Borrowing from special effects techniques used in the movies, facial prosthetics are now virtually indistinguishable from the real thing.
Henry Fiorentini lost his ear to cancer, but you’d never know it by looking at him. Whether playing hockey or flying high, he lives an active lifestyle, but a few years ago a very common form of skin cancer, basal cell carcinoma, almost took his life.
The cancer started on his right ear. Fiorentini lost his hearing and his ear. Despite multiple surgeries, the cancer remained, along with a mass of scar tissue.
“It’s like, wow, there it is on a direct path to your brain. Good bye life. It’s kind of scary to say the least. No one else in the country really wanted to do this surgery.” Fiorentini told Ivanhoe.
Dr. Sam Marzo of the Loyola University Health System in Chicago says Henry risked paralysis if his facial nerve was cut, but Marzo successfully removed the cancer, and with advances in prosthetics you’d never know what Fiorentini had been through.
“If you think about the special effects industry in movies, those kind of materials are now available for patients.” Marzo told Ivanhoe.
Easily removable, Fiorentini’s ear is made of silicone. From birthmarks to blood vessels, his ear looks just like the other.
“Let me tell you, nobody can tell that this is a false ear.” He said.
The silicone prosthetic ears last from three to five years. Dr. Marzo says 3D printers and scanners are on the horizon to quickly create an exact mirror image prosthetic when the ears need to be replaced.
EAR DEFORMITY: Ear deformities don’t only occur at birth but can also be acquired through an accident or trauma. Some have ears too large (protruding) or a part is folded in (constricted) and some have a deformity in the ear canal itself. A common ear condition in children is that of microtia which happens at birth and keeps the ear from developing the correct way. What the child is left with is an ear that’s like flower bud that hasn’t yet bloomed. Microtia occurs in about one out of every 6,000 births and occurs in both of the child’s ears in 20 percent of the cases. Source: http://www.chop.edu/service/plastic-and-reconstructive-surgery/conditions-we-treat/ear-deformities.html)
EAR TUMORS: There are three main cancerous tumors that require surgery on the ear. Ear canal cancer causes the canal, eardrum and hearing bones to all be removed. Complete hearing loss takes place. A glomus tumor is a benign tumor that forms behind the ear drum and can cause damage the functions of the ear and face and if left untreated, could travel to the brain. Acoustic neuroma is a type of ear tumor that forms in the canal between the ear and the brain. If the tumor is small enough, hearing can sometimes be preserved in this procedure. (Source: http://my.clevelandclinic.org/head-neck/diseases-conditions/tumors.aspx)
NEW TECHNOLOGY: Prosthetic limbs have been around for years but now doctors are providing prosthetic ears to children and adults that have malformed ears or have lost them due to infection or disease. Ears that have been lost to ear cancers can now be replaced with replicas that look like real ears. The prosthetics are made of light silicone that give them a soft rubbery feeling similar to a real ear and also manage to replicate the blood vessels and skin tone exactly like the person’s other ear. Greg Goin at Medical Arts Prosthetics in Wisconsin has made this prosthesis which can be easily removed and put back on via three tiny magnets. This technology is giving people with deformed or missing ears hope. Doctors and patients alike are calling the new prosthetic ears virtually undetectable to the average person and a dream come true. (Source: http://www.medicalnewstoday.com/releases/142922.php)
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Loyola University Medical Center
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Sam Marzo, M.D., Professor of Otolaryngology, Head and Neck Surgery.
If you could tell us a little bit about Henry’s case and what made it unique.
Dr. Marzo: Sure, Henry came to us with a cancer of the ear and the first time we saw him he had an open wound with a bandage over it and exposed bone. He had multiple surgeries and my concern was that he had persistent cancer in that area. He came to me asking us if we could close the wound and I said I didn’t think that was a good idea because I thought there was still cancer in there and I recommended further surgery for him as well as reconstruction.
So he had been through several surgeries before that?
Dr. Marzo: He had several surgeries and the last surgery had removed his ear and gone in to the area called the temporal bone in part of his skull. That’s how he came to me because I’m an ear surgeon so he had wanted us to try to reconstruct him and I said that’s not a good idea. I told him we should get all the cancer out first and then we can reconstruct.
What made his case so complex when you actually went in to do that surgery?
Dr. Marzo: He had gone as a lot of patients do to get other opinions and nobody else in the country really wanted to do his surgery. They kind of just wanted to radiate him and hope it would heal but with the exposed bone and everything there was no way it was ever going to heal. He was going to have a chronic wound that was draining and causing problems and we didn’t want that to happen. What made the surgery challenging was that there was a nerve right in the middle of the field called the facial nerve that controls the movement of your face and your eye. It’s important for your appearance as well as eating and functioning. That nerve had to be found with very few landmarks and then traced out and preserved. That’s why a lot of other people in the country were kind of afraid to tackle that surgery.
At this point he had already lost his hearing in his right ear because of the cancer?
Dr. Marzo: He was deft in that ear and had an open wound that was draining, had no ear and I believe had cancer in the field.
Can you describe what you had to do that made it so different?
