Maxillofacial rehabilitation of nasal defect with nasal prosthesis using donor method: A case report.

Maxillofacial prosthetics is the branch of prosthodontics which involves rehabilitation of the defects in the maxillofacial region involving the hard and soft tissue with the prosthesis. Facial defects that occur in the midfacial regions are commonly due to trauma and neoplasms like basal cell carcinoma which involves the nose. Reconstruction of the nose is an important esthetic challenge due to its esthetic and retention problems. This article emphasis rehabilitation of the nasal defect of a patient with nasal prosthesis using donor method.

Virtual Treatment Planning for Implant-Retained Nasal Prosthesis: A Clinical Report.

Osseointegrated craniofacial implants have improved retention and patients' perceptions of implant-retained nasal prostheses; however, the determination of the available bone sites for implant placement post-rhinectomy is difficult. This case report describes the use of cone beam computed tomography scanning and computer-assisted virtual planning in conjunction with digital photographs for rehabilitation of a facial defect with an implant-retained silicon nasal prosthesis. Two implants were planned in the anatomical area with adequate bone volume to achieve favorable cosmetic outcomes and accessibility for hygiene maintenance. The implant-retained nasal prosthesis resulted in a meaningful improvement in the esthetics without the need for plastic surgery. In such cases, the post-rhinectomy reconstruction surgery should be limited to preparation of the surgical defect area for an implant-retained prosthesis. Silicone prostheses are reliable alternatives to surgery and should be considered in selected cases.

Single-stage osseointegrated implants for nasal prosthodontic rehabilitation: A clinical report.

Malignant tumors in the nasal region may be treated by means of invasive surgical procedures, with large facial losses. Nasal prostheses, retained by osseointegrated facial implants, instead of plastic surgery, will, in most patients, offer good biomechanical and cosmetic results. This clinical report describes the prosthetic rehabilitation of a patient with nasal cancer who had the entire nasal vestibule removed in a single-stage surgical procedure in order to shorten the rehabilitation time. The nasal prosthesis was built on a 3-magnet bar and was made of platinum silicone with intrinsic pigmentation, thereby restoring the patient's appearance and self-esteem. The authors concluded that single-stage implants may reduce the rehabilitation time to as little as 1 month, and the correct use of materials and techniques may significantly improve the nasal prosthesis.

Rhinectomy for the management of nasal malignancies.

BACKGROUND: Tumours of nasal skin or mucosa are common, and can usually be treated with limited surgical excision or radiotherapy. This paper highlights a subset of high risk tumours which require rhinectomy for complete oncological clearance. METHOD: Retrospective case note review of 14 patients undergoing rhinectomy for nasal tumours. Clinical and histological findings, treatment and outcome are reviewed and discussed. RESULTS: Forty-three per cent of patients had recurrent disease and underwent rhinectomy as a salvage procedure following previous surgery or radiotherapy. Most tumours (79 per cent) were basal cell carcinoma or squamous cell carcinoma. After a mean follow up of 30.1 months (range, zero to 96 months), seven patients (50 per cent) were alive and disease-free. Reconstruction was most commonly with a prosthesis. CONCLUSION: Rhinectomy is an oncologically sound procedure for the management of high risk nasal malignancies. Prosthetic rehabilitation can be an excellent alternative to surgery, particularly in those patients unsuitable for major reconstruction.

Missing facial parts computed by a morphable model and transferred directly to a polyamide laser-sintered prosthesis: an innovation study.

Mirroring of missing facial parts and rapid prototyping of templates have become widely used in the manufacture of prostheses. However, mirroring is not applicable for central facial defects, and the manufacture of a template still requires labour-intensive transformation into the final facial prosthesis. We have explored innovative techniques to meet these remaining challenges. We used a morphable model of a face for the reconstruction of missing facial parts that did not have mirror images, and skin-coloured polyamide laser sintering for direct manufacture of the prosthesis. From the knowledge gleaned from a data set of 200 coloured, three-dimensional scans, we generated a missing nose that was statistically compatible with the remaining parts of the patient's face. The planned prosthesis was manufactured directly from biocompatible skin-coloured polyamide powder by selective laser sintering, and the prosthesis planning system produced a normal-looking reconstruction. The polyamide will need adjustable colouring, and we must be able to combine it with a self-curing resin to fulfil the requirements of realistic permanent use.

Designing and manufacturing an auricular prosthesis using computed tomography, 3-dimensional photographic imaging, and additive manufacturing: a clinical report.

The method of fabricating an auricular prosthesis by digitally positioning a mirror image of the soft tissue, then designing and using rapid prototyping to produce the mold, can reduce the steps and time needed to create a prosthesis by the traditional approach of sculpting either wax or clay. The purpose of this clinical report is to illustrate how the use of 3-dimensional (3-D) photography, computer technology, and additive manufacturing can extensively reduce many of the preliminary procedures currently used to create an auricular prosthesis.

Implant-retained nasal prosthesis for reconstruction of large rhinectomy defects: the Salisbury experience.

