Maxillofacial prosthetic rehabilitation: A survey on the quality of life

Novel Approaches for the Treatment of Maxillofacial Defects

Maxillofacial defects, located in a region characterized by a complex interplay of soft and hard tissues, along with a sophisticated capillary and neural network, have long posed significant challenges in both clinical practice and research [...].

Accuracy and resolution of conventional and additively manufactured silicone elastomers as applied in maxillofacial therapies

STATEMENT OF PROBLEM

Silicone elastomers are becoming more readily available for additive manufacturing, which may be advantageous for fabricating maxillofacial prostheses. However, the properties of three-dimensionally (3D) printed silicone as compared with conventionally processed silicone have not been well studied.

PURPOSE

The purpose of this in vitro study was to compare the dimensional accuracy and surface resolution of additively manufactured with conventional room-temperature vulcanized (RTV) silicones.

MATERIAL AND METHODS

A custom aluminum mold was used to generate hand-spatulated specimens (A103 and VerSilTal-50F, n=20). A computer-aided design and computer-aided manufacturing workflow was used to generate additively manufactured specimens (Sil30 and TrueSil, n=20). Digital surface scans of each specimen were recorded; a scan of the mold served as the control. Surface dimensions were measured with a digital metrology software program, while digital overlays were made using a 3D processing software program. The surface resolution of the specimens was assessed by analyzing 4 topographical landmarks (flat surfaces, raised lines, domes, and scribed lines) with a visual qualitative grading scale. The data were analyzed with 1-way analysis of variance, followed by a Student-Newman-Keuls post hoc test (α=.05).

RESULTS

The specimens demonstrated statistical differences in trueness and precision (P<.001). The TrueSil specimens showed the largest deviation in measurements of trueness and precision (up to -1.374%). The other specimens yielded percentage mean differences that were more consistently within the range of the American Dental Association International Organization for Standardization standard for elastomers. The manually fabricated specimens yielded more consistently ideal ratings for resolution than did the additively manufactured ones, with the Sil30 specimens receiving the most Charlie (not clinically acceptable) ratings.

CONCLUSIONS

Numerical differences between each specimen and the control were considered negligible for maxillofacial applications. Notable discrepancies related to the quality of resolution, wherein the benchtop-manufactured specimens consistently generated better results compared with additively manufactured ones. Other factors, such as resiliency, odor, and cost, posed limitations in justifying the use of silicones in a direct-to-print workflow.

Factors Related to Masticatory Rhythm in Patients with Oral Tumors

Background: Older adults who have undergone surgery for oral tumors are at increased risk of impaired masticatory rhythm. This study investigated the correlations between masticatory rhythm, objective masticatory performance, and subjective masticatory performance as well as factors related to masticatory rhythm. Methods: The participants were 44 adults (24 men, 20 women; age range 42~90 years old) who had undergone maxillectomy, mandibulectomy, or glossectomy and were rehabilitated with a maxillofacial prosthesis. The number of functional contact teeth pairs was confirmed by intraoral examination. Chewing rate, cycle duration, coefficient of variation (CV) for cycle duration (reflecting the stability of masticatory rhythm), and mixing ability were measured simultaneously using a mastication movement rhythm tracking device during gum chewing. Maximum occlusal force was measured using the dental prescale system. Patients' perception of chewing ability was rated using a questionnaire. Results: The Spearman's rank correlation test revealed that mixing ability, patient-rated masticatory scores, cycle duration, CV for cycle duration, and maximum occlusal force showed significant correlations with chewing rate. Multiple linear regression analysis identified mixing ability and the CV for cycle duration as significant predictors of masticatory rhythm. Conclusions: Factors associated with a faster chewing rate were higher mixing ability and masticatory scores, greater maximum occlusal force, shorter cycle duration, and smaller CV for cycle duration. Stable masticatory rhythm and mixing ability are significant predictors of chewing rate. Poor masticatory performance and unstable masticatory rhythm can result in slower chewing and thus a higher risk of inadequate dietary intake.

Maxillofacial prosthetics and digital technologies: Cross-sectional study of healthcare service provision, patient attitudes, and opinions

PURPOSE

Digital technologies are continuously improving the accuracy and quality of maxillofacial prosthetics, but their impact on patients remains unclear. This cross-sectional study aimed to analyze the impact of facial prosthetics service provision, patients' perception, and digital technology on prostheses construction.

