SCIENCE
New nose
for a cancer survivor
Christy K. Robinson
 |
| Mrs. Keniston as she appeared before cancer surgery. |
After losing
her nose, palate and upper teeth and lip to cancer surgery, 83 year-old
Betty Keniston came to Loma Linda University School of Dentistry to get
a new nose and an obturator to allow her to speak and eat normally again.
To accomplish this complex treatment, a team of LLU faculty
dentists worked together: Philip Boyne, DMD, oral and maxillofacial surgeon;
Mathew Kattadiyil, BDS, MS’99, and Wayne Campagni, DMD, prosthodontists,
James Nethery, SD’65, maxillofacial prosthodontist andclinical director
of the School of Dentistry’s Dental Oncology Service; and the late
Dr. Robert James, the founder of the School’s Implant Dentistry Clinic.
In addition, laboratory services were provided by Dr. Bill Westrick, Luis
Carillo, and Gary Hill, dental technicians.
For six years, since she lost part of her face to cancer,
the petite 83 year-old Betty Keniston lived with a large cavity in her
face, covered by a bandage. Without the bandage, one could see a cavity
reaching from the bridge between her eyes, to her tongue and lower jaw.
Now she has a new acrylic palate and denture (an obturator) and a prosthetic
nose to allow her to appear normal when she looks in the mirror or ventures
out into the world.
The prosthesis is not just for looks. Mrs. Keniston has
had trouble speaking, eating and drinking since the cancer surgery. To
drink, she had to use a syringe to squirt the liquid into her mouth. To
eat, she had to “shove” food in, she said.
The combination of rhinectomy and bilateral maxillectomy,
done in 1991 at the University of Arizona, is very rare in North America,
according to Mrs. Keniston and her doctors.
In 1928, when Betty was 13 years old, she received radiation
treatment for blackheads on the skin around her nose, a therapy commonly
used in the early days of radiologic medicine. “At that time,”
Mrs. Keniston said, “they gave x-rays to kids with acne. It was done
very carefully, measured and timed. They just didn’t know in 1928
that it could have such devastating effects later.”
Mrs. Keniston remembers having a “very nice complexion”
up until the age of 40, at which time she had the first of many cancerous
lesions removed from her face, including part of one nostril.
“The doctor gave me a local anesthetic,” she said matter-of-factly.
“He’d peck, peck, peck at the lesion, and then go to the pathology
department. He’d come back and peck some more, looking for healthy
tissue. By the time he finished, a space about this big [the size of a
small lima bean] was gone. It was small enough to cover with a Band-aid.”
 |
| Dr. Nethery checks the edges of the silicone nose before replacing it on Betty Keniston’s face. |
The basal cell carcinoma, a painless skin cancer which is
thought to have begun with the 1928 radiation exposure, reappeared many
times over the years. Three bulges appeared under the skin on the side
of Mrs. Keniston’s nose in the late 1980s, just before she moved
to Tucson. Her dermatologist and plastic surgeon told her that her entire
nose would have to be removed.
How did Mrs. Keniston take such an emotional blow?
“I took it in stride. The real surprise was that they
had to take my palate, too. My doctor wondered how I’d cope with
it,” she recalled. “I have a sense of humor, which is the greatest
gift God can give a person. And I’m very aware of my blessings. A
lot of good things have happened to me. Little things are very important:
they make up a life.”
After the radical surgery, Mrs. Keniston came to Loma Linda
to begin a series of reconstructive surgeries and maxillofacial prosthesis
to repair the cancer damage.
“Betty’s condition was too complex to treat in
a private practice,” said Dr. Kattadiyil. “She needed a dental
school like LLU with all its specialties represented on the premises.
“When Betty came here, she was feeling hopeless about
her situation,” he continued. “I was given a free hand to design
her prostheses. Dr. Campagni was involved in the designing of the metal
framework for the prosthesis, which was the most critical part.”
Keniston’s primary surgeon here, Dr. Philip Boyne,
used bone marrow from Keniston’s hip to form bone as a basis for
the implants.
“She’s been a tremendous patient,” said Dr.
Boyne. “During all this time, she’s had a great sense of humor
and ability to take setbacks and still persist. Many patients would have
just decided to go the easy way and live with a bandage. She’s a
little dynamo.”
Keniston can breathe through her new nose, and with the
obturator, she can eat, drink and speak normally.
 |
| Mrs. Keniston, right, with Drs. Philip Boyne, James Nethery, and Mathew Kattadiyil, on the day she received the final prostheses. |
Dr. Kattadiyil made an impression of the nasal cavity, and
sculpted a “wax-up” nose. He, Dr. Nethery, Dr. Bill Westrick,
dental laboratory director, and Luis Carillo, a dental technician, consulted
with Excel Dental Laboratory on the best mold, shape and color for the
prosthesis. Magnets were imbedded in the silicone nose, and when it’s
placed on her face, the magnets “grab” the metal ends of the
implants inside the cavity. A little adhesive seals the plastic edges
to Keniston’s cheeks, and she’s ready for makeup.
In response to the publicity and photographs surrounding
the completion of her surgeries,treatments, fittings, and makeover, Mrs.
Keniston joked to her prosthodontist, Dr. Kattadiyil: “I think you’re
going to start selling more noses now!”
A prosthetic nose usually lasts about one year and then
has to be replaced. Discolorations can occur in strong sunlight and exposure
to cigarette smoke. Mrs. Keniston sleeps without the nose and has to carefully
clean all the attachments.
Mrs. Keniston enjoys socializing with her friends, going
to movies, playing cards, shopping and sightseeing, and she loves to have
company in her home. Now that she can speak more easily, and eat and drink
normally, she expects to live a full life. “I don’t want to
stagnate. I should grow, and start a new life,” she said.
Little things taken together really do make up a life. The
four foot-nine inch, energetic, 83 year-old Betty Keniston will tell you
that.
The following article called Clinical team approach to treatment of post-oncologic surgery patient describes some of the clinical aspects of the treatment of Mrs. Keniston.
All contents copyright © 2001 Loma Linda University.
All rights reserved. Revised February 14, 2001
Send comments and questions to webmaster@univ.llu.edu
URL: http://www.llu.edu