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Hoffmann KJ, Büsch C, Moratin J, Ristow O, Hoffmann J, Mertens C. Peri-implant health after microvascular head and neck reconstruction-A retrospective analysis. Clin Oral Implants Res 2024; 35:187-200. [PMID: 38010660 DOI: 10.1111/clr.14214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/04/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Prosthodontic rehabilitation after reconstruction with microvascular revascularized free flaps following ablative tumor surgery is challenging due to the altered anatomical and functional conditions. The aim of this retrospective study was to determine whether the type of graft and the type of peri-implant tissue have an effect on peri-implant inflammatory parameters and implant survival. MATERIALS AND METHODS Patients who received a free flap reconstruction with subsequent implant-prosthetic rehabilitation between 2010 and 2022 were retrospectively included. The primary outcome variable was the probing depth (PPD) at a minimum of 1 year after completion of prosthetic restoration. Predictive variables were type of free flap, emergence profile, and history of radiation. RESULTS Seventy-one patients after free flap reconstruction were included in the analysis. At a minimum of 24 months after implant insertion the primary outcome, PPD showed no clinically relevant differences between the types of free flaps used. The emergence profile through a skin island resulted in an increase in BOP compared to native mucosa in the descriptive analysis (p-value > .05). The analysis showed a 5-year implant survival of 96.2% (95% CI: 0.929-0.996) in cases without irradiation and 87.6% (95% CI: 0.810-0.948) with irradiation of the region evaluated (p-value .034). CONCLUSION Flap and associated soft tissue type had no significant effect on 5-year implant survival or peri-implant inflammatory parameters. However, the large heterogeneity of the patient population indicates that further prolonged studies are required for a more differentiated assessment of the long-term success.
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Affiliation(s)
- Korbinian Jochen Hoffmann
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Christopher Büsch
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Julius Moratin
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver Ristow
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Jürgen Hoffmann
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian Mertens
- Department of Oral- and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, Germany
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Migliorelli A, Sgarzani R, Cammaroto G, De Vito A, Gessaroli M, Manuelli M, Ciorba A, Bianchini C, Pelucchi S, Meccariello G. Reconstructive Options after Oncological Rhinectomy: State of the Art. Healthcare (Basel) 2023; 11:1785. [PMID: 37372903 DOI: 10.3390/healthcare11121785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The nose is a central component of the face, and it is fundamental to an individual's recognition and attractiveness. The aim of this study is to present a review of the last twenty years literature on reconstructive techniques after oncological rhinectomy. METHODS Literature searches were conducted in the databases PubMed, Scopus, Medline and Google Scholar. "Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA)" for scoping review was followed. RESULTS Seventeen articles regarding total rhinectomy reconstruction were finally identified in the English literature, with a total of 447 cases. The prostheses were the reconstructive choice in 213 (47.7%) patients, followed by local flaps in 172 (38.5%) and free flaps in 62 (13.8%). The forehead flap (FF) and the radial forearm free flap (RFFF) are the most frequently used flaps. CONCLUSIONS This study shows that both prosthetic and surgical reconstruction are very suitable solutions in terms of surgical and aesthetic outcomes for the patient.
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Affiliation(s)
- Andrea Migliorelli
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44100 Ferrara, Italy
| | - Rossella Sgarzani
- DIMES Department, Bologna University, 40100 Bologna, Italy
- Plastic Surgery, M. Bufalini Hospital, AUSL Romagna, 47521 Cesena, Italy
| | - Giovanni Cammaroto
- ENT Department, Morgagni Pierantoni Hospital, AUSL Romagna, 47121 Forliì, Italy
| | - Andrea De Vito
- Head-Neck and Oral Surgery Unit, Department of Head-Neck Surgery, Otolaryngology, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
| | - Manlio Gessaroli
- Maxillo-Facial Unit, M. Bufalini Hospital, AUSL Romagna, 47521 Cesena, Italy
| | - Marianna Manuelli
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44100 Ferrara, Italy
| | - Andrea Ciorba
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44100 Ferrara, Italy
| | - Chiara Bianchini
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44100 Ferrara, Italy
| | - Stefano Pelucchi
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44100 Ferrara, Italy
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Dżaman K, Ziemska-Gorczyca M, Anurin I, Błaszczyk M. The Latest Craniofacial Reconstructive Techniques Using Anchored Implants after Surgical Treatment of Nasal and Paranasal Sinuses Tumors. Healthcare (Basel) 2023; 11:1663. [PMID: 37372781 DOI: 10.3390/healthcare11121663] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/24/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Reconstructive surgery after surgical treatment of neoplasms in the head and neck region is always a challenge. Many factors are responsible for the success of reconstruction. The anatomy of the facial region is complex, which significantly influences the aesthetic effect of the reconstruction. Moreover, many patients undergo postoperative radiotherapy after surgical treatment, which affects the range of reconstructive techniques. The aim of this study is to review current reconstructive methods in the craniofacial region, using bone-anchored implants to attach nasal prostheses. The article also comprises the authors' own experience with successful single-stage, Vistafix 3 osseointegrated implants for the attachment of an external nasal prosthesis in a 51-year-old man after surgical removal of squamous cell carcinoma of the nose and paranasal sinuses. The literature search for articles regarding implants in craniofacial reconstructions was performed using the three following databases: Scopus, Web of Science and MEDLINE (through PubMed), and follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA). A systematic literature search was set for 2018-2023 and retrieved 92 studies. From them, 18 articles were included in the review.
