“MaxFac” Clinic: Restoration of Faces, Voices, Dignity

Patients with severe maxillofacial defects caused by trauma, cancer, or other diseases and those who can no longer speak due to neuromuscular disease can turn to maxillofacial prosthodontist Candice Zemnick, DMD, to restore their faces and voices.

“We often have to step in when conventional treatments are just not possible or have failed,” says Dr. Zemnick, associate professor of dental medicine and acting director of the Division of Prosthodontics, who has directed the Maxillofacial Prosthetics Clinic at Columbia for more than a decade. The clinic was founded in 1993.

Dr. Zemnick recently treated a patient who lost most of her upper jaw and the contents of her eye socket after cancer surgery. The patient was unable to speak and eat without food going into her nasal and sinus cavities and orbit. The treatment also left her with less humidification of the nasal area, allowing the internal anatomy to become dry.

To protect the area, restore function, and allow for facial esthetics, an obturator—a prosthesis that closes off defects of the upper jaw—and an orbital prosthesis were created. “The patient was then able to communicate and eat and drink and the rebuilding of the eye and surrounding soft tissue allowed the patient to be more comfortable in public,” says Dr. Zemnick.

Another recent case involved an ALS patient whose soft palate had become too weak to create closure at the back of the throat, making his voice unintelligible. Dr. Zemnick fabricated a palatal lift prosthesis to support the soft palate and reduce the excessive throat opening. “With treatment, the ALS patient does not have to expend as much effort in creating speech and can conserve energy, which is precious with this debilitating illness,” she says.

“We try to improve the quality and dignity of life, and for our patients who are terminal we try to support the quality and dignity of dying,” says Dr. Zemnick. “Sometimes we are creating prostheses just so that they can say goodbye to their grandchildren without frightening them. We do not care how long the prosthesis will be used. It could be a day, a month, a year. If it offers any comfort for any period of time, it completely validates our efforts.”

Dr. Zemnick collaborates with specialists in otolaryngology, oncology, radiation oncology, neurology, pediatrics, plastic surgery, speech pathology, and oral & maxillofacial surgery. “Collectively we focus on providing compassionate care and empowering patients to achieve their highest level of recovery,” she says. “It is amazing to be in a position to observe and learn from other disciplines.”

Dr. Zemnick first heard about maxillofacial prosthetics as a dental student at Tufts University, where she heard “amazingly poignant and informative lectures that illustrated the humanitarian scope of this field and the creative approaches needed to address the challenges of severely compromised patients,” she says. 

At Columbia, former faculty member John Piro, DDS, mentored Dr. Zemnick as she specialized in prosthodontics, followed by completion of a subspecialty in maxillofacial prosthetics at Columbia and the James J. Peters VA Medical Center.

Dr. Zemnick is among fewer than 200 maxillofacial prosthodontists actively practicing in the United States. With the nation’s small number of training programs—only five domestic programs plus Navy and Air Force programs—graduating a few fellows each year, the specialty will remain limited. She has seen patients who have traveled great distances from various countries, including Saudi Arabia, the Dominican Republic, countries in Africa and Central America, and patients from across the United States. “It is not uncommon for a patient to tell me that they could not find a maxillofacial prosthodontist in their state and that is why they have traveled to see me.”

Though technology has transformed many medical and dental procedures, facial prosthetics is a field that still relies on a specialized artistic approach that current technology cannot emulate. “My approach to the patient has remained largely the same using traditional methods we’ve successfully used for decades,” she says. “This may change as technology improves and becomes more versatile.”

Dr. Zemnick has received several teaching and mentorship awards during her Columbia career. In addition to encouraging her students to apply common sense and logical thinking to developing their cognitive and manual operative skills, she emphasizes the importance of empathy. “Treatment involves the ethical and expert application of clinical care, but the impression left with the patient on a personal level is often far more impactful,” she said. “Mastering empathy for the patient and the patient’s circumstance allows for a greater acceptance of treatment and trust. This fosters a far more enjoyable experience for everyone. I try to instill empathy in students through case-based vignettes that go beyond biomedical and interdisciplinary didactics and clinical procedures and merge with patient psychosocial needs.”