A Norwegian woman who underwent jaw surgery at Mercy Hospital in June now is recovering from more surgery last week to implant a custom-made prosthesis of a jaw joint.

Heidi Sakkestad was released from the hospital Thursday to the care of her Penn Hills friend, Michele Grindheim. She is to receive follow-up care in Pittsburgh and then return soon to her home, where her husband and 13-year-old son wait for her.

As of Friday, she was eating soft foods, such as oatmeal, mashed potatoes and smoothies.

"Surgery went just as expected. It couldn't have gone any more smoothly," said her surgeon, Dr. Daniel Pituch, Mercy's chief of oral and maxillofacial surgery.

Touched by her suffering after surgery in her own country that irreparably damaged her right jaw, Dr. Pituch and Dr. Mark Ochs donated their services. So did TMJ Concepts, the company that created the $10,000 artificial joint, made from the same materials as hip and knee joint prostheses.

Ms. Sakkestad's Norwegian surgery four years ago to correct an overbite left her with eating and speaking difficulties, muscle spasms, pain and loss of sight in her right eye. The June operation straightened her jaw, removed her right temporomandibular joint and otherwise prepared her for the joint replacement. While she waited for it to be made precisely for her anatomical needs, her jaw was wired shut for five weeks.

The replacement took more time than expected, but it was made in a state-of-the-art engineering feat that raises hope for many patients with jaw problems.

A precise picture of the top piece of her joint was taken with a high-density CT scanner. That image data was sent to a Colorado firm, ProtoMed, that creates custom anatomical models. ProtoMed fabricated a 3-D stereolithographical model using lasers and epoxy resin. Layer by layer, the laser draws each section of the image, and the epoxy is polymerized into a solid piece.

That model was sent to California-based TMJ Concepts, which used it to precisely fit a prosthetic joint -- top and bottom -- made of wax. The wax form and the model were then sent to Dr. Pituch for modifications. A flange was added to the lower part to create a natural-looking jaw line for Ms. Sakkestad.

TMJ then cast the prosthesis in titanium and other materials in two separate castings for the socket component and the ball component.

Dr. Pituch explained that the new socket was installed at the base of skull. The ball was attached to the mandible, or lower jaw.

"There are several types of jaw prostheses," Dr. Pituch said. "This is the latest, made from scratch. No adjustment is needed. It's perfect."

"[Her condition] affected her general health, her nutrition, self-esteem, her ability to go outside, be with family, to socialize," Dr. Pituch said. "It created a lot of anxiety for her."

After Wednesday's surgery, Ms. Sakkestad's jaw works as a hinge, corrected to work better than it ever has, Dr. Pituch said.

"Now she has a very rigid and solid jaw that opens normally, with no deviation. It's the most stable it's ever been."

An added benefit, he said, was the ability to restore his patient's jaw line.

"She had lost her jaw line due to the surgery in Norway," he said.

"She was disfigured. We fixed the spasticity on the right side in the first surgery. Stabilizing her jaw, wiring it, cured her spasticity and allowed her to see again. It restored some semblance of normalcy."

Looking ahead, he said she may need some physical therapy and will need follow-up care in Norway, but no long-term need for care is expected. She still has braces on her teeth to correct her bite, with orthodontic care and braces donated by Dr. Ron Sepic.

Her friend, Ms. Grindheim, said the patient is glad to have the surgery behind her.

She said medical expenses had placed a financial hardship on the family, adding that the family is waiting for a statement from the doctors here before taking legal action against the Norwegian doctors who first operated on Ms. Sakkestad.

"I feel so badly for them. They're hardworking people; they're good people," Ms. Grindheim said. "All this has occurred through no fault of their own."