This past year I was working at a dental office that specialized in full mouth prosthetics as I was working for a prosthodontist. While seating a patient one day to remove their implants for a repair, I was caught completely off guard. Inside of the patients mouth around the area where they received a graft, hair was growing. Yes, you read that correctly. After the patient left, I immediately did research on how this could be possible. Turns out, the patient had undergone oral reconstructive surgery due to an accident. For this procedure the surgeon will typically use skin from another part of the body that grows hair as the graft. For many patients who receive this treatment, hair growing inside the mouth tends to be common as the hair follicles in the skin are still intact. Fascinating right?
So…what does one do was my next question? As it turns out, a collective study was done regarding treatment to stop the hair growth. Bains (2017), collected data based on cases that removed intraoral hair. As one can imagine, the options are limited. In most cases it was found that using a laser known as neodymium-doped yttrium aluminum garnet (Nd:YAG) was found to be the most successful at stopping the hair growth. Intraoral hair growth can cause physiological stress as it can lead to difficulty in speech and swallowing. While oral reconstruction surgery is crucial to many patients, in the future I hope that medical professionals can address with full autonomy the possible outcomes of their treatment. While having hair in the mouth is a minimal side effect of life altering dental construction surgery, it should none the less be addressed.
Bains, P., & Mahajan, A. (2017). Hair in the Mouth: A Rare Presentation. International journal of trichology, 9(1), 43–44. https://doi.org/10.4103/ijt.ijt_97_16
This is wild. How is this in practice in 2020 with all of the advances in modern medicine? I can imagine that the surgery and subsequent graft would be much desired by the patient, but having a constant hair ball in your mouth seems like quite the lasting side effect.
ReplyDeleteAfter a hasty search, I found that in some cases doctors can resect skin to the dermal level, effectively creating a myodermal flap instead of a myocutaneous flap. Both the myodermal and myocutaneous flaps were placed into dogs and had similar survival rates of the graft, as well as decreased hair growth.
As it turns out, this issue is mostly cosmetic in the oral surgery side of things, but can pose serious complications when such sections of hairy skin are used for grafts in the upper GI tract of post-oncological patients.
Eliachar I, Kraus DH, Bergfeld WF, Tucker HM. Prevention of hair growth in myocutaneous flap reconstruction. Arch Otolaryngol Head Neck Surg. 1990;116(8):923-927. doi:10.1001/archotol.1990.01870080045013
I cannot stand when I get a hair in my mouth, let alone constantly having a whole patch of it growing there. I couldn't even imagine this being a permanent problem because of a skin graft that I was required to get from surgery. There has to be a better way. What's interesting is that the treatment of using a Nd:YAG laser, is a treatment for a whole bunch of other issues. They use this laser for tattoo removal, vascualar or pigmented lesions, and onychomycosis (nail disorder caused by fungus). The laser does not perfectly fix the problem either and can take quite a bit of time. So not only do these patients now have a patch of hair, but they must do 2-6 treatments every 4-6 weeks and lasers don't feel the greatest. Each use of the laser feels like snapping a rubber band on your skin. I like Zach's findings, the previous comment, on a way to prevent this from every happening (Ranaweera et. al., 2014).
ReplyDeleteReference:
Anoma Ranaweera, Todd Gunson, Amanda Oakley. Neodymium YAG laser treatment. 2014. https://dermnetnz.org/topics/ndyag-laser-treatment/
This is so crazy to me to think that for a surgery that may be necessary for some patients, this is a side effect that they will have to deal with afterwards. Not only would it be annoying to have that patch of hair in your mouth, but what about the patients that cannot afford the Nd:YAG laser treatment? I agree with your thoughts on the autonomy of the situation and I think we can apply non-maleficence as well. Having the patients best interest at hand and doing what they can to find a solution that will make the patient more comfortable instead of putting them at risk for the physiological stress, as you mentioned above. As I was reading your post, I thought about other potential sources for skin grafts that would work just as well, but without hair follicles. Tissue engineering can be used as skin substitutes, replacement for lost tissue, facilitate healing, manage pain, and long-term aesthetic results (Chocarro-Wrona et al., 2019). I think with more research and trials, the different techniques for skin grafting and substitutes could improve patient symptoms post-op, and hopefully not have hairy mouths!
ReplyDeletesource: Chocarro-Wrona, C., López-Ruiz, E., Perán, M., Gálvez-Martín, P., & Marchal, J. A. (2019). Therapeutic strategies for skin regeneration based on biomedical substitutes. Journal of the European Academy of Dermatology and Venereology : JEADV, 33(3), 484–496. https://doi.org/10.1111/jdv.15391