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Doctor
puts a smile on elderly faces
Cape
Argus news
October
22, 2003
A Cape Town-based maxillo-facial and oral surgeon is giving new
hope to aged patients, having devised a technique that allows them to
regrow bone in their jaws where it has thinned.
The crone-like profile, common in children's books about witches whose
pictures show their jaws almost connecting with the ends of their noses,
is certainly no joke for the elderly who lose bone-mass in the jaw.
Not only do they lose their teeth, but wearing dentures becomes
increasingly uncomfortable without a solid jaw to rest on.
It is exactly these people to whom Dr Rushdi Hendricks's innovative work
in
Cape Town
is offering new hope.
Hendricks, a maxillo-facial and oral surgeon working at the Newlands
Surgical Clinic in Claremont, published his findings earlier this year in
the International Journal of Oral and Maxillo-Facial Surgery, the official
publication of the International Association of Oral and Maxillo-Facial
surgeons.
Simply put, his technique allows patients to regrow bone in their jaws
which has thinned, or resorbed, with age or after early loss of their
teeth.
It's a major step forward from the older technique of taking bone from the
hip to augment the jaw in order to house dental implants.
The principle of regrowing bones lies in the work of Russian orthopaedic
surgeon Gavriel Ilizarov who presented his famous research illustrating
bone-lengthening devices on long bones in
London
in 1988.
He had discovered that bone could in fact be stretched. When a bone is
broken, the new bone that forms to heal it is called callus which is a
jelly-like bone cement that can be carefully stretched while it is still
soft.
What makes Hendricks's work especially difficult is the Inferior Alveolar
Nerve, which runs inside the jaw under the gum. It's this nerve that has
put other surgeons off following his technique because of the risk of
potential permanent nerve damage.
But that didn't deter Hendricks who, in 1993, designed the operation. He
performed 40 procedures before presenting his results at an International
Conference in 2001. He cut laterally through the bottom jaw, moving the
nerve out of the way and then built up the jaw with hip grafts in a
"sandwich" technique.
Also in 2001, he began to fine-tune his technique, swopping the hip graft,
which is naturally uncomfortable for patients, for the bone-stretching
method of the Russian Ilizarov.
Called Distraction Osteogenesis or Callotasis, the technique pulls apart
vertically the two parts of the lower jaw, which Hendricks has cut in
half, and from which he has removed the vital nerve that runs from either
side into the cheeks.
Once the distraction device is in place, Hendricks says, patients are
given a tiny screwdriver which they turn 1mm a day, for between 10 and 12
days.
"That 1mm that the screws are turned translates to a bone growth of
1mm a day. In the entire time, patients will grow between 1cm and 1.5cm of
new jaw bone," Hendricks explains.
After that, the gum and jawbone is left alone for three months to allow
the bone to consolidate.
Hendricks' findings showed that in the 40 cases of the study, the nerves
of all patients had recovered fully by six to 12 months later.
"It's a breakthrough to give patients with dentures new life. After
three months we can place five dental implants in the jaw and onto that
you can construct a full bridge of teeth or an overdenture system.
"These patients are eating apples and biltong - and they've got a
lower facelift as well.
"Also there is hardly any post-operative pain as the nerve is stunned
and by the time feeling returns the mouth has already healed,"
Hendricks told the Cape Argus shortly after returning from Johannesburg
where he conducted a two and a half hour teaching programme for about 140
dental colleagues, including orthodontists, maxillo-facial surgeons, and
other oral health specialists.
He also conducted a live operation for 50 colleagues who watched from a
room alongside the operating theatre at the
Lenmed Private
Hospital
.
To date, Hendricks has moved more than 100 Inferior Alveolar Nerves to
conduct the jaw bone regrowing technique, and he says there has been
nothing but praise from the elderly people for whom his work has meant,
literally, a whole new smile.
Sam's story
Our son Sam was born with what a plastic surgeon described at the time as
'the biggest cleft palate he'd ever seen'.
Today he is a happy and healthy seven-year-old with a full palate - thanks
to the wizardry of that same plastic surgeon.
Sam was born by emergency caesarean after 16 hours of labour. My wife
Melanie and I were exhausted, so the paediatrician's news that our first
child was not 'perfect' was a numbing blow.
The immediate problem was feeding: without a palate, Sam could not suck.
We soon found ourselves in the surgery of an orthodontist who provided us
with a made-to-measure plastic prosthesis, which Sam had to keep in his
mouth all the time.
Before long we were also equipped with squeezy feeding bottles ordered
from the Cleft Lip and Palate Association in the
UK
, and we finally found teats that Sam could manage, although we always had
to enlarge the holes in them with a sterilised needle.
Sam was permanently hungry, because he simply wasn't able to take in
enough milk to satisfy himself. Feeds often lasted for three or four
hours.
He responded to his hunger by crying for hours, every day. One way to stop
him crying was to take him for long walks in his pushchair.
I returned from a 90-minute walk round our neighbourhood one Sunday
morning to find the prosthesis missing from his mouth - and he desperately
needed to feed.
In a panic, I retraced my steps backwards and found the plastic plate
lying undamaged in the middle of a road.
Sam dribbled constantly and copiously. During feeds, at least 50 percent
of the milk we managed to get into his mouth came out again before
reaching his throat.
We had to wait eight long months until he could be operated on. The time
was needed to allow growth of tissue on the margins of his cleft. This
tissue could then be used in the creation of a palate.
The operation went well, but before long a new cleft developed in the
'manufactured' palate.
In spite of this, his ability to feed improved dramatically, we tossed out
the plastic palate and he started to gain weight rapidly. A second
operation was needed seven months after the first.
Today Sam is left with an almost invisible hole in the centre of his
palate. He is able to push air back and forth between his mouth and nose
through this gap.
In a couple of years he may have a minor operation to eliminate the gap
but the surgeon hopes it will close on its own. Speaking difficulties are
common in children born with cleft palates, but a therapist who assessed
Sam said his speech was better than most children his age.
Orthodontic problems are also common but so far Sam's teeth are coming
through well-spaced and even.
Cleft palates have a radical effect on the lives of children and parents
alike.
The good news is that surgical skills and techniques mean a normal life is
nearly always the outcome.
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