Dr. Marzo: We had to do a couple of things. The first thing is cure him, get rid of all his cancer. We had to go find the important structures like the facial nerve and his balance canals as well as his carotid artery in his neck and preserve all the important structures and then take everything out lateral to that. We took out his temporal bone which is the bone on the side of your skull preserving the brain and the import structures in there. We had to preserve his facial nerve so we found it within the temporal bone and traced it out into the carotid gland. We took out his carotid gland as a margin and he did have cancer in the carotid gland so it was good we did the surgery. We also did a neck dissection to make sure he did not have any spread of disease into his neck and he did not. Once we took all the cancer out, I then had my partner come in and bring a flap up to reconstruct that area, to seal it and close it so that he would not have a draining wound or pain or things like that. We let him heal up. His stay in the hospital was very uneventful, he went home and then we gave him radiation therapy afterwards just to make sure that everything was addressed. Sometimes these cancers can have little microscopic extensions. We did the radiation therapy and he tolerated that well and he’s been cancer free for many, many years. Once he completed his therapy we were able to reconstruct him. So we put in some prostheses which allow a silicone artificial ear to be placed on the side of his head.
How long does it take it to heal in between getting the prosthetic and that?
Dr. Marzo: We did the surgery first, then waited six weeks and did the radiation therapy and waited six months for the wound to totally heal. We worked with an anaplastologist to make the artificial ear and I put the implants in so that we could put his artificial ear into place.
And that’s all through a magnet?
Dr. Marzo: It’s held in place with a magnet and clips basically.
Can you tell me how that would work?
Dr. Marzo: In the past people would just glue the ears on but sometimes the glue didn’t stick or if they got sweaty the ear would fall off and that’s not something you want when you’re at a restaurant or something like that. By putting in implants, we put three implants in and then the implants allow for the prosthesis to snap on and to be held in place with a magnet. Then it’s not going to go anywhere, it’s going to stay in place, he will put it on in the morning and take it off before he goes to bed.
So it’s easily removable?
Dr. Marzo: Easily removable and very cosmetic. Sometimes when you look at him you forget which side you operated on. So he now has a very good quality of life and he’s cancer free. So it was a win-win for Henry.
And he’s been cancer free for how long now?
Dr. Marzo: Seven or eight years now.
When you first met him there was so much scar tissue, can you talk about that?
Dr. Marzo: Correct, when we first saw him he had basically an open wound with exposed bone. His skull was exposed. Somewhere in there was the facial nerve but the normal landmarks that we use to find the facial nerve were all gone. I had to basically use his balance canal which was his only landmark left to find the nerve there and preserve the nerve and then I traced the nerve out from here all the way out into the carotid gland and traced out on the branches so that we could safely preserve that nerve and take out the tumors. It was challenging and took several hours to do that. We used a monitor to help us stimulate the nerve and identify the nerve from scar tissue but it went really well.
Has anything changed in the way that you do these surgeries now since that was a few years ago?
Dr. Marzo: Well we’re all fortunate in that I have a team of partners who can help me. We have plastic reconstruction surgeons in our department to help put the flaps in place to close these big defects. I don’t have to worry about his cosmetic aspect of things so I can go in and take all the cancer out and then my partner is going to come in and be able to reconstruct and give him a very good functional outcome.
I was wondering if there’s anything new to the story.
Dr. Marzo: The new to the story is that these prostheses are relatively new and if you think about the special effects industry in movies those kinds of materials are now available for patients. Silicone ear impressions and other things like that so that we can make an ear to match the other side and it will look just like the normal side. There is an anaplastologist that I work with who makes the prostheses that we use.
It’s interesting how it’s almost borrowing from Hollywood.
Dr. Marzo: Yes, it is. You think about all those special effects and all that and those same materials are now available in the medical industry, it’s great.
So the ears just made of silicone?
Dr. Marzo: It’s silicone and it should last five or six years or so. We make it based on his other ear. We take an impression of the good ear, reverse it, and make the new ear, then we use a template to match it up so that it’s the same level on both sites.
So where how was the cancer spreading?
Dr. Marzo: The scar tissue was around the facial nerve. We had to trace the branches out by following each one of these, there’s five different branches so the nerve comes out at the bottom of the temporal bone. We had to trace out all of the branches and take the cancer out that was lateral to that nerve and around that nerve and preserve that nerve. This is the skull and this is the actual size of the human skull and then this is the actual Temple bone where his cancer was. This is the ear canal and his cancer was in the ear canal so we had to basically take this bone out of the skull to get access to this tumor and get this whole tumor out.
Is this something that you normally see with this type of cancer, the basal cell skin cancer?
Dr. Marzo: No, for most people it can be, but the way the ear develops, it develops from six little areas and they kind of fuse together. In between those areas of fusion the tumor can go deep because it just doesn’t form from one cell. It goes through six different areas of budding and these tumors can grow deep on those planes of fusion and that’s what happened, it went deep and nobody realized. You have to get the deep margins; otherwise it will come back and spread.
But it’s normally not something that would be quite as malignant?
Dr. Marzo: Basal cell cancer is malignant and is the most common type of skin cancer. Most of them just grow locally and don’t spread deep. If it gets in a tricky area like the ear it can spread deep and so that’s what they were doing with Henry the first time. They were chasing the tumor and unfortunately I don’t think they were prepared to deal with it.
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Sam Marzo, MD
Loyola University Health System
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