Technique for fabricating a lightweight, urethane-lined silicone orbital prosthesis.

A technique is presented for packing an acrylic resin core and controlling the thickness of an orbital prosthesis with the use of an irreversible hydrocolloid matrix. This technique provides a durable core without damaging the orbital prosthesis mold and permits a controllable thickness and therefore a lighter prosthesis.

Extraoral maxillofacial prosthetic rehabilitation at the M. D. Anderson Cancer Center: a survey of patient attitudes and opinions.

STATEMENT OF PROBLEM: Measures of satisfaction after extraoral maxillofacial prosthetic rehabilitation have been sparsely reported. PURPOSE: This article reviews the care-related opinions of patients who were provided extraoral prostheses at the M. D. Anderson Cancer Center over the course of 10 years. MATERIAL AND METHODS: A questionnaire was delivered to 263 extraoral prosthetic patients to elucidate their degree of satisfaction with several parameters, including prosthetic use, care, quality, durability, longevity, and cost. In addition, issues relating to self-image, socialization frequency, and income-earning ability before and after rehabilitation were surveyed. RESULTS: The views of 76 respondents demonstrated a general satisfaction with their prostheses. A majority believed that their prostheses fit comfortably, and most were satisfied with cosmesis. In addition, a preponderance of respondents reported no substantial alteration in social activity after rehabilitation. Although the number of respondents relying on their own employment fell by more than 50% after rehabilitation, nearly all reported a relatively static income before and after rehabilitation. CONCLUSION: The survey revealed a high degree of patient satisfaction with extraoral maxillofacial prostheses. Nevertheless, areas of potential improvement were not lost on the survey's population. The patients desired prostheses that last longer and have improved color stability. An interest in improved retentive mechanisms was mentioned by several patients, and only about half of the respondents perceived prosthetic cost to be completely reasonable.

Guided tissue fabrication from periosteum using preformed biodegradable polymer scaffolds.

A successful tissue engineering method for bone replacement would imitate natural bone graft by providing the essential elements for new bone formation using synthetic scaffolds, osteogenic cell populations, and bone induction factors. This is a study of the suitability of various formulations of poly(DL-lactic-co-glycolic acid) (PLGA) foams to provide a tissue conducting scaffold in an ovine model for bone flap fabrication. Three formulations were used of different copolymer ratio and molecular weight. Porous wafers of PLGA were stacked into rectangular chambers (volume 4 cm3) enclosed on five sides. Some chambers also contained autologous morcellized bone graft (MBG). The chambers were inserted with the open face adjacent to the cambium layer of the periosteum in rib beds of seven sheep and harvested after 8 weeks in vivo. Gross and histologic examination of the resulting tissue specimens demonstrated molded units of vascularized tissue generally conforming to the shape of the chambers and firmly attached to the periosteum. Polymer degradation appeared to occur by varying degrees based on polymer formulation. New bone formation was observed only in areas containing MBG. There was no evidence of significant inflammatory reaction or local tissue damage at 8 weeks. We conclude that a PLGA foam scaffold is (1) an efficient conductor of new tissue growth but not osteoinductive, (2) contributes to the shape of molded tissue, and (3) biocompatible when used in this model. Further studies are warranted to develop practical methods to deliver bone induction factors to the system to promote osseous tissue generation throughout the synthetic scaffold.

Prosthetic rehabilitation of patients with advanced nonmelanoma skin cancer.

Attention to detail at all stages of treatment can ensure a successful prosthetic rehabilitation. This detail must be considered a priority at presurgery, surgery, and at every stage in fabricating the prosthesis. Teamwork between the surgeon and maxillofacial prosthodontist will ensure an optimal surgical preparation and definitive prosthesis. Evidence of interaction among team members most certainly can be encouraging to the patient. It is important that during the prosthetic phase of treatment, attention be made in terms of tissue assessment, impression making, sculpting, mold fabrication, familiarity with materials, appreciation of color, delivery of instructions, and patient education, which will ensure a satisfactory outcome. With the desire, determination, and encouragement from the restorative team to make the most of this artificial replacement, a patient can have a higher quality of life and a more normalized lifestyle.