MATERIALS AND METHODS

All patients who presented for evaluation and management of facial defects between January 2021 and December 2021 at the ENT clinic were eligible for study enrollment. Patients requiring prosthetic reconstruction of their missing facial parts were included in the study. Forty-five questionnaires were delivered, inquiring about the patients' prosthetic demographics, prosthesis manufacture using 3D technologies, and their perceptions and attitudes.

RESULTS

A total of 37 patients responded (29 males, eight females; mean age 20.50 years). The congenital cause was the highest among other causes (p = 0.001) with auricular defects being the highest (p = 0.001). A total of 38 prostheses were constructed and 17 prostheses were retained by 36 craniofacial implants (p = 0.014). The auricular and orbital implants success rates were 97% and 25%, respectively. The implant locations were digitally planned pre-operatively. Digital 3D technologies of defect capture, data designing, and 3D modeling were used and perceived as helpful and comfortable (p = 0.001). Patients perceived their prosthesis as easy to handle, suited them, and they felt confident with it (p = 0.001). They wore it for more than 12 h daily (p = 0.001). They were not worried that it would be noticed, and found it comfortable and stable during various activities (p = 0.001). Implant-retained prosthesis patients were more satisfied with it, and found it easy to handle and stable (p = 0.001).

CONCLUSIONS

Congenital defects are the main cause of facial defects in the study country. The overall acceptance of maxillofacial prostheses was good, showing high patient perception and satisfaction. Ocular and implant-retained silicone prostheses are better handled, more stable, and the latter is more satisfying than traditional adhesive prostheses. Digital technologies save time and effort invested in manufacturing facial prostheses.

Perception of color mismatch or conspicuous marginal adaptation in extraoral prostheses with eye-tracking

STATEMENT OF PROBLEM

Color matching and marginal integrity are major challenges when providing extraoral maxillofacial prostheses. Which of the color and marginal harmony features are more important for the extraoral prostheses to be inconspicuous is unclear. Studies on the perception of these prostheses with objective evaluation criteria are lacking.

PURPOSE

The purpose of this observational study was to investigate the significance of color mismatch and conspicuous marginal adaptation in the perception of extraoral maxillofacial prostheses using eye-tracking technology. The secondary aim was to evaluate the perception of extraoral maxillofacial prostheses with regard to the observers' sex.

MATERIAL AND METHODS

Twenty-seven face images, in 3 groups, representing well-fitting orbital prostheses with a color mismatch (IC), prostheses with a good color match but distinct marginal adaptation (IM), and symmetrical face images, were viewed for 5 seconds by 52 laypeople. Time to first fixation (TFF), fixation duration (FD), and fixation count (FC) at defined areas of interest were recorded and analyzed by an eye-tracking device. Because of the nested structure of data, a sex- and age-adjusted random intercept linear mixed effects model was used to assess the difference between IC, IM, and SI. Bonferroni corrected P values were used for pairwise comparisons. The difference between observers' sex was evaluated with random intercept mixed model by adjusting for age for each image. For repeated measurement analysis, the lm4, lmerTest, and emmeans libraries in R version 4.3.1 (R Foundation for Statistical Computing) were used (α=.05 for all tests).

RESULTS

Significant differences were found between the symmetrical image group and other study groups at the facial prosthesis region in all parameters (each P<.001). Observers first focused on the facial prostheses in IC (0.72 seconds) and in IM (0.789 seconds). Longer fixation durations, 1.909, 1.989 seconds for IC and IM (PIC<.001, PIM<.001), respectively, and a higher fixation count for IC (5.28) (P<.001) and for IM (5.45) (P<.001) were recorded on facial prostheses compared with other areas of interest. Women were more focused on the prosthesis than men in the IC and IM groups considering FD (PIC=.003, PIM<.001) and FC values (PIC=.016, PIM<.001, PSI<.001). Fixation duration for women and men was 2.097 seconds and 1.739 seconds in the IC group, 2.219 seconds and 1.78 seconds in the IM group, and 1.364 seconds and 1.222 seconds in the SI group, respectively.

CONCLUSIONS

Since the color mismatch and distinct marginal adaptation of maxillofacial prostheses were recognized using eye-tracking technology, both features appeared to be equally significant to be considered in fabrication procedures.