The authors report their experience with 34 patients who had large full thickness nasal defects reconstructed with an implant-retained prosthesis. Their technique of modifying post-rhinectomy defects is described and factors influencing implant success are evaluated. 111 implants were placed to retain a nasal prosthesis. Age, sex and tumour histology did not affect the outcome. Smoking, extent of rhinectomy, use of radiotherapy (pre- and post-implant), hyperbaric oxygen, length and location of the implant and type of retention (bar/magnets) influenced implant success. The overall success rate was 89% (99/111); 94% in patients who did not receive radiotherapy and 86% in those who did. The prosthesis was in place in all patients (100%) at the time of last follow up. Post-rhinectomy defect modification enables adequate access for safe placement of long implants with good primary stability and helps the maintenance of good hygiene (further enhanced by the use of skin grafts). The authors think implant-retained prosthesis is a reliable option for reconstructing large full thickness rhinectomy defects. They suggest their technique of modifying the defect, use of long implants and magnets for retention is responsible for the high success rate of implants used to retain a nasal prosthesis.

The figure-of-eight radix nasi flap for medial canthal defects.

Basal cell carcinomas commonly involve the medial canthal region and reconstruction of medial canthal defects is a challenging problem in reconstructive surgery. A new axial pattern flap raised from radix nasi region has been successfully used for the medial canthal defects in eight patients in figure-of-eight manner. One of the ellipses of the figure of eight is the defect, the other is the radix nasi flap. The radix nasi flap with a dimension up to 25 mm is transposed to the defect based either on ipsilateral anastomosis of the dorsal nasal artery with angular artery (AA) or with the connection of its source artery (i.e. ophthalmic artery) if the AA is damaged. All flaps survived and no tumour recurrence was observed. The donor sites were closed primarily and hidden at the radix nasi crease in all cases. The radix nasi flap in figure-of-eight fashion is good alternative for defects of the medial canthal area in terms of attaining a suitable colour and texture and minimal surgical scars.

An unusual soft tissue radiopacity--radiographic appearance of a dermal filler.

We present a case that describes the radiographic findings of Radiesse, a calcium hydroxyapatitie-based dermal filler. This dermal filler was detected during radiographic examination for implant treatment planning. This case illustrates the typical radiographic appearance of this material and the importance of differentiating it from pathological conditions.

Auricular rehabilitation by means of bone grafting from the iliac crest in combination with porous extraoral implants: a case report.

BACKGROUND: Maxillofacial defects caused by cancer treatment are a huge problem affecting the quality of life of patients. Some of these deformities are minimized using facial epitheses, which need some additional retention devices like glasses or skin adhesives. The use of extraoral fixtures as bone anchorage was introduced many years ago and since then many patients were rehabilitated with better results. PURPOSE: Because of poor bone conditions, for example, irradiated bone, the success rate of extraoral implants is less than in the oral cavity, causing difficulties to rehabilitation. One possible cause of fixture failure could be the poor primary stability achieved in some cases, hence, with an increased bone contact implant stability and survival could be improved. The present report discusses possibilities to use extraoral fixtures with a modified surface structure. MATERIALS AND METHODS: A new porous surfaced Brazilian extraoral implant (MasterExtra, Conexão, Sistema de Próteses, São Paulo, Brazil) was used. A bone transplant from the iliac crest was taken to make it possible to insert at least three extraoral implants for an auricle epithesis. Clinical evaluation and resonance frequency analysis (RFA) measurements were performed during the course of the treatment. RESULTS: Eight months after grafting, four fixtures were inserted. Three fixtures were used for connection of an auricular epithesis. RFA measurements did show high initial values and the values remained stable during the course of the treatment and at later checkups. CONCLUSION: Porous fixture is a good option in areas where the bone is compromised. RFA is a good tool also in the clinical setting to evaluate immediate and long-term stability of extraoral fixtures.

Reconstrução total de pálpebra inferior com retalho frontal / Inferior eyelid reconstruction with frontal flap

A reconstrução de pálpebra inferior se apresenta como um desafio técnico devido à complexidade funcionale estética da região envolvida. Os autores descrevemo caso de um paciente de 72 anos, branco, do sexomasculino, que apresentou carcinoma basocelular ulcerado em pálpebra inferior. A ressecção tumoral resultounum defeito de espessura total de pálpebra inferior direita, em toda sua extensão. O paciente foi submetido àreconstrução com cartilagem auricular e retalho frontalbaseado nas artérias supra-troclear e supra-orbital esquerdas.Este retalho apresenta um arco de rotação capaz de alcançar defeitos palpebrais e até maxilares.As seqüelas estéticas da área doadora são bem aceitáveis após o período de um ano, restando apenas cicatrizesdiscretas. O retalho frontal é seguro, com pouca morbidade na área doadora e é uma importante opçãopara as reconstruções palpebrais. A necessidade de um ato cirúrgico posterior para a ressecção do pedículo e doexcesso de volume de tecido adiposo do retalho é uma das principais desvantagens deste procedimento. O paciente apresentou evolução pós-operatória adequada,sem complicações.