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Affiliation(s)
- Karolina Dżaman
- Department of Otolaryngology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland
| | - Marlena Ziemska-Gorczyca
- Department of Otolaryngology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland
| | - Igor Anurin
- Department of Otolaryngology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland
| | - Magdalena Błaszczyk
- Faculty of Science and Technology, University of Silesia in Katowice, 40-007 Katowice, Poland
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Slijepcevic AA, Afshari A, Vitale AE, Couch SM, Jeanpierre LM, Chi JJ. A Contemporary Review of the Role of Facial Prostheses in Complex Facial Reconstruction. Plast Reconstr Surg 2023; 151:288e-298e. [PMID: 36696329 DOI: 10.1097/prs.0000000000009856] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Maxillofacial prostheses provide effective rehabilitation of complex facial defects as alternatives to surgical reconstruction. Although facial prostheses provide aesthetically pleasing reconstructions, multiple barriers exist that prevent their routine clinical use. The accessibility of facial prostheses is limited by the scarce supply of maxillofacial prosthodontists, significant time commitment and number of clinic appointments required of patients during prosthesis fabrication, short lifespan of prostheses, and limited outcomes data. METHODS A literature review was completed using PubMed and Embase databases, with search phrases including face and maxillofacial prostheses. Patient cases are included to illustrate the use of facial prostheses to reconstruct complex facial defects. RESULTS The clinical use of facial prostheses requires a multidisciplinary team including a reconstructive surgeon, a maxillofacial prosthodontist, and an anaplastologist, if available, to provide patients with aesthetically appropriate facial prostheses. Developing technology including computer-aided design and three-dimensional printing may improve the availability of facial prostheses by eliminating multiple steps during prosthesis fabrication, ultimately decreasing the time required to fabricate a prosthesis. In addition, enhanced materials may improve prosthesis durability. Long-term outcomes data using validated measures is needed to support the continued use of facial prostheses. CONCLUSIONS Facial prostheses can be used to reconstruct complex facial defects, and bone-anchored prostheses are associated with high patient satisfaction. Multiple barriers prevent prostheses from being used for facial reconstruction. New technologies to assist the design and fabrication of prostheses, and cost reduction measures, may allow their use in the appropriately selected patient.
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Affiliation(s)
| | - Azadeh Afshari
- Division of Maxillofacial Prosthodontics, Barnes-Jewish Hospital
| | - Ann E Vitale
- Division of Maxillofacial Prosthodontics, Barnes-Jewish Hospital
| | | | | | - John J Chi
- Division of Facial Plastic and Reconstructive Surgery, Washington University in St. Louis
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Alberga J, Eggels I, Visser A, van Minnen B, Korfage A, Vissink A, Raghoebar G. Outcome of implants placed to retain craniofacial prostheses - A retrospective cohort study with a follow-up of up to 30 years. Clin Implant Dent Relat Res 2022; 24:643-654. [PMID: 35699941 PMCID: PMC9796566 DOI: 10.1111/cid.13106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To retrospectively assess the treatment outcomes of endosseous implants placed to retain craniofacial prostheses. MATERIAL AND METHODS Patients with craniofacial defects resulting from congenital disease, trauma, or oncologic treatment had implant retained prostheses placed in the mastoid, orbital, or nasal region and then assessed over a period of up to 30 years. Implant survival rates were calculated with the Kaplan-Meier method. Clinical assessments consisted of scoring skin reactions under the prosthesis and the peri-implant skin reactions. Possible risk factors for implant loss were identified. Patient satisfaction was evaluated using a 10-point VAS-scale. RESULTS A total of 525 implants placed in 201 patients were included. The median follow up was 71 months (IQR 28-174 months). Implants placed in the mastoid and nasal region showed the highest overall implant survival rates (10-year implant survival rates of 93.7% and 92.5%, respectively), while the orbital implants had the lowest overall survival rate (84.2%). Radiotherapy was a significant risk factor for implant loss (HR 3.14, p < 0.001). No differences in implant loss were found between pre- and post-operative radiotherapy (p = 0.89). Soft tissue problems were not frequently encountered, and the patients were highly satisfied with their implant-retained prosthesis. CONCLUSION Implants used to retain craniofacial prostheses have high survival and patient satisfaction rates and can thus be considered as a predictable treatment option. Radiation is the most important risk factor for implant loss.