Vascularized Composite Allograft Versus Prosthetic for Reconstruction After Facial and Hand Trauma: Comparing Cost, Complications, and Long-term Outcome

ABSTRACT

In the past decade, vascularized composite allotransplantation (VCA) has become clinical reality for reconstruction after face and hand trauma. It offers patients the unique opportunity to regain form and function in a way that had only been achieved with traditional reconstruction or with the use of prostheses. On the other hand, prostheses for facial and hand reconstruction have continued to evolve over the years and, in many cases, represent the primary option for patients after hand and face trauma. We compared the cost, associated complications, and long-term outcomes of VCA with prostheses for reconstruction of the face and hand/upper extremity. Ultimately, VCA and prostheses represent 2 different reconstructive options with distinct benefit profiles and associated limitations and should ideally not be perceived as competing choices. Our work adds a valuable component to the general framework guiding the decision to offer VCA or prostheses for reconstruction after face and upper extremity trauma.

A Systematic Review on Maxillofacial Prosthesis with Respect to Their Color Stability

The aim of this systematic review was to identify and analyze the findings of various studies that analyzed the changes in the color stability of maxillofacial prosthetic materials after the addition of various colorants and nanoparticles and assess the change in color after being subjected to either natural or artificial accelerated aging as well as outdoor aging. This systematic review was conducted in accordance with the guidelines of transparent reporting of systematic reviews and meta-analysis (PRISMA Statement). The primary objective of this systematic review was to evaluate the color stability of maxillofacial prosthesis. The secondary objective was to assess the effect of various colorants; pigments; opacifiers; UV absorbers-such as inorganic colorants (dry earth pigments); metal oxides; and organic colorants. The time period of the included studies extended from 2013 to 2023. Electronic database search identified a total of 217 studies. Ten studies were included to meet the research question. All 10 included studies analyzed the effect of various colorants and their exposure to various aging and weathering conditions. It was found that various pigments and nanoparticles had an effect on the color stability. Also weathering and aging conditions had a direct effect on the color stability as well. In terms of disinfection, although there was not much color difference observed, highest change in color stability was observed when rubbing or brushing of the prosthesis was carried out. In conclusion, the color stability of maxillofacial prosthetics is a critical factor that influences both patient satisfaction and the overall cosmetic look. The potential of pigments and nanoparticles to enhance the color stability of silicone-based maxillofacial prosthesis has received much research. By avoiding color fading and discoloration brought on by environmental variables including UV radiation, aging, and chemical exposure, the inclusion of various pigments and nanoparticles has been demonstrated to improve the color stability of silicone maxillofacial prostheses.

Evaluation of the Mechanical and Physical Properties of Maxillofacial Silicone Type A-2186 Impregnated with a Hybrid Chitosan-TiO2 Nanocomposite Subjected to Different Accelerated Aging Conditions

The effects of incorporating a pioneer chitosan-TiO2 nanocomposite on the mechanical and physical properties of room-temperature vulcanization (RTV) maxillofacial A-2186 silicone under accelerated aging protocols were rigorously examined. This investigation utilized 450 samples distributed across five distinct silicone classifications and assessed their attributes, such as tensile strength, elongation, tear strength, hardness, and surface roughness, before and after various accelerated aging processes. Statistical methodologies, including a one-way ANOVA, Tukey's HSD, and Dunnett's T3, were employed based on the homogeneity of variance, and several key results were obtained. Silicones infused with 1 wt.% chitosan-TiO2 showed enhanced tensile strength across various aging procedures. Moreover, the 1 wt.% TiO2/Chitosan noncombination (TC) and 2 wt.% TiO2 compositions exhibited pronounced improvements in the elongation percentage. A consistent rise was evident across all silicone categories regarding tear strength, with the 1 wt.% chitosan-TiO2 variant being prominent under certain conditions. Variations in hardness were observed, with the 1 wt.% TC and 3 wt.% chitosan samples showing distinctive responses to certain conditions. Although most samples displayed a decreased surface roughness upon aging, the 1 wt.% chitosan-TiO2 variant frequently countered this trend. This investigation provides insights into the potential of the chitosan-TiO2 nanocomposite to influence silicone properties under aging conditions.

