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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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Balshi TJ, Wolfinger GJ, Pellecchia R, Reiger W, Blakely JW, Balshi SF, Kachlan MO. 9-year follow up on maxillofacial implant-supported framework designed to accommodate childhood growth. J Prosthodont 2022; 31:551-561. [PMID: 35544676 DOI: 10.1111/jopr.13528] [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: 01/17/2022] [Accepted: 04/24/2022] [Indexed: 10/18/2022] Open
Abstract
This clinical report focuses on the challenges and solutions for a child subjected to craniofacial trauma from a wild hyena biting off his nose and anterior maxilla. Unique considerations in prosthodontics and biomedical engineering were required based on future craniofacial growth and development of the child. The physical requirement of a maximum retentive prosthesis for an active, athletic child required unique engineering designs and executions. The sequence of treatment and prosthesis fabrication are detailed. The patient has been followed for nine years without physiologic complications and only minor prosthodontic complications. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Thomas J Balshi
- Founder and Prosthodontist, Pi Dental Center (Prosthodontics Intermedica, LLC), Institute for Facial Esthetics, currently Private mentoring implant surgery, Fort Washington, Pennsylvania, USA
| | - Glenn J Wolfinger
- Prosthodontist and President, Pi Dental Center, Institute for Facial Esthetics, Fort Washington, Pennsylvania, USA
| | - Robert Pellecchia
- Chairman and Program Director, Lincoln Hospital, Bronx, New York, USA
| | - William Reiger
- Maxillofacial Prosthodontist, Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania, USA
| | - James W Blakely
- Maxillofacial Anaplastologist, Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania, USA
| | - Stephen F Balshi
- Director of Research and Biomedical Engineering, Pi Dental Center, Institute for Facial Esthetics, Fort Washington, Pennsylvania, USA.,President, CM Prosthetic, Inc., Fort Washington, Pennsylvania, USA
| | - Mamdouh O Kachlan
- Prosthodontic Resident, University of Maryland School of Dentistry, Baltimore, Maryland, USA.,Research Associate, Pi Dental Center, Institute for Facial Esthetics, Fort Washington, Pennsylvania, USA
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Jazayeri HE, Kang S, Masri RM, Kuhn L, Fahimipour F, Vanevenhoven R, Thompson G, Gheisarifar M, Tahriri M, Tayebi L. Advancements in craniofacial prosthesis fabrication: A narrative review of holistic treatment. J Adv Prosthodont 2018; 10:430-439. [PMID: 30584472 PMCID: PMC6302084 DOI: 10.4047/jap.2018.10.6.430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 06/28/2018] [Accepted: 08/13/2018] [Indexed: 01/17/2023] Open
Abstract
The treatment of craniofacial anomalies has been challenging as a result of technological shortcomings that could not provide a consistent protocol to perfectly restore patient-specific anatomy. In the past, wax-up and impression-based maneuvers were implemented to achieve this clinical end. However, with the advent of computer-aided design and computer-aided manufacturing (CAD/CAM) technology, a rapid and cost-effective workflow in prosthetic rehabilitation has taken the place of the outdated procedures. Because the use of implants is so profound in different facets of restorative dentistry, their placement for craniofacial prosthesis retention has also been widely popular and advantageous in a variety of clinical settings. This review aims to effectively describe the well-rounded and interdisciplinary practice of craniofacial prosthesis fabrication and retention by outlining fabrication, osseointegrated implant placement for prosthesis retention, a myriad of clinical examples in the craniofacial complex, and a glimpse of the future of bioengineering principles to restore bioactivity and physiology to the previously defected tissue.
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Affiliation(s)
- Hossein E Jazayeri
- Oral and Maxillofacial Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Steve Kang
- Oral and Maxillofacial Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Radi M Masri
- Department of Endodontics, Prosthodontics and Operative Dentistry, University of Maryland School of Dentistry, Baltimore, MD, USA
| | - Lauren Kuhn
- Department of Oral Rehabilitation, Division of Endodontics, Medical University of South Carolina, Charleston, SC, USA
| | | | - Rabecca Vanevenhoven
- Division of Oral and Maxillofacial Surgery and Dentistry, New York Presbyterian Weill Cornell Medical Center, New York City, NY, USA
| | - Geoffrey Thompson
- Department of Prosthodontics, Marquette University School of Dentistry, Milwaukee, WI, USA
| | - Maryam Gheisarifar
- Department of Prosthodontics, Marquette University School of Dentistry, Milwaukee, WI, USA
| | | | - Lobat Tayebi
- Marquette University School of Dentistry, Milwaukee, WI, USA
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Brandão TB, Vechiato Filho AJ, de Souza Batista VE, Prado Ribeiro AC, Filho HN, Chilvarquer I, Nunn ME, Santos-Silva AR, Barão VAR, Wee AG. Assessment of treatment outcomes for facial prostheses in patients with craniofacial defects: A pilot retrospective study. J Prosthet Dent 2017; 118:235-241. [DOI: 10.1016/j.prosdent.2016.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 10/17/2016] [Accepted: 10/17/2016] [Indexed: 10/20/2022]
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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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Dawood A, Kalavrezos N, Barrett M, Tanner S. Percutaneous implant retention of a nasal prosthesis. J Prosthet Dent 2016; 117:186-190. [PMID: 27492986 DOI: 10.1016/j.prosdent.2016.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 12/22/2022]
Abstract
This report describes an approach to the simultaneous retention of a nasal prosthesis and an intraoral prosthesis for a patient who had undergone a total rhinectomy with resection of the upper lip and premaxilla. At the time of the nasal resection, 2 dental implants were placed adjacent to the resection margins in the first premolar positions. These were used to anchor an intraoral, milled titanium bar and overdenture to replace the missing anterior teeth and provide support for the upper lip, which had been reconstructed with a vascularized radial forearm free-flap. The titanium bar also incorporated a connection for a tissue-penetrating percutaneous nasal extension, which pierced the radial forearm flap near the junction with the hard palate. Magnetic attachments screwed to the nasal extension retained a nasal prosthesis. The predictable and straightforward implementation of this novel concept with digital design and manufacture of the titanium components and guided placement of the nasal extension was made possible with software planning.
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Affiliation(s)
- Andrew Dawood
- Honorary consultant, Department of Head and Neck Surgery, University College Hospital London, United Kingdom.
| | - Nicholas Kalavrezos
- Consultant, Department of Head and Neck Surgery University College London Hospital, United Kingdom
| | - Mark Barrett
- Consultant, University College London Hospital, United Kingdom
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