Stop by Michigan Technical Implant Prosthetics Unlimited in Clarkston, Michigan, and, chances are, you'll think you've stumbled upon a Hollywood special effects set. But don't be fooled. The lifelike silicone ears, noses and eyes in the laboratory are much-needed facial prostheses for real people.
Owner David Guelde, CDT, MPT, trained as a dental technician at Ferris State University and as a maxillofacial prosthetic technician at Indiana University's dental technology maxillofacial prosthetics program. While the bulk of the lab's work is complex implant cases, he and his two staff technicians also fabricate artificial facial prostheses for patients who are missing body parts as a result of a birth defect, injury or cancer, and can also fix the dental problems that often accompany them.
For example, many of the lab's cancer patients have had surgery to remove part of their face or head--leaving a large cavity--and they also often need new teeth due to radiation treatment. Receiving radiation to the head and neck can permanently damage the major salivary glands, causing saliva to lose its ability to destroy bacteria, resulting in rapid tooth decay, or radiation caries. Other patients have suffered severe trauma. For instance, Guelde will soon fabricate a nose and ears for a young child whose abusive mother put him in a pot of boiling water.
"Some of our patients' defects are so severe that many of them won't even leave their homes," says Guelde, who once recreated half of a patient's face, including an eye, nose, cheek and upper lip. "Our prostheses are amazing. We can make an ear that looks so real that from two feet away you can't tell it's a prosthetic. We help patients feel comfortable going out in public again."
For all the faces Guelde and his staff--including Carole Hicks, Shelley Connors and Raymond Walker--rebuild, many more people go untreated; very few technicians are trained in this specialty, and the prostheses are expensive and not covered by insurance.
Most of the lab's patients are referred to them by general dentists and other doctors. Since the lab only takes a very small number of facial prosthetic cases each year, Guelde interviews each patient to determine which cases he'll take on. Once accepted, the patient comes directly to the state-of-the-art facility Guelde built in 1997 which even features a color-corrected solarium for shade matching the prostheses to the patient's skin.
Just like a dental restoration, each facial prosthesis is custom-designed for the patient and looks amazingly realistic. For instance, eye prostheses feature real human hairs for the lashes and eyebrow, while nasal prostheses even have actual, open nasal passages so the patient can breathe normally.
The fabrication procedure is also similar to dental laboratory techniques. While the patient breathes through a straw, Guelde takes a moulage--or facial impression--with a fast-setting pourable silicone. He then makes a model of the face with die stone and sculpts the missing portion out of flesh-colored modeling clay, referring to past photos of the patient or even pictures of other people's facial features the patient wants Guelde to emulate.
Then comes the most difficult part of the process: the patient returns for a try-in, and Guelde makes any requested alterations. "Most of our male patients are just happy to get a nose, but for some women it's about getting the ultimate nose, and it can be very time consuming to get the final approval," says Guelde, who sometimes fabricates several different nose shapes to speed the decision-making process.
Once the device is approved, he fabricates the final prosthesis out of a medical-grade silicone that is impervious to ultraviolet light and can withstand heat up to 500o. To make the material look like natural skin, he uses a custom milling machine to mill color, texture and other custom details--like freckles or moles--into thin, transparent silicone sheets and builds the prothesis in layers. After curing for 14 hours, the final prosthesis is delivered to the patient. The prostheses can be held in place by a special paint-on adhesive or by magnets that adhere to implants in the patient's bone; patients can even swim with them in place. Every two weeks, the prosthesis must be removed and cleaned with soap and water, and most will last the patient a lifetime.
Guelde and his staff also design other cutting-edge appliances that address their patients' special needs. For instance, since chronic dry mouth is also a side effect of radiation-damaged salivary glands, the lab fabricates dentures with small, refillable reservoirs of artificial saliva that the patient sucks on to lubricate his mouth. Another appliance, a silicone tube, helps reduce the damage caused by radiation. The tubes carry rods that pinpoint the radiation directly on the tumor and lessen the damage to the surrounding area, including the salivary glands.
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