Patient Care: A Team Effort

Concepcion Barboza, D.D.S., Susan Horta with patient Terri Davis
Prosthodontist Concepcion Barboza, D.D.S., and Susan Horta, senior dental assistant, celebrate with patient Terri Davis (center) who completed extensive reconstruction treatment after battling tongue cancer.

Dental Specialists Help Patient Triumph Through Cancer Battle

By Catherine Duncan

In 2017, Terri Davis of New Braunfels went to a local otolaryngologist after she noticed a recurring spot under her tongue. After performing a biopsy and determining it was cancer, he referred her to Frank R. Miller, M.D., FACS, director of head and neck surgery at the Mays Cancer Center, home to UT Health San Antonio MD Anderson Cancer Center. He is an expert in cancer of the tongue.

At the time, Davis had no idea that this suggestion would lead her to a compassionate, specialized team at the School of Dentistry as well as colleagues across UT Health San Antonio.

Daniel E. Perez, D.D.S.
Daniel E. Perez, D.D.S., oral and maxillofacial surgeon (left), was part of an interprofessional team providing care to Terri Davis before, during and after cancer surgery and reconstruction.

Dr. Miller, professor of otolaryngology—head neck surgery and the Thomas Walthall Folbre, M.D. Endowed Chair in Otolaryngology, examined Davis and recommended UT Dentistry at the Center for Oral Health Care & Research for the dental part of her treatment. For the first phase, Daniel E. Perez, D.D.S., oral and maxillofacial surgeon, and OMS residents removed her lower teeth.

“I had my first surgery in August 2017. Dr. Perez pulled all my lower teeth so Dr. Miller would have access to be able to remove the cancer,” Davis said. “In September 2017, Dr. Miller performed a partial glossectomy to remove the cancer from my tongue. At that time, he also removed all of my lymph nodes so he could test them to see if the cancer had spread.”

Dr. Miller said Davis had an oral tongue cancer on the front interior part of the tongue. “Although her first doctor had removed the cancer, it grew back on her tongue. Complex cancer like this is referred to us at the Mays Cancer Center. In these cases, the patients need multidisciplinary care. Our oncologists, physicians and dentists work in a very collaborative environment,” he said.

By working together, Dr. Miller said the specialists at UT Health San Antonio can help patients through cancer care and then assist them in returning to a functional level for everyday life.

While spending two weeks recovering in intensive care, Davis learned there was no cancer in her lymph nodes, and she wouldn’t have to undergo radiation. She underwent two procedures on her tongue by Howard T. Wang, M.D., UT Health Physicians plastic surgeon and division chief. Dr. Wang first did microsurgical reconstruction of the cancer defect immediately after Dr. Miller finished his procedure using an anterior lateral thigh flap to rebuild her tongue using skin from her thigh. Later on, the flap was revised for better contour and fitting of teeth in a second procedure.

In July 2018, Davis returned to UT Dentistry so that Dr. Perez could surgically insert four implants in her lower jaw. Concepcion Barboza, D.D.S., UT Dentistry prosthodontist, created a temporary prosthesis, which most patients usually wear only for three months while the permanent bridge is created.

Pre operation photo
PRE-OP — Patient’s mouth is shown after initial OMS surgery to remove the lower teeth so tongue cancer could be surgically removed.

“Because of the removal of my bottom teeth and most of my tongue, my top teeth had shifted. I chose to have one year of orthodontic work to correct the alignment of my top teeth,” Davis said. “This meant I had to delay getting my permanent bottom bridge until the top teeth were realigned.”

The orthodontic work was performed by dental graduate Jerome “Jay” Gibson, D.D.S. Class of 1989, at his private practice. (Dr. Gibson volunteers once a month at the dental school clinic.) Once the top teeth were in their new permanent location, Dr. Barboza was able to create a permanent lower bridge to fit perfectly with the newly positioned upper teeth and with her shortened tongue.

While the temporary prosthesis was acrylic and more bulky, the permanent prosthesis has a sleek titanium bar covered in acrylic. In August 2019, Dr. Barboza was able to install the permanent prosthesis, ending a more than two-year treatment period.

“I love my new permanent teeth. They feel great,” Davis said, who was interviewed the day she received the permanent bridge. “I can touch the top of my mouth a little bit now. I hope my ability to eat, swallow and speak will improve even more. This prosthesis is much more streamlined.”

Sporting a huge smile, Davis said she truly believes she had the best team of doctors, including Drs. Miller, Barboza, Perez, Gibson and Wang. “They are all here, and they all talk to each other.

Post operation photo
POST-OP —The completed treatment features four implants in the lower jaw to anchor the permanent, streamlined prosthesis.

“I have to admit that when Dr. Miller first recommended that I get my dental treatment at the dental school, I was hesitant. But Dr. Miller told me that if he needed such treatment, he would come here. He would send his family members here. I decided to trust him. I’m so glad I did.”

Dr. Barboza said Davis was able to participate in an implant study on quality of life so the cost was reduced. The study involves a questionnaire before the implants and one after the procedures are completed. “Not only are we able to do research, we are also able to help improve the patients’ quality of life.

“When we put the permanent prosthesis in Terri’s mouth, she started crying. My senior dental assistant, Susan Horta, started crying. It was wonderful to see Terri cry with happiness. She is much more confident in her appearance and can talk more easily with others.

“We are so fortunate to be at a place where we are teaching and serving patients. We get the more complicated cases here. It is so challenging but so rewarding because we can provide the care.”

Edward Ellis III, D.D.S., M.D., professor and chair of oral and maxillofacial surgery, said his department is fortunate to have many great faculty members, including Drs. Barboza and Perez.

“They treat patients with routine needs stemming from tooth loss but also patients with complex needs stemming from jaw injuries, jaw resections and reconstructions because of tumors, infections, etc. Our dental implant program develops and implements treatment plans for patients who require prosthetic reconstruction. We truly are able to make lives better for our patients.”

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In the 2019 issue of Salute

Salute is the official magazine for the alumni and friends of the School of Dentistry at The University of Texas Health Science Center at San Antonio. Read and share inspiring stories highlighting our dental alumni, faculty and students who are revolutionizing education, research, patient care and critical services in the communities they serve.

View the 2019 issue

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