CDA Essentials 2018 • Volume 5 • Issue 4

29 Issue 4 | 2018 | I ssues and P eople move three millimetres to the right, you can change the position of the implant on the computer and it will navigate you three millimetres to the right,” Dr. Somogyi-Ganss says. “It’s very flexible.” A difference of even just a few millimetres can make or break a surgical implant, according to Dr. Higgins. “Some of these patients don’t have a lot of bone left or they’ve had radiation therapy, and so, the bone is less reliable and is thin,” he explains. “And you can’t put the implant in air — like an eggshell of bone with air underneath it — because it won’t take. It won’t stay or it will just get infected. It’s like hanging a picture on a thin wall. It won’t work; you need an anchor point.” He hopes the new navigational system will take an already accurate surgical procedure and make it even more precise, while also making the pre- operative experience easier on patients by eliminating an extra CT scan and the need for a mask. All of this lays a solid foundation for the next step in the process. “The real essence of the program is the prosthetic. If the anchor points are stable, the anaplastologists can make the rest happen,” says Dr. Higgins, referring to the specialists who make prosthetics. “That’s where the artistry is.” Dr. Somogyi-Ganss notes that the Craniofacial Prosthetics Unit team is like a village. “It takes the whole team to plan, make the prosthetic, execute the surgical implant and then place the prosthetic properly. It’s not a quick fix,” she says. “But if you make and fit an implant-retained prosthetic for a patient who has trouble wearing a glue-on one, that’s a major victory for all of us.” Dr. Higgins agrees. “If you can imagine someone who’d otherwise be covered in a mask or not going outside [and] completely socially withdrawn, to now be able to go out into public and be treated like any other human being, to re-enter the workplace, to have a social life — that is quality of life, which is immeasurable. As we advance our ways of treating traumas and cancers, we must advance the ways we provide quality of life, too.” After the surgery Brenda continues to adjust to life with a visual impairment. A hair colourist and technician before her injury, she can no longer work in that field. She has, however, found joy in other things — acrylic painting in bold colours, attending Blue Jays games with her husband, Michael, and travelling down south each year. As her implants stabilize over the coming months, Brenda is waiting patiently until she can start the next step of her magnetic prosthetic – the modelling, painting and fitting. “This one wasn’t life-saving surgery, but it was life-changing surgery. I’m so excited for my new prosthetic,” Brenda says. “People have always been kind since my injury, but it’s always about my face. I get lots of questions. It’ll be nice to be in the world and it won’t always be about that.” a Inside Sunnybrook’s Craniofacial Prosthetics Unit Sunnybrook’s Craniofacial Prosthetics Unit (CPU) is the only multidisciplinary clinic in Ontario where surgeons, dentists and anaplastologists work as a team. The only other unit like it in Canada is in Edmonton (University of Alberta – Institute for Reconstructive Sciences in Medicine). Sunnybrook’s CPU team is made up of two anaplastologists (specialists trained in the art and science of creating custom prosthetic devices), two head and neck surgeons, a coordinator and a maxillofacial prosthodontist (a highly specialized dentist who is an expert in the prosthetic rehabilitation of patients with facial differences due to trauma, cancer or congenital malformation). The team makes and fits about 50 prostheses per year for a mix of new patients and existing patients. Prostheses last about two years before they start to wear out and undergo colour changes. Patients come from all over Ontario and some from other provinces and even beyond. Prostheses for Ontario residents are partially funded by the Assistive Devices Program of the Ministry of Health and Long-Term Care (75%) with the balance being the patient’s responsibility. This is the first year that surgical implants will be 100% funded by the Ministry of Health and Long-Term Care for Ontario residents. Sunnybrook’s team will treat about 15 patients with surgical implants this year. Reasons for requiring a facial prosthesis: • 44%: cancer • 37%: congenital • 14%: trauma • 5%: other It takes the whole team to plan, make the prosthetic, execute the surgical implant and then place the prosthetic properly. It’s not a quick fix. – Dr. Eszter Somogyi-Ganss