's adhesive or using dental or other forms of implants to help with the retention. And at that point, then we start working with the surgeons and we plan things out appropriately to get the best results.

I may see patients from my friends in speech pathology, and they may send me patients for prosthetics, such as palatal augmentation prosthesis, or a palatal lift prosthesis. Basically their prosthetics to help with speech and swallowing and due to non-function or a lack of anatomy in the soft palatal region.

So I work very closely with them. I'll make the prosthesis, and then I usually send them back to see speech path and then they'll evaluate the patient from their end. And we'll kind of work together to determine what needs to be done with the prothesis to optimize the patient's outcome.

Host: Such a comprehensive and intricate nature of your job, Dr. Kase as we get ready to wrap up, I'd like you to tell referring physicians what you would like them to know in terms of maxillofacial prosthetics, and dental oncology practice, and what is really exciting in your field right now, what's really getting you jived and, and something that you see coming in the horizon that you say, oh, I'm so really glad to be in this field because that's going to be awesome.

Dr. Kase: Well, what I would tell any physician that might be listening to this is I might be able to help you. It sounds pretty, uh, broad spectrum, but every once in a while we get a patient that's kind of a last ditch effort to see if we can help them. And we end up being able to help them, whether it's a patient that suffered third degree burns across their head and neck region, their whole body. And we need to make a prothesis that stretches their mouth to allow their mouth to open again so they can fit in something larger than a baby spoons to feed themselves. Or again, a patient might need a finger or a toe things like that are aspects of care that we can help with that well you might not think a dentist can do.

So if you ever run into any brick wall, and you're just wondering if there's something that might be able to be done, I might be able to help you. As far as what gets me excited is probably how we're involving technology in our care. Just yesterday, we had a patient for a jaw in a day procedure, and I'm not sure if Dr. Moreland had mentioned this in one of our previous podcasts, but essentially in, one day we take the patient to the OR, one of the surgeons will do the mandibularectomy and take part of the lower jaw out with the tumor. And then the other surgeon will do the fibula free flap reconstruction, but at the same time, place dental implants into the leg bone while it's still attached to the vasculature in the leg.

And then my team, the prosthetics team comes in there and we deliver, essentially we deliver teeth to the leg and then once everything's in place, we bring all of that up to the mouth. And then the microvascular team comes in and finishes the reanastomosis of the vessels. And the patient goes to sleep with teeth and wakes up with the prosthesis. And that's pretty exciting to me.

Host: Well, wow. It certainly is to me. Absolutely fanscinating. And do you just have any final thoughts for other providers on this exciting field that you're in?

Dr. Kase: I'm just happy to be here and happy to help. So don't be shy and reach out to me and see if I can help, because there's a good chance, I probably can.

Host: Excellent. Excellently said. What a great podcast. Such great information, Dr. Kase what a great guest you are. Thank you so much for joining us today. And a physician can refer a patient to UAB Medicine by calling the mist line at 1-800-UAB-MIST or by visiting our website at UABmedicine.org/physician. That concludes this episode of UAB Med Cast. For updates on the latest medical advancements, breakthroughs and research, follow us on your social channels. I'm Melanie Cole.