A day after being brutally attacked by an ex-boyfriend wielding a machete, a 20-year-old woman was rushed into an operating room at St. Barnabas Hospital to repair the devastation that had been done to her face.
According to Dr. Christopher Lane, the oral surgeon who treated her, “We couldn’t examine her at first because she was in so much pain. And we didn’t know the extent of how deep the laceration went.”
Using CT scans reformatted into “crystal clear” 3-dimensional images by the department’s Cone Beam CT technology, Dr. Lane was soon able to visualize the damage to the young woman’s face and formulate his surgical game plan. “The laceration went through her lip into her maxilla, cleaved off three or four millimeters of the inferior aspect of the zygomatic bone, fractured the right side of her nasal bones, and knocked out her lateral incisor,” he says. “It went through the skin and cut all the muscles. You could see the tendon cleaved right through. I’ve never seen anything like this. It was brutal.”
In the seven-plus hour reconstruction, Dr. Lane put surgical bars onto the young woman’s teeth in order to close down, reposition and stabilize the teeth; repositioned the maxilla; used a titanium mesh plate placed above the roots of the teeth; and lifted up and reduced the nasal fractures. Closure of the wounds and sewing and repositioning the muscles alone, he says, took more than two and half hours.
Several weeks after her surgery, the patient says she is doing much better. “I can open my mouth wider now and I can speak better. I’m not in any pain. I’m doing better.”
While she was still reduced to eating soup, beans and mashed potatoes, her ability to chew solid foods should return eventually, says Dr. Lane.
Planning for Battle
This type of digital technology, which is state-of-the-art in a hospital setting, has allowed SBH’s oral surgeons, orthodontists and prosthodontists to see the whole picture in 3-D and plan accordingly before they start working. This is tantamount to a battle commander who has the opportunity to scrutinize a map that includes the position of enemy forces before planning an attack. By offering benefits to the provider, the patient benefits as well.
“Everything is planned virtually now,” says Dr. Rebecca Sternberger, a prosthodontist at SBH. “This technology has existed for some time in some private dentists’ offices, but not as frequently in hospitals. With a digital platform, you push a button and everything is faster and more efficient. You know where you’re going; there’s no guesswork.”
The hospital’s Con Beam CT unit, which Dr. Sternberger calls “life changing” for patients, resembles what you would expect a time machine to look like. Furthermore, it is tied into the hospital’s radiology department where scans can be reviewed by radiology staff. This is particularly important in the case of patients who may require confirmation of a head or neck malignancy, to determine if wisdom teeth are too close to the nerves, or whether there is sufficient bone to place an implant. The experience is seamless for patients, who remain in the dental chair while the images are examined. It also exposes the patient to less radiation.
Implant patients of prosthodontists like Dr. Sternberger benefit as well through the digital technology. Through the use of iTero, a wand-like device, crowns are designed in a far more cost effective and efficient method for provider and patient. “You can check for errors in the impression real time when the patient is still in the chair,” says Dr. Sternberger. The wand captures thousands of frames per second of the patient’s mouth, which are pierced together to create a three-dimensional visualization.
Another piece of new technology, the Cerec, which scans and designs, is expected to arrive shortly. “It takes a minute or two to scan it, you design it in a couple of minutes, and it takes about 45 minutes, depending on the material (usually resin or ceramic based), before it’s ready to go. You know where you’re going. There’s no guesswork.”
As for an oral surgeon like Dr. Lane, the ability to plan his surgery virtually removes the guess work.
“You couldn’t see the whole picture before, instead you’d see one area at time and have to scroll down like in a storybook. When you see it on 3-D, you can plan before you start, you can see the extent of the injuries and plan everything virtually.”
This is especially important with the young woman who suffered serious traumatic injuries.
“She is very fortunate in that the facial nerve was not affected, and she has good facial animation,” he says. “She’ll have scarring, but she should heal. She has no visual problems, good lip contour and some paresthesia of the nasal area that is not painful. The trauma might be the most difficult thing she will have to live with.”