Intranasal prostheses, splints, and stents

Fabrication of three-dimensionally printed polylactic acid nasal stent prosthesis for postnasal reconstruction using extraoral scanning and photogrammetry techniques: A report on two patients

Severe and combined nasal defects associated with trauma or neoplasm excision can cause significant functional and esthetic problems. To avoid nasal synechia following reconstructive surgeries, a nasal stent prosthesis is required to act as an internal scaffold to support the graft and residual tissues. The purpose of the stent is to maintain internal airway patency and to prevent collapse and contracture of the donor tissues. A conventional nasal stent prosthesis has disadvantages, including the difficulty in maintaining adequate thickness and internal patency during fabrication. Hence, this clinical report introduces the fabrication technique for 3-dimensionally printed polylactic acid nasal stent prostheses using extraoral scanning and photogrammetry methods.

A technique for fabricating a hollowed nasal stent using a connector of an intravenous infusion set to manage iatrogenic nasal vestibular stenosis in an infant

The presented technique describes the steps for fabricating a hollow and rigid intranasal stent to maintain the patency of the nasal passage after iatrogenic nasal vestibular stenosis in an infant. The technique uses a connector between the injection bulb or site and the hypodermic needle of an intravenous infusion set to ease the impression making and avoid the additional step of hollowing the stent.

Novel prosthodontic technique in fabrication of customized nasal stent in an infant

Burn injuries have a major impact on the physical and functional aspects of patients, thereby affecting their quality of life. Nasal stenosis which occurs as a result of wound contraction may lead to serious complications if not intervened at the earliest. In the prosthodontic front, nasal stents may be utilized in conjunction with reconstructive surgery procedures to minimize scar contraction and prevent nasal stenosis. This clinical report focuses on a customized technique in the fabrication of nasal stent to maintain the nasal airway patency in an infant who had suffered burn injuries. An intraoral tip was employed as a receptacle for accurate impression making, followed by the insertion of an intermediate stent fashioned from a scalp vein set catheter. The definitive stent fabricated using methyl methacrylate resin served to maintain the patency of the nasal passageway.

Custom-fabricated nasal conformers and surgical stents in the management of midfacial acid burn injuries: A clinical report

Acid burn injuries in the midfacial region cause contracture of the skin and nasal aperture, which can lead to nasal airway obstruction. Management of such complicated situations requires a multidisciplinary approach, including prosthetic intervention. This article describes a clinical treatment for fabricating a custom nasal conformer for a 28-year-old man who presented with a history of an acid burn injury leading to obstructed external nares and fusion of the tip and columella of the nose with the philtrum of the upper lip. The prosthesis served the dual function of maintaining the nasal airway passage and preventing the contracture of the graft placed over the upper lip during reconstructive surgery.

Fabricating a partial nasal prosthesis with a custom nasal dilator design

Patients undergoing partial rhinectomy with limited size may have the major portion of the nasal structure preserved. However, the fibrosis or scar formation after the surgery may cause distortion of remaining tissues, followed by nasal airway obstruction. By physically expanding an affected nostril during the impression and using digital technology to design a custom flexible internal nasal dilator, embedded in the medical grade silicone during processing, a partial nasal prosthesis with airway-maintaining purpose can be fabricated to improve quality of life both esthetically and functionally.

A simplified approach of prosthetic management of posttraumatic nasal obstruction using a custom-made unilateral intranasal stent in 14-year-old child

Infections, trauma, iatrogenic causes, congenital malformations, or complications of systemic diseases can result in perforation of the nasal septum. An intranasal stent is a removable prosthesis that can be inserted into the nasal cavity to support the form of nose. The stenting can be used for recanalization and nasal valve preservation. This case report presents a method for the fabrication of a customized nasal stent in a 14-year-old female patient with posttraumatic unilateral collapsed nasal vestibule.

An esthetic modification of a nasal conformer

Facial contractures caused by burns can collapse the nasal aperture and lead to airway obstruction. Management in such situations requires surgical and prosthetic intervention. Prosthetically, although a nasal conformer is the treatment of choice, even a well-fabricated nasal conformer may be esthetically unappealing and require an aid for enhanced retention. Expensive implant-aided conformers are not always a viable option. This article introduces a technique for fabricating a nasal conformer that is both esthetically appealing and cost-effective. The technique is illustrated by the treatment of a 12-year-old girl who presented with a history of burn injuries leading to nasal contracture that was effectively managed with this concept.

Personalized Bioactive Nasal Supports for Postoperative Cleft Rhinoplasty

PURPOSE

After cleft lip and palate surgical procedures, patients often need nostril supports to help the reconstructed nostrils retain their shape during healing. Many postoperative nasal stents use a one-size-fits-all approach, in which a standard rubber tube retainer is trimmed and used to support the healing nares. The purpose of this study was to examine photogrammetry and 3-dimensional (3D) printing as a fabrication tool for postoperative patient-specific nasal supports that can be loaded with bioactive agents for localized delivery.