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Affiliation(s)
- Jamie Alberga
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Iris Eggels
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Anita Visser
- Department of Dentistry, Dental School GroningenUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Baucke van Minnen
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Anke Korfage
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Gerry Raghoebar
- Department of Oral and Maxillofacial SurgeryUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
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Jablonski RY, Veale BJ, Coward TJ, Keeling AJ, Bojke C, Pavitt SH, Nattress BR. Outcome measures in facial prosthesis research: A systematic review. J Prosthet Dent 2021; 126:805-815. [PMID: 33581868 PMCID: PMC8664412 DOI: 10.1016/j.prosdent.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022]
Abstract
STATEMENT OF PROBLEM Facial prosthesis research uses a wide variety of outcome measures, which results in challenges when comparing the effectiveness of interventions among studies. Consensus is lacking regarding the most appropriate and meaningful outcome measures to use in facial prosthesis research to capture important perspectives. PURPOSE The purpose of the systematic review was to identify and synthesize outcome measures used in facial prosthesis research. MATERIAL AND METHODS Electronic searches were performed in 11 databases (including nonpeer-reviewed literature). The citations were searched, and expert societies were contacted to identify additional studies. Inclusion criteria comprised studies of participants with facial defects who required or had received prosthetic rehabilitation with an external facial prosthesis. Exclusion criteria comprised participants with ocular prostheses, case reports, case series with fewer than 5 participants, laboratory-based studies, and studies published before 1980. Study selection was performed independently by 2 reviewers. Discrepancies were resolved through discussion or by a third reviewer. Outcome measures were synthesized with a categorization approach based on the perspective, theme, and subtheme of the outcome measures. Quality assessment was performed with an appraisal tool that enabled evaluation of studies with diverse designs. RESULTS Database searching identified 13 058 records, and 7406 remained after duplications were removed. After initial screening, 189 potentially relevant records remained, and 186 full texts were located (98% retrieval rate). After full-text screening, 124 records were excluded. Citation searches and contact with expert societies identified 4 further records. In total, 69 articles (grouped into 65 studies) were included. Studies were categorized as per the perspective of their outcome measures, with the following findings: patient-reported (74% of studies), clinical indicators (34%), clinician-reported (8%), multiple viewpoints (6%), and independent observer-reported (3%). Patient-reported outcome measures included tools to assess satisfaction, quality of life, and psychologic health. Variability in the choice of outcome measures was evident among the studies, with many self-designed, unvalidated, condition-specific questionnaires reported. A greater number of outcome measure themes emerged over time; themes such as service delivery and health state utility have recently been evaluated. CONCLUSIONS Over the past 40 years, facial prosthesis research has focused on patient-reported outcome measures. Outcome measures relating to other perspectives have been used less frequently, although new themes appear to be emerging in the literature. Future research should use outcome measures with appropriate measurement properties for use with facial prosthetics.
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Affiliation(s)
- Rachael Y Jablonski
- Specialty Registrar in Restorative Dentistry and NIHR Doctoral Fellow, Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, UK.
| | - Benjamin J Veale
- Medical Student, Hull York Medical School, University of York, York, UK
| | - Trevor J Coward
- Reader and Honorary Consultant in Maxillofacial and Craniofacial Rehabilitation, Academic Centre of Reconstructive Science, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Andrew J Keeling
- Clinical Associate Professor, Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, UK
| | - Chris Bojke
- Professor of Health Economics, Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Sue H Pavitt
- Professor of Translational and Applied Health Research, Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK
| | - Brian R Nattress
- Clinical Professor and Honorary Consultant, Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, UK