Total midface reconstruction after radical tumor resection: a case report and overview of the problem.

We report an unusual repair of a massive midface defect resulting from resection of a recurrent squamous cell carcinoma of the nasal vestibule. The defect included both maxillas, the hard palate, the upper lip, and all nasal and perinasal tissues. After treatment, reconstruction was accomplished using prostheses and autologous tissue transferred from local and distant sites. The osseous component of the transferred tissue permitted placement of osseointegrated implants for fixation of maxillary and nasal prostheses. The rationale for this reconstruction and the problems associated with midface reconstruction after radical tumor resection are discussed.

Technique for fabricating a mirror-image prosthetic ear.

A simple technique for producing a mirror image of a cast for sculpting an auricular prosthesis is described. A transparency copy of the cast assist the operator in sculpting the contours of the facial prosthesis.

Rehabilitation of a midface defect with reconstructive surgery and facial prosthetics: a case report.

This paper reports a case in which reconstruction of a midface defect was accomplished by using microvascular surgery with free tissue transfer of the fibula for a 55-year-old man with squamous cell carcinoma in the nasal vestibule and nasal wall. This technique was developed and first used to reconstruct mandibular defects. Using a surgical template during the midface reconstruction can help the surgeon place the graft in a position that will complement the definitive facial prosthesis, as illustrated in this report.

A hybrid-mold technique for fabricating facial prostheses.

A hybrid-mold technique is described for fabricating facial prostheses with delicate contours and/or undercuts that require additional support. This quick and simple technique combines several common laboratory materials and protects select areas of the stone mold during prosthesis fabrication. This technique also extends the mold's years of service and the number of prostheses that can be fabricated from the mold.

Technique for magnetic placement and orientation of a facial prosthesis.

A simple technique is described for placing and orienting a facial prosthesis with a magnetic holder. This technique involves samarium-cobalt magnets embedded in a silicone prosthesis and counter magnets placed in a holding device.

Guided bone growth in sheep: a model for tissue-engineered bone flaps.

The emerging field of tissue engineering is yielding a variety of new strategies for bone replacement. In vivo assessment of candidate bone substitutes to demonstrate biocompatibility, degradability, and the ability to produce meaningful quantities of bone is essential prior to clinical use. We present results of a large animal model using formed plastic chambers implanted adjacent to the rib periosteum in sheep to fabricate vascularized bone flaps of different shapes. Chambers packed with morcellized corticocancellous bone graft, representing the most favorable natural circumstances for bone formation, were compared to empty chambers, representing the least favorable. Implants containing bone chips yielded formed blocks of vascularized bone after 6 weeks with evidence of remodeling after 13 weeks. Histomorphometric analysis demonstrated that there was full bone penetration into shallow (5 mm) chambers and 8.8 mm (+/-0.6) penetration into deep (10 mm) implants after 6 weeks. Molded bone segments failed to grow in empty chambers. This model presents a quantifiable range of bone forming potential to which different bone substitutes may be compared for usefulness in creating tissue engineered bone flaps for reconstructive surgery.

Color stability of facial prostheses.

The limited service of facial prostheses is the result of degradation of the elastomer and color instability. Deterioration may be caused by many factors, which include environmental exposure and changes in humidity. This investigation assessed the efficacy of an additive, intrinsic, broad-spectrum ultraviolet light absorber on the color stability of a pigmented facial elastomer. Samples were weathered artificially and outdoors at exposure levels of radiant energy of 150 to 450 kJ/m2. The samples changed color slightly but perceptibly. Artificial aging caused a greater change than outdoor aging. The ultraviolet light absorber UV-5411 did not protect the samples from color changes.

Minimizing oral complications of cancer treatment.

