If you're a veteran with a broken face, odds are pretty good that Alvin Wee and Kim Creamer can put you back together.
Wee, 46, is a prosthodontist at the Creighton University School of Dentistry. He hones his technical skills rebuilding jaws, eye sockets, noses and ears at the Veterans Administration Nebraska-Western Iowa Health Care System in Omaha.
Creamer, 53, is a longtime dental technician who has developed an unusual talent for fashioning realistic noses and ears out of silicone.
During their three-year partnership at the VA Medical Center, they've replaced noses and ears lost to melanoma or congenital defects, fashioned a new palate and eye socket for a victim of oral cancer, and crafted a new titanium upper jaw for a soldier who was wounded by a roadside bomb.
“Every defect is different,” Wee said. “We have to get together to be creative.”
Their partnership, in the dental subspecialty called oral and maxillofacial prosthodontics, is one piece of a plan to boost the profile of the VA's dental clinic. The specialty is particularly rare, even in civilian medicine. Wee said there are about 15 hospitals nationwide that offer the service. Ten training programs graduate about 14 specialists each year.
While federal money is tight, the VA has fared relatively well because of the influx of veterans from the Iraq and Afghanistan wars and the political popularity of supporting them.
The VA's budget has more than doubled in the past 10 years to $152 billion for 2014. The portion of the budget for medical care is expected to be about $58 billion, up from $35 billion in inflation-adjusted dollars in 2004. Both are sharply higher than the two previous spending peaks after World War II and the Vietnam War.
Omaha's VA Medical Center has benefited. In early 2011, an upgraded $3 million dental facility, in a renovated former office space next to the main hospital building, boosted the number of treatment rooms from eight to 14.
It's part of the vision of the Medical Center's director of dental services, Dr. Allan Hancock, who served on the staff of the Air Force's assistant surgeon general for dental services before retiring as a colonel in 2005.
Hancock has added partnerships with the University of Nebraska Medical Center and with Creighton University. UNMC family dentistry and oral surgery residents now rotate through the clinic. The VA has expanded its partnership with the Air Force's Ehrling Bergquist Medical Clinic in Bellevue, too.
One of Hancock's goals is to turn the VA dental clinic into what the military calls “a center of excellence,” that is, a national destination for veterans who need oral and maxillofacial surgery and rehabilitation. Not just impacted wisdom teeth, but the kind of work needed to repair cancer-ravaged jaws or bullet wounds to the face.
“We've built up our staffing to accommodate that vision — a place where you can get this more complicated oral surgery,” Hancock said. “This is going to be a VA hub.”
Currently, the VA clinic in Omaha is the only one to offer oral and maxillofacial prosthodontics in a region that covers all or part of 10 Upper Midwest states. They've drawn patients from as far away as Minnesota and New Mexico.
Hancock believes it's worth the money for the VA to develop its own specialists rather than send them to the private sector. He said referrals frequently cost $10,000 or more, even before treatment starts.
“It just makes sense. These vets, they have trauma,” Wee said. “In the Midwest, there is no center of maxillofacial prosthodontics.”
Many veterans prefer to be treated at the VA, where medical staff and the patients usually share the common bond of military service.
“By and large, the veterans are comfortable here,” Hancock said. “We speak the same language they do.”
It is at Hancock's urging that Joe McKee is reclined in Wee's dental chair, getting fitted for a prosthetic ear.
A year ago McKee, 81, drove up with his wife, Dorothy, from their home in Lincoln to get some dental work done. Hancock noticed the lower two-thirds of McKee's left ear was missing, lost to a surgeon's scalpel 20 years ago during a bout with melanoma.
“He said, 'Oh, we can fix that!' ” Dorothy recalled.
McKee, a retired homebuilder, had had a prosthetic ear for a few years in the 1990s, but over time it faded to white. A replacement never fit right, so he gave up.
He doesn't like to admit it, but the stares his missing ear drw bothered him.
“I know people look. They'll watch when I go by,” McKee said. “Little kids will just stare at you. Parents will shush them up. But I'd rather talk about it.”
He is grateful to be cancer-free after so many years, thanks to frequent visits with a dermatologist and lots of sunscreen. But wouldn't it be great to fix the cosmetic damage, too?
First, McKee needed to complete a series of 20 hour-long sessions in a hyperbaric chamber, the kind of room where divers may go to be treated for the bends. That's because the radiation treatments that follow cancer surgery weaken the bones. The pure-oxygen environment of the chamber helps to regrow blood vessels and strengthen the affected area.
After months of such treatment, some small titanium posts were implanted in the bone immediately behind McKee's ear hole. This was tricky, Wee said, because the original surgeon took out so much of the bone. That made it necessary to put the posts a little farther back than normal. They'll be a little more visible than Wee would like.
McKee received 10 more treatments in the hyperbaric chamber. Then Wee and Creamer fashioned a model ear made of wax, with magnets mounted in its base. They are testing to see how well it fits and how well it matches. Creamer shaves some off because the prosthetic ear sticks out a little too much.
“We're trying to make sure it flows with the face,” Wee said.
Once they've got it exactly right, Creamer will use the wax model to fashion a mold. Then she'll inject silicone into the mold, tinted to match McKee's skin tone. She adds her own creative touches, too, for example, mixing in tiny threads of red yarn to simulate veins.
“It's a way I can be creative,” Creamer said. “When I put (a prosthesis) on the patient and it matches, it's such a good feeling.”
If all goes well, McKee will return next week for one last fitting — and go home with his new ear.
That's good news. He and Dorothy had hoped it would be ready before their grandson Brian's wedding next month in Pennsylvania.
“I did not say I had to have it by a certain time,” McKee said. “But my wife did.”
“I could tell he wanted it,” Dorothy added softly.
Now they can attend confident the guests will focus on the beautiful bride, not on grandpa's funny ear.
And Joe can go out in public, confident that no one will stare.