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Wrobel C, Keppeler D, Meyer AC. [Optimized fitting of a midface implant to anchor a magnetic nasal prosthesis using 3D printing]. HNO 2021; 70:200-205. [PMID: 34463790 PMCID: PMC8866386 DOI: 10.1007/s00106-021-01100-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 11/24/2022]
Abstract
Hintergrund Plattenbasierte Ankersysteme zur fazialen Epithesenversorgung bieten gegenüber extraoralen Einzeltitanimplantaten Vorteile hinsichtlich einer flexibleren Wahl knöcherner Verankerungspunkte und höherer Stabilität. Nachteile werden in einer aufwendigen individuellen intraoperativen Anpassung der Plattensysteme am meist schlecht zugänglichen Knochen deutlich. Wir stellen eine Methode vor, diese Nachteile zu überwinden und die Vorteile plattenbasierter Systeme stärker auszuspielen. Methodik Das knöcherne Mittegesicht eines Patienten mit erfolgter Rhinektomie bei Karzinom des Naseneingangs wurde anhand der präoperativen Computertomographie als virtuelles 3‑D-Modell rekonstruiert. Die verwendete Open-Source-Software (3-D-Sclicer) ermöglichte die einfache und schnelle Rekonstruktion sowie Anpassung zum Druck des 3‑D-Modells mittels transparenten Kunststoffs (MED610; stratasys Ltd., MN, USA). Ergebnisse Die als Epithesenanker verwendete Titan-Brückenplatte (MEDICON) konnte am 3‑D-Druck des Mittelgesichts äußerst präzise vorangepasst werden. Wichtige anatomische Strukturen wurden geschont und die Verschraubungspunkte entsprechend der gegebenen Knochendicke gewählt. Die Implantation der vorangepassten Titanplatte erfolgte komplikationslos ohne weitere intraoperative Anpassungen. Schlussfolgerung Die Voranpassung plattenbasierter Ankersysteme für faziale Epithesen am 3‑D-Druck des Mittelgesichts überwindet deren Nachteile einer aufwendigen ggf. unpräzisen intraoperativen individuellen Anpassung. Diese Methode spielt die Vorteile der besseren Kraftverteilung durch mehr mögliche Verschraubungen, auch in dünnerem Knochen, weiter aus und kann somit Implantatlockerungen vorbeugen. Zudem ermöglicht die Voranpassung am 3‑D-Modell die bessere Identifikation und Schonung wichtiger anatomischer Strukturen und spart Op.-Zeit ein.
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Affiliation(s)
- Christian Wrobel
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
| | - Daniel Keppeler
- Institut für Auditorische Neurowissenschaften, Universitätsmedizin Göttingen, 37075, Göttingen, Deutschland
| | - Alexander C Meyer
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsmedizin Göttingen, Georg-August-Universität Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
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Motsch C, Dehnbostel S, Ulrich J. Epithetische Versorgung nach subtotaler Rhinektomie. J Dtsch Dermatol Ges 2021; 19:1229-1232. [PMID: 34390133 DOI: 10.1111/ddg.14411_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Christiane Motsch
- Klinik für Dermatologie und Allergologie, Harzklinikum Dorothea Christiane Erxleben, Quedlinburg
| | | | - Jens Ulrich
- Klinik für Dermatologie und Allergologie, Harzklinikum Dorothea Christiane Erxleben, Quedlinburg
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Gaur V, Perumal SM, Rahmaan F, Pałka Ł. A practical approach to orofacial rehabilitation in a patient after inferior maxillectomy and rhinectomy with mono framework construction supported on a zygomatic implant placed in the glabella: a case report. Maxillofac Plast Reconstr Surg 2021; 43:25. [PMID: 34255204 PMCID: PMC8276903 DOI: 10.1186/s40902-021-00312-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background In the field of craniofacial tumor surgery, an adequately performed excision, despite being a life-saving procedure, is only a first step to successful treatment. During such a procedure, the main goal is to completely remove the lesion, paying less attention to factors contributing to future rehabilitation possibilities. One ty 2of the possibilities for prosthetic rehabilitation of such cases is utilizing one-piece implants with bicortical anchorage. Case presentation This case report presents a case of a 48-year-old patient with oral squamous cell carcinoma (OSCC). The treatment protocol consisted of radical surgery to remove the tumor, and intraoral and extraoral rehabilitation with a single framework prosthesis anchored with one-piece implants. Moreover, the intraoral stomatognathic deformity was corrected with a fixed implant-retained prosthesis, and the extraoral defect was covered with a removable epithesis. Conclusions The use of one-piece implants with bicortical anchorage may be an additional tool in reconstructing maxillofacial defects. Properly executed treatment may improve the esthetics, speech, masticatory function, muscle support, and the overall quality of life of patients with extensive defects in the maxillofacial region.
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Affiliation(s)
- Vivek Gaur
- Department of Oro-Maxillofacial Surgery, Jaipur Dental College, Jaipur, India. .,, Ghaziabad, India.