Quality of life and psychological evaluation of patients after anaplastology

A comprehensive questionnaire with 43 questions was designed to evaluate quality of life, based on rehabilitation with a facial prosthesis. Each patient's psychological situation was assessed using the validated questionnaire and associated scales. Different patient groups were compared with each other in terms of questionnaire scores and general data. In total, 76 patients with a prosthesis of the orbit, nose, or ear, or a combination thereof, were included. There was a highly significant difference in overall satisfaction with defect reconstruction via a prosthesis of the ear compared with the orbit and nose (F(3) = 6.511, p = 0.001). Patients with congenital defects showed a significantly higher level of general satisfaction compared with patients with acquired defects (F(2) = 5.795, p = 0.001). Patients who returned to work were significantly more satisfied with their quality of life (T(57) = 2.626, p = 0.011). With regard to improvements to the state-of-the-art prostheses, the majority of patients suggested better retention, more durable colors, make-up possibilities, less noticeable margins, softer materials, and a movable orbital prosthesis. Within the limitations of the study it seems that facial epitheses improved mental wellbeing and increased quality of life among patients with facial defects. Multiple factors, such as type of facial defect, location of residence, and education can have a potential influence on the quality of life of affected patients. However, further studies are needed, since the psychological and social challenges remain.

The Latest Craniofacial Reconstructive Techniques Using Anchored Implants after Surgical Treatment of Nasal and Paranasal Sinuses Tumors

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.

Effect of spatial arrangement and clinical service lifetime simulation on the retention of magnetic units used in implant-anchored orbital prostheses

STATEMENT OF PROBLEM

Evidence for the optimal spatial arrangement of magnetic attachments in implant-supported orbital prostheses is lacking.

PURPOSE

The purpose of this in vitro study was to assess the effect of 6 different spatial arrangements on the retentive force of magnetic attachments following the in vitro simulation of clinical service by insertion-removal test cycles and the contribution of artificial aging to the morphological alterations induced on the magnetic surfaces.

MATERIAL AND METHODS

Ni-Cu-Ni plated disk-shaped neodymium (Nd) magnetic units (d=5 mm, h=1.6 mm) were secured on leveled (50×50×5 mm, n=3) and angled (40×45×40 mm, interior angle=90 degrees, n=3) pairs of test panels in 6 different spatial arrangements: triangular_leveled (TL), triangular_angled (TA), square_leveled (SL), square_angled (SA), circular_leveled (CL), and circular_angled (CA) generating corresponding test assemblies (N=6). TL and TA arrangements included 3 magnetic units (3-magnet groups) and SL, SA, CL, and CA 4 (4-magnet groups). The retentive force (N) was measured at a mean crosshead speed of 10 mm/min (n=10). Each test assembly was subjected to insertion-removal test cycles with a 9-mm amplitude, ν=0.1 Hz, and n=10 consequent retentive force measurements at a crosshead speed of 10 mm/min at 540, 1080, 1620, and 2160 test cycles. Surface roughness alterations following the 2160 test cycles were measured by calculating the Sa, Sz, Sq, Sdr, Sc, and Sv parameters with an optical interferometric profiler with 5 new magnetic units used as a control group. Data were analyzed with 1-way ANOVA and Tukey HSD post hoc tests (α=.05).

RESULTS

The 4-magnet groups had statistically significantly higher retentive force than the 3-magnet ones at baseline and following the 2160 test cycles (P<.05). In the 4-magnet group, the ranking at baseline was SA<CA<CL<SL (P<.05) and following the test cycles SA=CA<CL<SL (P<.05). No statistically significant differences were found in the surface roughness parameters (Sa, Sz, Sq, Sdr, Sc, and Sv) following the 2160 test cycles among the experimental groups tested (P>.05).

CONCLUSIONS

Four magnetic attachments placed on an SL spatial arrangement resulted in the highest retention force but presented with the highest force reduction following the in vitro simulation of clinical service by insertion-removal test cycles.

Evaluation of the accuracy of digital and conventional implant-level impression techniques for maxillofacial prosthesis

Objectives

This study aims to evaluate the accuracy of digital impression making based on trueness and precision measurements of dental implants placed in maxillofacial lesions to produce Maxillofacial prosthesis substructures.

Methods

Two intra-oral scanners (Trios 3 and CS 3700) and one Desktop scanner (open technology) were examined in this study. A Model of a patient with a lesion in the ear region was created as a reference. The reference model was scanned by each scanner 10 times. Standard Tessellation Language files were provided from each scanner and were examined in terms of Trueness and Precision aspects.