The inferior eyelid reconstruction if presents as a challenge technician due to functional and aesthetic complexity of the involved region. The authors describethe case of a patient of 72 years, white, masculine, that presented basocelular carcinoma in the inferior eyelid.The tumoral ressection resulted in a defect of total thickness of right inferior eyelid, in all of your extension. The patient was submitted the reconstruction with auricular cartilage and frontal flap based on the left arteriessupra-troclear and supra-orbital. This flap presents an arc of rotation capable to reach eyelids and until maxillarydefects. The aesthetic defects of the area giver are well acceptable after the period of one year, remaining onlydiscrete scars. The frontal flap is safe, with little damage in the area giver and is an important option for the eyelidreconstructions. The necessity of a posterior surgical act for the resection of the flap excess remnant is one of themain disadvantages of this procedure. The patient presented adequate postoperative evolution, withoutcomplications.

Upper lip reconstruction with the alar crescent flap: A new approach.

PURPOSE: The alar crescent advancement flap technique has been widely used for repair of large central defects of the upper lip and base of the nose because of its 1-stage procedural simplicity and good results. Several more complicated and multiple staged procedures that respect either structure or function, often compromising one to achieve the other, have become popular and have recently taken its place. However, these procedures are more complex and in many cases require a staged approach. In this study, we present a series of 33 patients who underwent reconstruction of large upper lip defects utilizing alar crescent flaps between 1992 and 2002. PATIENTS AND METHODS: A series of 20 patients underwent reconstruction of large upper lip defects using alar crescent flaps between 1992 and 2002. Malignant etiologies were responsible for the defect in all patients. Reconstruction was performed as a 1-staged procedure in 19 cases. In 1 patient with a total upper lip defect, bilateral alar crescent flaps were used in conjunction with a cross lip flap that was later divided in a second stage procedure. RESULTS: All patients tolerated the procedure well with no major complications. Minor complications not requiring surgical intervention occurred in 5 patients. During the 12- to 60-month follow-up, all patients were found to be satisfied with the functional result. However, 7 patients underwent minor surgical procedures for esthetic improvement. There was no recurrence of disease in the 20 patients who underwent resection of malignancy. CONCLUSIONS: In these 20 cases, we have shown the utility of the alar crescent flap for varying length partial and full-thickness reconstruction of upper lip defects. This simple and straightforward technique provided good functional and esthetic results. The disadvantage of this procedure is the loss of philtral anatomic detail. Its primary advantage is that it is a single-stage procedure with a relatively low morbidity and patient inconvenience. As a single-stage technique it satisfies concerns over cost containment over more complex and staged procedures while still providing a good functional and cosmetic result. Furthermore, for those same reasons, this procedure is a good first choice in the elderly.

The use of free fibular flap for functional mandibular reconstruction.

PURPOSE: The purpose of this investigation is to document our experience using the free vascularized fibular flap for comprehensive reconstruction of discontinuity defects in the mandible, after combined resections of malignant and aggressive odontogenic tumors, with special emphasis on functional aspect of the reconstruction process. MATERIALS AND METHODS: The study group consisted of consecutive patients treated for reconstruction of discontinuity defects of the mandible, using the fibular vascularized free flap, between 1997-2002. All procedures were performed in the same hospital and by the same surgical team. RESULTS: A total of 13 patients (9 males, 4 females) were treated in our department in a period of 6 years for reconstruction of discontinuity mandibular defects using the free fibula vascularized flap. Wound healing disturbances at the donor site occurred in 4 cases. Two flaps were lost, 1 because of total failure in a patient who was heavily irradiated because of osteosarcoma, the other because of resorption of the bone tissue transfer in a case of total avulsion of the mandible caused by a fall from height. CONCLUSION: Fibula free vascularized flap is a safe and reliable method for comprehensive functional and esthetic mandibular defect reconstruction. Our protocol has a significant impact on preserving the patients quality of life.

Nasal prosthesis rehabilitation: a case report.

A nasal prosthesis can reestablish esthetic form and anatomic contours for midfacial defects often more effectively than can surgical reconstruction. This case report describes the clinical and laboratory procedures for fabricating a nasal prosthesis.

Improved edge strength in a facial prosthesis by incorporation of tulle: a clinical report.

This clinical report describes the use of tulle for increasing the tear resistance of a facial prosthesis. By incorporating tulle, a prosthesis' margins may be more stable, more resistant to tearing, and less likely to deform while adhesive, cosmetics, and cleaning agents are applied and removed.

Subtotal nasal reconstruction using a bi valved paramedian forehead flap.

Many surgical options have been proposed for total or subtotal reconstruction of the nose after extirpative surgery or trauma. Careful replacement of all anatomic layers including the structural framework and internal and external nasal lining is essential to successful reconstruction. If adequate internal lining is present, reconstruction of the structure of the nose and the external nasal lining is often straightforward. Difficulty arises with providing sufficient internal nasal lining in patients who underwent full thickness reconstruction of half of the nose with a bi-valved paramedian forehead flap. A different plane of dissection is used for the flap and structural grafts are placed between the layers of the axial pattern flap. The anatomy, plane of flap dissection, and biomechanics of flap transfer are presented as well as the specific technique for nasal reconstruction. The bi-valved paramedian forehead flap presents another surgical option for reconstruction of full thickness defects of the nose.

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.