| | - S Mahendra Perumal
- Department of Oral and Maxillofacial Surgery, K S R Institute of Dental Science and Research, Erode, Tamilnadu, India
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Motsch C, Dehnbostel S, Ulrich J. Epithetic reconstruction after subtotal rhinectomy. J Dtsch Dermatol Ges 2021; 19:1229-1232. [PMID: 33890403 DOI: 10.1111/ddg.14411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Christiane Motsch
- Klinik für Dermatologie und Allergologie, Harzklinikum Dorothea Christiane Erxleben, Quedlinburg
| | | | - Jens Ulrich
- Klinik für Dermatologie und Allergologie, Harzklinikum Dorothea Christiane Erxleben, Quedlinburg
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D'heygere V, Mattheis S, Stähr K, Bastian T, Höing B, Lang S, Hussain T. Epithetic nasal reconstruction after total rhinectomy: Oncologic outcomes, immediate and long-term adverse effects, and quality of life. J Plast Reconstr Aesthet Surg 2020; 74:625-631. [PMID: 33189623 DOI: 10.1016/j.bjps.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Total rhinectomy for tumors of the nasal cavity substantially alters patients' appearance and requires local reconstruction. While full nasal epitheses are well-established for this purpose, potential long-term adverse effects and impact on patients' quality of life are not fully understood. METHODS Sixteen patients who underwent total rhinectomy with ensuing nasal reconstruction with a full nasal epithesis were included in the study. Oncologic outcomes were assessed, and adverse effects and quality of life analyses were performed based on a patient-reported outcomes tool. RESULTS In patients with squamous cell carcinomas of the nasal cavity, total rhinectomy led to excellent local tumor control. Immediate and long-term adverse effects of total rhinectomy and placement of a nasal epithesis were predominantly limited to the immediate nasal region. While patients were satisfied with their nasal appearance, they reported a worse assessment of their facial appearance and a measurable long-term effect on their psychological well-being. CONCLUSION Total rhinectomy and reconstruction with a full nasal epithesis is a safe and oncologically sound treatment approach. However, its effects on patients' overall appearance and psychological well-being need to be considered during treatment planning and follow-up.
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Affiliation(s)
- Victoria D'heygere
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Stefan Mattheis
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Kerstin Stähr
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Tobias Bastian
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Benedikt Höing
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Stephan Lang
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Timon Hussain
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany.
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Zaoui K, Jung A, Rückschloß T, Möhlenbruch M, Plinkert P, Federspil P. Measurement of bone thickness at the site of titanium miniplates used to retain nasal prostheses in fused computed tomographic data. Br J Oral Maxillofac Surg 2020; 58:546-551. [DOI: 10.1016/j.bjoms.2020.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 02/11/2020] [Indexed: 11/16/2022]
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Abstract
Implant-retained craniofacial prostheses (or epitheses) made of silicone are state of the art for prosthetic rehabilitation of facial defects. With the modern extraoral implant systems, prostheses may be securely anchored to the bone regardless of size and location of the defect. Prerequisite for successful implantation is the classical atraumatic surgical technique with avoidance of any thermal trauma to the bone. The treatment intention may be a temporary measure, a rescue procedure after failed (re)construction, or a definitive treatment option. This article gives an overview of the strategies in various facial regions stratified according to the age of the patient and the etiology of the defect. Moreover, prosthetic rehabilitation offers additional options for septal perforations, distorted and leaky tracheostomies, and treatment-resistant tracheoesophageal fistula.
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Zaoui K, Jung A, Wimmer W, Engel M, Möhlenbruch MA, Federspil PA. Topographic bone thickness maps to evaluate the intuitive placement of titanium miniplates for nasal prostheses. Int J Oral Maxillofac Surg 2020; 49:1232-1241. [PMID: 32204964 DOI: 10.1016/j.ijom.2020.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 01/10/2020] [Accepted: 02/26/2020] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate the intuitive placement of titanium miniplates. The hypothesis was that virtual planning can improve miniplate placement. Twenty patients were included in the study. These patients were fitted with 21 titanium miniplates (16 y-plates, three t-plates, and two u-plates) to retain nasal prostheses between 2005 and 2017. Colour-coded topographic bone thickness maps (TBTMs) were created in fused pre- and postoperative computed tomography. Implants were virtually transposed at the position of highest bone thickness. The bone thickness index (BTI) was calculated as the sum of points assigned at each screw (1 point per millimetre up to 4 mm, and 5 points for greater values) divided by the number of screws. One plate broke after 2.8 years, thus plate survival after 5 years was 91% using the Kaplan-Meier method. The BTI for all 21 plates increased from 3.4 to 4.1 points using virtual transposition (P<0.001). No significant changes were observed in t- and u-plates, but the median BTI increased from 3.1 to 4.1 points (P<0.0005) in 16 y-plates. The change was substantial (≥0.5 points) in 9/16 y-plates. Therefore, the hypothesis that virtual planning improves implant placement was accepted.
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Affiliation(s)
- K Zaoui
- Department of Otorhinolaryngology, University Hospital Heidelberg, Germany
| | - A Jung
- Department of Otorhinolaryngology, University Hospital Heidelberg, Germany
| | - W Wimmer
- Hearing Research Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Switzerland; Department of Otolaryngology, Bern University Hospital, Inselspital, University of Bern, Switzerland
| | - M Engel
- Department of Oral and Maxillofacial Surgery, University Hospital Heidelberg, Germany
| | - M A Möhlenbruch
- Department of Neuroradiology, University Hospital Heidelberg, Germany
| | - P A Federspil
- Department of Otorhinolaryngology, University Hospital Heidelberg, Germany.