MATERIALS AND METHODS

A "normal" right nostril injection mold was prepared from a left-sided unilateral cleft defect, and the negative-space impression was modeled using a series of photographs taken at different rotation angles with a commercial mobile phone camera. These images were "stitched" together using photogrammetry software, and the computer-generated models were reflected, joined, and digitally sculpted to generate hollow bilateral supports. Three-dimensional prints were coated with polyvinylpyrrolidone-penicillin and validated for their ability to inhibit Escherichia coli using human blood agar diffusion assays.

RESULTS

The results showed that our approach had a high level of contour replication and the antibiotic coating was able to inhibit bacterial growth with a mean zone of inhibition of 15.15 ± 0.99 mm (n = 9) (P < .0001) in disc diffusion assays.

CONCLUSIONS

Consumer-grade 3D printing displays potential as a fabrication method for postoperative cleft bilateral nasal supports and may support the surgically reconstructed internal contours. The results of this study suggest that such types of bioactive 3D prints may have potential applications in personalized drug-delivery systems and medical devices.

Post septorhinoplasty custom-made unilateral nasal stent for nasal cleft deformity

CONTEXT

Nasal cleft deformity is a complicated problem. Utilization of nasal stent in post septorhinoplastyaims at establishing and maintaining airway patency, tissue position, and reduces tissue contracture after surgery.

CASE REPORT

A 16-year-old female patient presented with history of surgical reconstruction of congenital cleft lip and cleft palate with secondary septorhinoplasty of nasal cleft deformity. Patient was referred for nasal stent 1 week after septorhinoplasty. This case report provides a novel technique for fabrication of esthetic nasal stent after postseptorhinoplasty for secondary cleft nose deformity correction.

CONCLUSION

This case report presents a simple, convenient technique for nasal stent fabrication for prevention of restenosis for cleft nose deformity post secondary septorhinoplasty. Provision of nasal stent allows breathing, maintains esthetics, comfort, nasal patency, and contour with minimal discomfort.

Silicone nasal prosthesis retained by an intranasal stent: a clinical report

Nasal defects after tumor excision can leave a patient functionally and esthetically impaired. Loss of nasal septal cartilage support causes the soft tissue to collapse or undergo stenosis, further compounding the problem. Intranasal stents can be used to maintain the patency of such nasal defects. This clinical report describes the use of an acrylic resin nasal stent bonded to a silicone nasal prosthesis to rehabilitate a patient with a nasal defect.

Prosthetic management of post surgical nasal skin graft contracture

The sequelae of trauma to the nose include nasal deformity and nasal obstruction that can have a long term negative impact on patient's quality of life. Successful management of posttraumatic nasal obstruction relies on a detailed history, careful analysis, and accurate diagnosis. Treatment must balance the seemingly disparate goals of re-establishing structure, improving contour and esthetics, as well as restoring the nasal airway. Indications and technical steps for fabricating bilateral nasal stents are presented, for a case of surgical opening of bilateral nasal synechia necessitated due to failed initial corrective surgery, post contracture and collapse of skin grafts. The objective of nasal stent was to maintain patency of nasal passage post surgical intervention. This is achieved by support to graft and residual tissues and prevention of mouth breathing. The nasal stents were modified post insertion at regular intervals to ensure adaptation to changes in mucosal lining of nasal.

The combined use of the nasal prosthesis with nasal stents

Severe and composite defects of the nose due to trauma or excision of neoplasms can cause significant functional and aesthetic problems. It has been known that nasal stents have been used to maintain the nasal patency and nostril shape for a long time. Recently, nasal prosthesis was introduced as a method to solve aesthetic problems of the patients who had an amputated nose. In the present study, nasal prosthesis combined with nazal stents was used to camouflage the nasal disfigurement and to maintain the nasal patency in two adult female patients. Functional and aesthetic results was accepted as satisfactory by both the patients and the physicians.

Prosthetic management of large nasal septal defects

Large nasal septal defect is defined as a defect that exceeds in size a stretched nostril. Large nasal septal defects cannot be closed by hard acrylic resin nasal septal obturators because of access and path-of-insertion problems. However, obturation can be achieved by construction of a nasal stent that fits into one of the nasal cavities. This article describes a procedure used to manage a large nasal septal defect with an intranasal heat-processed acrylic resin stent. The medial wall of the stent indirectly allows for the partition of the two nasal cavities. The stent is rendered patent to allow for comfortable breathing. The impression making and construction of these stents is not difficult. These nasal stents indirectly separate the two nasal cavities and effective obturation of large nasal septal defects is achieved.

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.

Intranasal stent for stabilization and fixation of interstitial radioactive isotopes

This article introduces the use of an intranasal stent for the stabilization and fixation of afterloading catheters during interstitial radiation therapy. After catheters have been positioned to desired locations within the stent, they are immobilized with light polymerizing resin. The fixation of the catheters to the stent allows the radiotherapist to afterload predetermined radiation sources to desired locations. This technique maximizes tumor response and minimizes untoward effects to normal surrounding tissues.