By Matt Westerfield
It began as a swollen red mark on his nose, but that swelling grew so fast that when 70-year-old Gladstone Jones of Waynesboro went to have it checked by a physician, the dermatologist said they had to take immediate action.
“He referred us to the ENT that day for a biopsy,” said Jones’ wife, Nina. That swelling, which Nina Jones originally thought was nothing more than a blemish, turned out to be squamous cell carcinoma and quickly progressed to the point where unthinkable surgery was required.
In April of 2011, Gladstone Jones had his nose removed by a head and neck surgeon at the University of Mississippi Medical Center’s Oral Oncology Clinic. But Nina was all smiles earlier this month when her husband received a brand new nose.
Thanks to the clinic’s growing expertise in designing and fabricating facial prosthetics, Jones received a lifelike silicone nose, modeled after his real one, which fits onto titanium implants in his nasal cavity.
“This is the third nose we’ve done, and the case was challenging but everything came together beautifully,” said Dr. Harold Kolodney, professor in the division of Oral Oncology and Biochemical Medicine at the Cancer Institute. “Mr. Jones has been very appreciative, very patient. He understood that this sort of thing takes time and it’s a team effort.”
After Jones’ surgery last year, Kolodney and his team used computer-modeling software to plan where the implants for the prosthetic nose would be screwed into the bone of the nasal cavity. Last fall, head and neck surgeons implanted the two titanium rods.
“The bone in the floor of the nose is not super-dense bone, so we wait four to six months for the bone to grow around the implants and make them solid,” said Kolodney, who has a dual appointment in the School of Dentistry as a professor of oral and maxillofacial surgery.
In the meantime, senior dental lab technician Gary Swedenburg designed the wax prototype for the prosthesis.
Kolodney said that ideally, they would take an impression of the patient’s real nose before it’s removed and make a mold for the new nose, but the tumor made that impossible. Instead, Swedenburg sculpted the prototype using only two pictures of Jones’ original nose. Jones visited the clinic in February and gave the team its first chance to see how well the prosthetic snapped onto the implants and how it looked on his face. “Once we get it fitted like we want, we’ll have a medical artist come in, and she’ll do the painting,” Swedenburg said during the February visit.
Jones was scheduled to return in March for the final fitting, but physical ailments kept him home in Waynesboro until he was well enough to travel.
Meanwhile, Swedenburg shipped his wax prototype to Stephanie Kline, an anaplastologist and digital surgical planner at the University of Michigan. Anaplastology is a small field of specialists who customize facial prosthetics.
Kline and Jones spent July 10-13 at the Oral Oncology Clinic to complete work on the prosthesis. After Kline and Swedenburg fine-tuned the wax nose with Jones present, they cast a stone mold, which would then be filled with silicone.
Instead of simply painting the nose once it had cured, Kline demonstrated how she combined the gel-like silicone with basic colors to create a skin-tone base color.
“This is the color that’s the undertone of his skin, and it’ll be the last color that we pack inside the mold,” she explained on the morning that the prosthesis was made. “All these colors will be painted into the mold; they’ll be catalyzed and they’ll set or cure, and we’ll get a rubber, silicone nose. We try to put as many colors and variations that are natural and match the patient inside the prosthesis so they cure and are inside the silicone.”
Swedenburg seized the opportunity to learn from Kline and build on his skills, which are relatively new compared to what he’s done most of his career. For 35 years, he worked in the family business his father started, Swedenburg Dental Lab, making dentures, crowns and implants.
“Three years ago, Dr. Kolodney came to me and asked, ‘How would you feel about making facial prosthetics?’ I said yeah, I need a change. I left the family business, and I’ve been having a good experience over here,” he said. “I get to talk to the patients, get to know them and see the final result.”
The final result for Jones was a hit. After curing two separate noses, Kline did some touch-up, or extrinsic, painting while Jones wore them to make sure they blended in perfectly.
“It looks very real. The rough draft looked pretty good, but this looks so realistic,” Nina Jones said. “We’re very grateful and appreciative. It’ll help his self-esteem greatly.”
“His wife said he wouldn’t even look in a mirror before this,” Kolodney said. “You can tell he appreciates it.”
FIELD OF DREAMS
Kolodney, who completed a fellowship in maxillofacial prosthetics at the Memorial Sloan-Kettering Cancer Center, said he’s happy to be working at this level after years in private practice.
“It was always my dream to have the opportunity to do this, and you can’t really do this kind of work out of an office. It can only be successful at an academic medical center where a program like this can really flower and reach its potential.”
Kolodney cites advances in digital technology that have allowed the program to work on cutting-edge prosthetics, including ears and orbital prosthetics, where cancer of the sinus cavity requires the resection of orbital bone.
“We want to be a program where everything is in-house,” he said. “Traditionally, people would have gone out of state to get this done. But with a complete cancer institute that includes otolaryngologists, oral and maxillofacial surgeons and oral oncologists, we are well-equipped to provide this service for the people of Mississippi.”