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15
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Balaghi F, Hasanzade M, Zarati S. Implant-Retained Nasal Prosthesis with Bar and Clip for a Patient with Total Rhinectomy: A Clinical Report. Front Dent 2019; 16:478-483. [PMID: 33089250 PMCID: PMC7569273 DOI: 10.18502/fid.v16i6.3448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 10/04/2019] [Indexed: 11/29/2022] Open
Abstract
The present clinical report describes the fabrication of an implant -retained prosthesis with bar and clip retention for a patient with total rhinectomy due to basal cell carcinoma (BCC). The nasal prosthesis was retained on the face by a reverse Y-shaped bar with horizontal and vertical extensions, resulting in favorable retention and function.
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Affiliation(s)
- Fatima Balaghi
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahya Hasanzade
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Simindokht Zarati
- Dental Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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16
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Moore P, Grinsell D, Lyons B, Hewson I. Outcomes of dental and craniofacial osseointegrated implantation in head and neck cancer patients. Head Neck 2019; 41:3290-3298. [DOI: 10.1002/hed.25845] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 05/11/2019] [Accepted: 06/04/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Phillip Moore
- ENT/Head and Neck UnitSt Vincent's Hospital Melbourne Victoria Australia
| | - Damien Grinsell
- Plastic, Reconstructive, and Hand Surgery UnitSt Vincent's Hospital Melbourne Victoria Australia
| | - Bernard Lyons
- ENT/Head and Neck UnitSt Vincent's Hospital Melbourne Victoria Australia
| | - Ian Hewson
- ENT/Head and Neck UnitSt Vincent's Hospital Melbourne Victoria Australia
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17
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GASTALDI G, PALUMBO L, MORESCHI C, GHERLONE E, CAPPARÉ P. Prosthetic management of patients with oro-maxillo-facial defects: a long-term follow-up retrospective study. ORAL & IMPLANTOLOGY 2017; 10:276-282. [PMID: 29285330 PMCID: PMC5735392 DOI: 10.11138/orl/2017.10.3.276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The aim of this study is to determine the outcome of maxillofacial prosthetic rehabilitation after oncological resections, including both intra- and extra-oral prosthetic devices. METHODS In this study were included 72 patients, who have undergone an intra or extra-oral maxillofacial prosthetic rehabilitation after an oncologic resection. Tumors on the head and neck were analyzed and the defects of these resections have been divided in two different groups: intra and extra-oral defects. RESULTS 72 participants were treated with maxillofacial prosthesis, 3 of which with post-traumatic wounds and 69 with resections of tumors on the head and neck. Of the 69 treated for neoplastic disease, 43 received an intraoral prosthesis (palatal obturator) and 29 with an extraoral epithesis (18 with nasal prostheses, 8 with orbital implants and 3 with ear implants). The group included patients with different types of tumors. All the patients were evaluated in terms of aesthetic appearance after the construction of the prostheses and the results were satisfactory. CONCLUSION Within the limitations of this study, after the use of maxillofacial protheses patients feel more confident and self-assured. Maxillofacial protheses are a good solution in order to improve the life's quality in patients with tumors resections: prostheses are easy to handle and provide a satisfying social interaction for the patients.
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Affiliation(s)
| | | | | | | | - P. CAPPARÉ
- Correspondence to: Dr. Paolo Capparé, Department of Dentistry, IRCCS San Raffaele Hospital, Via Olgettina 48, 20132 Milan, Italy, Phone: 0039 0226433619; fax 0039 0226432953;, E-mail:
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18
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Aesthetic and functional outcomes in patients with a nasal prosthesis. Int J Oral Maxillofac Surg 2017; 46:1446-1450. [PMID: 28521966 DOI: 10.1016/j.ijom.2017.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/09/2017] [Accepted: 04/27/2017] [Indexed: 02/03/2023]
Abstract
The aim was to evaluate the aesthetic and functional outcomes in patients with a nasal prosthesis after radical tumour resection. A questionnaire with 15 domains was created to evaluate the satisfaction of patients with their nasal prosthesis. Correlations with the results of the University of Washington Quality of Life (UWQOL) questionnaire, which was also completed by the patients, were analyzed. Forty-three patients with a partial or total nasal prosthesis completed the questionnaire. Twenty-seven patients were male and 16 were female; their median age was 62 years. The median follow-up time after tumour resection was 33 months. The best result was obtained for overall function (85.5) and the worst result for nasal crusts (58.5). The average daily duration of prosthesis use was 17.4h. There were sex-dependent and age-dependent differences in the domain 'self-confidence', age-dependent differences in the domain 'stability during sporting activities', and differences in the domain 'nose bleed' depending on the time since tumour resection. All patients would recommend this rehabilitation after rhinectomy. 'Satisfaction with function' had the most influence on UWQOL domains. The nasal prosthesis is a well-accepted rehabilitation after rhinectomy. The results for appearance are comparable to those obtained for nasal reconstruction, and high scores were found for the functional domains.