Results

In Distance 1, in the one-way analysis of variance test, there was a significant difference between the three scanners. The Trios group has less deviation than the Open Technology group (P = 0.015) compared with the CareStream (CS) group that showed more deviation (P < 0.000). There is a statistically significant difference in distance 2 among scanners. The Trios group showed more deviation as compared with the Open Technology group (P < 0.000). While this deviation is not statistically significant compared with the CS group (P = 0.0907). Open Technology Group compared with the CS group also has less deviation in distance 2, which has been statistically significant (P < 0.000). The preparation of a precise model of maxillofacial lesions is still difficult for some Intraoral scanners.

Conclusion

There were significant statistical differences in Trueness and Precision among scanners. Used scanners can be applied as an alternative to conventional impression methods.

Patient-Reported Quality of Life versus Physical Examination in Treating Temporomandibular Disorders with Intra-Articular Platelet-Rich Plasma Injections: An Open-Label Clinical Trial

Temporomandibular disorders, often manifested by articular pain, limitation of the mouth opening range, and unpleasant acoustic symptoms originating from inside the joint, have been associated with reduced quality of life. These symptoms, among others, can be treated with intra-articular injections of various substances, including repeated platelet-rich plasma (PRP) administration. The reported study was designed as an uncontrolled open-label clinical trial of consecutive cases. The participants completed a Fonseca questionnaire and evaluated acoustic symptoms, and spontaneous and provoked pain on VAS, and were subjected to a physical examination before, during, and after PRP therapy. The total Fonseca questionnaire results were statistically significantly (p < 0.05) correlated with 340 out of 348 (98%) other variables. The fully subjective assessment of the presence and intensity of acoustic symptoms coming from the temporomandibular joints was correlated with the physical examination results (0.45-0.63) and the maximum mouth opening with the maximum pain-free mouth opening (0.73-0.87). There were no correlations observed between the patient's and the physician's assessment of mandibular mobility. The Fonseca questionnaire seems to cover the entire spectrum of temporomandibular disorders, making it a balanced tool for assessing the quality of life in TMDs. However, it is worth considering extending the standard 3-point response scale to an 11-point one. The patient is somewhat able to perform a self-diagnosis with regard to the acoustic symptoms, but it is not possible for them to determine without measurement whether the range of mandibular mobility is appropriate..

Outcome of implants placed to retain craniofacial prostheses - A retrospective cohort study with a follow-up of up to 30 years

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.

Facial Scanning and Additive Manufacturing Used in Production Nasal Prosthesis

Maxillofacial prosthesis is an effective treatment for patients with facial sequelae, but it remains challenging for professionals due to its high esthetic complexity. This study describes a clinical case of successful nasal prosthetic rehabilitation using digital technology and additive manufacturing. Initially, the 76-year-old patient, with a facial defect in the nasal region, had her face scanned with 3-dimensional scanner for laboratory planning of the prototype of a nasal prosthesis. After approving the prototype image, working models in muffle shape were obtained in additive manufacture for the inclusion of the prosthesis. In the final session, the prosthesis was colored extrinsically and installed. The procedures digital in the manufacture of the facial prosthesis was applicable and agile, allowing the professional greater predictability regarding the shape of the rehabilitated organ, esthetic improvement in the mutilated area and patient satisfaction in relation to the speed, of the procedure and the quality of the prosthesis.

Outcome measures in facial prosthesis research: A systematic review

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.

Systematic Review of Clinical Applications of CAD/CAM Technology for Craniofacial Implants Placement and Manufacturing of Orbital Prostheses

This systematic review was aimed at gathering technical and clinical applications of CAD/CAM technology for the preoperative planning of craniofacial implants placement, designing of molds and substructures and fabrication of orbital prostheses. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, an electronic search was executed. Human studies that utilized digital planning systems for the prosthetic rehabilitation of orbital defects were included. A total of 16 studies of 30 clinical cases, which were virtually planned through various digital planning and designing software, were included. The most common preoperative data required for digital planning were CT scans in 15 cases, the 3DSS-STD-II scanning system in 5 cases, an Artec Color 3D scanner in 3 cases and a NextEngine Desktop 3D laser scanner in 2 cases. Meanwhile, the digital designing software were Ease Orbital Implant Planning EOIPlan software in eight cases, Geomagic software in eight cases, Simplant software in four cases and Artec Studio 12 Professional in three cases. Surgical templates were fabricated for 12 cases to place 41 craniofacial implants in the orbital defect area. An image-guided surgical navigation system was utilized for the placement of five orbital implants in two cases. Digital designing and printing systems were reported for the preoperative planning of craniofacial implants placement, designing of molds and substructures and fabrication of orbital prostheses. The studies concluded that the digital planning, designing and fabrication of orbital prostheses reduce the clinical and laboratory times, reduces patient visits and provide a satisfactory outcome; however, technical skills and equipment costs are posing limitations on the use of these digital systems.