Aggressive cancer therapy places patients at greater risk for oral complications and treatment-related consequences. Unfortunately, prevention and/or treatment of such oral sequelae have become often overlooked priorities of the treatment team. We describe a philosophy of management of the cancer patient that specifically emphasizes the prevention and treatment of oral complications associated with cancer therapy. These concepts and principles are based on treatment protocols and ongoing clinical practices at The University of Texas M. D. Anderson Cancer Center in Houston, Texas.

Oral and dental management of the cancer patient: prevention and treatment of complications.

Aggressive cancer therapy places patients at greater risk for oral complications and treatment-related consequences. Unfortunately, prevention and/or treatment of such oral sequelae has become an often overlooked priority of the treatment team. We describe a philosophy of management of the cancer patient that specifically emphasizes the prevention and treatment of oral complications associated with cancer therapy. These concepts and principles are based on treatment protocols and ongoing clinical research at the University of Texas M.D. Anderson Cancer Center in Houston, Texas.

Prosthodontic and surgical considerations for pediatric patients requiring maxillectomy.

The quality of treatment and rehabilitation for the head and neck cancer patient, especially the pediatric patient, has progressed markedly over the years due to the cooperation of specialists involved in the total care of the patient. Defects of the oral cavity caused by trauma or removal of malignant or benign tissue require special treatment considerations with the pediatric patient. Aside from radiation and chemotherapy, other forms of adjuvant therapy, such as physical therapy, and patient and family counseling, are needed for proper rehabilitation. In addition, oral hygiene is essential in the overall rehabilitative process. Pediatric dental, orthodontic, prosthodontic, and oral and maxillofacial surgery specialties become integrated in treating the pediatric patient. The concentrated multidisciplinary treatment reduces post-treatment morbidity by shortening recovery and immediate rehabilitation time and by providing long-term care during the critical growth period.

Technique for magnet replacement in silicone facial prostheses.

Magnets are often used in silicone facial prostheses for retention. However, these magnets may need to be replaced or repositioned as a result of loss, wear, or poor initial placement. Replacement can be easily accomplished by use of a nylon mesh material and a simple laboratory technique.

Use of nonconductive tubing for nasal stent fabrication.

A new and effective technique for making and delivering a nasal stent that can be used for surgical, interim, and definitive stents is presented. The materials used are easily obtainable and inexpensive.

The efficacy of antifungal agents incorporated into a facial prosthetic silicone elastomer.

Microbiologic isolation techniques and scanning electron microscopy were used to determine whether a fungus is associated with the black discoloration of some silicone nasal prostheses. Colonies of fungal growth were seen on scanning electron micrographs of the affected areas of a nasal prosthesis, and a fungus belonging to the genus Penicillium was isolated from similar areas. Disk diffusion tests determined that the antifungal agent clotrimazole, when incorporated into silicone samples, was effective in inhibiting in vitro growth of the fungus.

Maxillofacial restoration after tumor ablation.

Communication between the surgeon and the maxillofacial prosthodontist before, during, and after surgery is the most important aspect to successful prosthetic rehabilitation of the head and neck cancer patient. Surgeons should understand the problems and limitations involved in prosthetic rehabilitation so that the patient is adequately educated during rehabilitation. Osseointegrated implants, although an important advancement in this field, should not take the place of proper defect preparation. The use of implants in the irradiated patient is currently being evaluated by controlled studies. However, if implants are used, then their position and number should be carefully planned in the pretreatment phase. Preparation of the defect by skin grafting and controlling the position of the remaining structures is important to the overall aesthetic and functional result of the prosthesis.

Postoperative care of the maxillectomy patient.

Guidelines for preoperative patient information and immediate postoperative care of the maxillectomy patient are discussed. Physical therapy, oral hygiene procedures, and current materials for surgical obturation and their uses are reviewed. Effective treatments for infections that arise in the surgical defect are highlighted.