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Brandão TB, Vechiato Filho AJ, de Souza Batista VE, de Oliveira MCQ, Visser A, de Faria JCM, Júnior GDC, Santos-Silva AR. A systematic comparison of bar-clips versus magnets. J Prosthet Dent 2016; 117:321-326.e2. [PMID: 27666496 DOI: 10.1016/j.prosdent.2016.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 05/04/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
STATEMENT OF PROBLEM Currently, which type of suprastructure is preferred when fabricating implant-retained craniofacial prostheses is unknown. PURPOSE The purpose of this systematic review was to identify the best retention system (bar-clips versus magnets) for implant-retained craniofacial prostheses. MATERIAL AND METHODS This systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic search of Medline/PubMed and Web of Science databases for clinical trials was conducted on implant-retained craniofacial prostheses published between 2005 and 2015. English-language studies that directly compared different types of retention systems or presented information on implant survival, periimplant soft tissue reactions, and prosthetic complications were included. Nonclinical studies were excluded to eliminate bias. RESULTS A total to 173 studies were identified, of which 10 satisfied the inclusion criteria. In total, 492 participants were included in these studies. Four selected studies displayed detailed information with regard to the number of implant failures according to the retention system. As reported, 29 (18.2%) of 159 implants with magnets failed, whereas 25 (31.6%) of 79 implants with bars failed. Overall auricular superstructures showed the highest survival (99.08%). In addition, 55.4% of all participants in the selected studies showed grade 0 of periimplant soft tissue reactions. CONCLUSIONS A systematic search for clinical studies resulted in few studies with a short-term follow-up and small number of participants. The limited data collected indicated that magnets show fewer complications than bar superstructures; however, no hard conclusions could be drawn. Further research, preferably in the form of clinical trials, is needed to validate these findings.
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Affiliation(s)
- Thais Bianca Brandão
- Coordinator, Dental Oncology Service, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
| | - Aljomar José Vechiato Filho
- Assistant, Dental Oncology Service, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Victor Eduardo de Souza Batista
- Doctoral student, Department of Dental Materials and Prosthodontics, Aracatuba Dental School, Sao Paulo State University, São Paulo, Brazil
| | - Maria Cecília Querido de Oliveira
- Assistant, Dental Oncology Service, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Anita Visser
- Assistant Professor, Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - José Carlos Marques de Faria
- Associate Professor, Plastic Surgery, University of São Paulo, São Paulo, Brazil; and Head, Plastic Surgery, Pontificia Universidade Catolica, Medical School, Campinas, São Paulo, Brazil
| | - Gilberto de Castro Júnior
- Attending Physician, Clinical Oncology, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Alan Roger Santos-Silva
- Professor, Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, Sao Paulo, Brazil
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Papaspyrou G, Schick B, Schneider M, Al Kadah B. Epithetic nasal reconstruction for nasal carcinoma: retrospective analysis on 22 patients. Eur Arch Otorhinolaryngol 2016; 274:867-872. [PMID: 27650361 DOI: 10.1007/s00405-016-4312-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 09/17/2016] [Indexed: 11/25/2022]
Abstract
Advanced nasal cancers usually demand partial or total rhinectomy followed by radiotherapy. Reconstruction of the resulting defects can be achieved by means of reconstructive plastic surgery and/or epithetic surgery. The data of 22 patients who had been treated after nasal ablation by means of custom-made silicone nasal epithesis fixed by bone-anchored magnets between 2003 and 2014 were evaluated retrospectively. There were 15 male (68.2 %) and 7 (31.8 %) female patients. The most common etiology that led to epithetic rehabilitation was a squamous cell carcinoma in 16 patients. An operative revision was necessary in two patients due to screw loss. Twenty patients were still alive with no evidence of disease after minimum follow-up of 2 years (90.9 %). Epithetic rehabilitation after nasal ablation to treat nasal malignancies is an interesting alternative to plastic and reconstructive surgery. Bone-anchored fixation using magnets can achieve a stable epithetic fixation after nasal ablation necessitating, in numerous cases, additional adjuvant therapy like radiation.
