Autologous versus prosthetic nasal and auricular reconstruction - patient, professional and layperson perceptions.

The aim of this study was to retrospectively evaluate the perceptions of aesthetic outcome following the autologous and prosthetic reconstruction of nasal and auricular defects among patients, professionals (oral and maxillofacial surgeons and ear, nose and throat surgeons) and people unfamiliar with reconstructive surgery. The influence of anatomical subunits on the overall perception of nasal and auricular reconstructions was also determined. A total of 119 patients treated for nasal and auricular defects between 1997 and 2016, with a minimum follow-up period of 6 months, were selected, and photographs of 77 of these patients (65%) were presented in a digital survey and reviewed using a standardized questionnaire. No clinically relevant correlations were found between the age or gender of patients (as well as those of the respondents) and their scores. Prosthetic reconstructions of nasal and auricular defects were considered advantageous over autologous reconstructions in terms of the subjective aesthetic outcome in the view of the professionals, in particular oral and maxillofacial surgeons; however, the patients judged both techniques to be equally effective in terms of aesthetics. No anatomical subunits were found to have a significant impact on the overall match of a nasal or auricular reconstruction with the patient's face.

Reliability and accuracy of skin-supported surgical templates for computer-planned craniofacial implant placement, a comparison between surgical templates: With and without bony fixation.

INTRODUCTION: The purpose is to determine the accuracy of guided implant placement in the orbital, nasal, and auricular region using computer-aided designed stereolithographic skin-supported surgical templates with and without bone fixation pins. MATERIALS AND METHODS: Preoperatively, cone-beam CT (CBCT) and multiple detector computed tomography (MDCT) scans were acquired from 10 cadaver heads, followed by virtual planning of implants in the orbital margin, auricular region and nasal floor. Surgical skin-supported templates were digitally designed to allow flapless implant placement. Fixation pins were used for stabilization comprising half of all templates in predetermined bone areas. The accuracy of the surgical templates was validated by comparing the achieved implant location to its virtual planned implant position by calculating the linear and angular deviations. RESULTS: Surgical templates with the use of bone fixation pins produced statistically significant greater implant deviations as compared to the non-fixated surgical templates. CONCLUSION: The results of this study indicate that significant deviation has to be taken into account when placing cranio-maxillofacial implants using skin-supported surgical templates. Surprisingly, the use of bone-fixated pins worsened the accuracy.

[A diagnosed follicular cyst turned out to be a squamous cell carcinoma]. / Een gediagnosticeerde folliculaire cyste bleek een plaveiselcelcarcinoom.

A 50-year-old man had undergone a complicated removal of tooth 48 which initially seemed related to a follicular cyst. Subsequently, it turned out that a squamous cell carcinoma had probably developed from the follicular cyst. The patient underwent excision of the tumour, hemimandibulectomy, a neck dissection, and reconstruction of the mandibula using a metal plate, followed by postoperative local radiotherapy. This type of development of a squamous cell carcinoma presents very rarely. From the literature, it can be concluded that the prognosis is unfavourable and that the tumour tends to grow aggressively. In case of abnormal wound healing after the removal of a tooth (with a follicular cyst), it is recommended to examine representative tissue histologically.

Extra-oral implants: insertion per- or post-ablation?

Although the benefit of extra-oral implants in the reconstruction of maxillofacial oncological defects is undisputable, some relevant issues need to be clarified. The purpose of this retrospective study was to evaluate the relationship between implants placed during ablation (DA-implants) and after ablation (AA-implants) of the tumor with respect to implant survival. In total, 103 implants were assessed: 44 nasal implants (17 patients) and 59 orbital implants (18 patients). All patients received their implant-retained maxillofacial epithesis between 1997 and 2010, with a mean follow-up of 35 months (range 8-156 months). The survival rate of DA-implants was 90.0% for the orbital region and 93.5% for the nasal region. The survival rate of the AA-implants for the orbital and the nasal region was 82.8% and 61.5%, respectively. This study shows a significant higher survival rate of extra-oral implants placed during ablative surgery compared to implants in a later stage (p=0.044), thereby stressing the importance of installing extra-oral implants during the ablative surgical session.

[Face the facial furuncle]. / De furunkel in het (ge) zicht.

The furuncle is a staphylococcal infection of a single hair follicle which can occur on the skin in the maxillofacial region. Untreated, this infection can lead to life-threatening situations. This article discusses the etiology, clinical findings, possible complications as well as a series of differential diagnoses. In addition, several therapeutic and preventive strategies are described.