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Affiliation(s)
- Giorgos Papaspyrou
- Department of Otorhinolaryngology, University Medical Centre Homburg/Saar, University of Homburg, Kirrberg Straße, 66421, Homburg/Saar, Germany.
| | - Bernhard Schick
- Department of Otorhinolaryngology, University Medical Centre Homburg/Saar, University of Homburg, Kirrberg Straße, 66421, Homburg/Saar, Germany
| | | | - Basel Al Kadah
- Department of Otorhinolaryngology, University Medical Centre Homburg/Saar, University of Homburg, Kirrberg Straße, 66421, Homburg/Saar, Germany
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21
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Hofstede TM, Jacob RF, Montgomery P, Wesley P. Surgical preparation of nasal defects to enhance the implant-retained facial prostheses: A case report. Head Neck 2016; 39:E4-E11. [PMID: 27618726 DOI: 10.1002/hed.24574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/26/2016] [Accepted: 07/25/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Skin cancers requiring nasal resection may be surgically reconstructed and/or prosthetically reconstructed. Singular surgical reconstruction may be ideal for smaller defects in which the nasal bone and cartilaginous portions of the nose are maintained, but surgical reconstruction falls short of providing acceptable aesthetic results for more extensive nasal defects. Prosthetic rehabilitation, or a combination of surgical and prosthetic rehabilitation, is more appropriate for larger defects, but prosthesis retention can be challenging when adhesives are required on adjacent mobile and secreting skin. METHODS We report 2 cases of patients with extensive nasal defects who were successfully rehabilitated with nasal prostheses. The nasal defects were surgically optimized with immediate preparation of the surgical margins, placement of a split-thickness skin graft (STSG) within the nasal cavities and exposed maxillary sinuses, and immediate placement of osseointegrated implants. RESULTS Excellent prosthetic retention can be achieved without the need for adhesives. A skin graft-lined defect has minimal secretions and allows for improved defect cleansing. CONCLUSION The success of a nasal prosthesis depends on appropriate surgical management of the defect, and, thus, collaboration between the various surgical and prosthetic teams is essential. © 2016 Wiley Periodicals, Inc. Head Neck 39: E4-E11, 2017.
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Affiliation(s)
- Theresa M Hofstede
- Department of Head and Neck Surgery, Section of Oral Oncology and Maxillofacial Prosthodontics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rhonda F Jacob
- Department of Head and Neck Surgery, Section of Oral Oncology and Maxillofacial Prosthodontics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patricia Montgomery
- Department of Head and Neck Surgery, Section of Oral Oncology and Maxillofacial Prosthodontics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peggy Wesley
- Department of Head and Neck Surgery, Section of Oral Oncology and Maxillofacial Prosthodontics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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22
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Chrcanovic BR, Nilsson J, Thor A. Survival and complications of implants to support craniofacial prosthesis: A systematic review. J Craniomaxillofac Surg 2016; 44:1536-1552. [PMID: 27591092 DOI: 10.1016/j.jcms.2016.07.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/17/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To assess the survival rate of craniofacial implants (CIs) to support facial prosthesis/epithesis and the prevalence of surgical/biological complications based on previously published studies. METHODS An electronic search was undertaken in March/2016. Only studies with a minimum of 5 patients were included. Untransformed proportions of implant failures for different regions were calculated. A meta-analysis evaluated the influence of radiotherapy on the failure rates. A meta-regression was performed considering the follow-up period as covariate. RESULTS Seventy publications included 2355 patients and 8184 CIs (545 failures). The probability of a failure was 5.5% for all CIs (95%CI 4.5-6.5, P < 0.001), 1.2% for CIs in the auricular region (95%CI 0.8-1.5, P < 0.001), 12.2% for the nasal region (95%CI 9.0-15.5, P = 0.017), and 12.1% for the orbital region (95%CI 9.3-15.0, P < 0.001). Radiotherapy statistically affected the CIs rates (OR 5.80, 95%CI 3.77-8.92, P < 0.00001). There was no statistically significant influence of the follow-up time on the proportion of implant failures (P = 0.814). Soft tissue adverse reactions were the most common complications. CONCLUSIONS Implants placed in the auricular region have a lower probability of failure than those in the nasal and orbital regions. Soft tissue adverse reactions were the most common complications. Radiotherapy significantly affected the CIs failure rates.
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Affiliation(s)
- Bruno Ramos Chrcanovic
- Department of Prosthodontics, Faculty of Odontology (Head: Dr. A. Wennerberg, DDS, PhD), Malmö University, Carl Gustafs väg 34, SE-205 06, Malmö, Sweden.
| | - Johanna Nilsson
- Department of Oral and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark; Department of Surgical Sciences, Oral and Maxillofacial Surgery (Head: Dr. Per Hellman, MD, PhD), Uppsala University, Uppsala, Sweden.
| | - Andreas Thor
- Department of Surgical Sciences, Oral and Maxillofacial Surgery (Head: Dr. Per Hellman, MD, PhD), Uppsala University, Uppsala, Sweden.
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