Fabricating nasal prostheses using four-dimensional facial expression models

Purpose Patients with facial prostheses face challenges such as maintenance of the prosthesis in place, especially around the margins, because of movement of surrounding facial skin. Conventional facial prostheses are fabricated on stationary models based on two points: neutral expression and smiling expression. We developed four-dimensional (4D) facial expression models which shape facial expressions that change over several points in time using a morphing technique. We fabricated facial prostheses using 4D models and evaluated their accuracy and fit compared with prostheses generated with the two-expression technique.Methods Seven patients with nasal defects or nasal deformities participated in this study. Facial expression morphing prostheses were fabricated based on the 4D scanned data of each patient, using five points between neutral expression (0%) and smiling (100%). Five nasal prostheses, one for each point, were evaluated in each patient objectively and subjectively for accuracy and fit.Results On subjective evaluation, the nasal prostheses fabricated using the 4D facial expression models had better marginal sealing over the range from the neutral expression to smiling, and showed better attachment during facial movement on objective evaluation.Conclusions Facial prostheses fabricated using 4D facial expression models provided better marginal sealing than those fabricated using conventional two-point modeling.

Three-Dimensional Printed Nasal Prostheses After Oncologic Rhinectomies: Workflow and Patients' Satisfaction

ABSTRACT

Reconstructions after oncologic full-thickness rhinectomies are often deferred from the ablative surgery. Definitive silicone prostheses are usually not used for transitional rehabilitation, and therefore, patients may deal with major facial defects for a long time before reconstruction. The aim was to develop a time- and cost-effective digital workflow to three-dimensional print temporary nasal prostheses and to assess patients' satisfaction. This prospective study enrolled all consecutive patients after full thickness ablative surgery and deferred reconstruction, from May 2018 to October 2019, at a tertiary care academic institution. With a dedicated software, the pre- and postoperative scans were three-dimensional processed to create the prosthesis and they were directly printed in elastic transparent resin. A cross-sectional survey was conducted 4 months after the rehabilitation to assess patients' satisfaction regarding comfort, aesthetics, and security of the retaining system. Seven patients were enrolled and they were all rehabilitated using this workflow. Mean time of design was 2h48 (SD 40 minutes), and mean printing time was 5h18 (SD 1 hour). Mean cost of production was 753 U.S. Dollars (SD 144 U.S. Dollars). Median scores of the visual analog scales were 8 out of 10 for each topic with interquartile range of 4 to 7 for aesthetics, 7 to 9 for comfort, and 7 to 10 for security of the retaining system. It has shown its feasibility in terms of costs and time of production. Patients were satisfied and it can be considered as a mean to help patients to deal with treatment sequelaes before definitive reconstruction.

Systematic Review of Clinical Applications of CAD/CAM Technology for Craniofacial Implants Placement and Manufacturing of Nasal Prostheses

The aim of this systematic review was to gather the clinical and laboratory applications of CAD/CAM technology for preoperative planning, designing of an attachment system, and manufacturing of nasal prostheses. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, an electronic search was carried out. Only human clinical studies involving digital planning for the rehabilitation of facial defects were included. A total of 21 studies were included with 23 patients, which were virtually planned through different planning software. The most common preoperative data for digital planning were CT scans in nine cases, CBCT in six cases, and laser scans in six cases. The reported planning softwares were Mimics in six cases, Geomagic Studio software in six cases, ZBrush in four cases, and Freeform plus software in four cases. Ten surgical templates were designed and printed to place 36 implants after digital planning, while post-operative assessment was done in two cases to check the accuracy of planned implants. Digital 3D planning software was reported for presurgical planning and craniofacial implants placement, fabrication of molds, designing of implants, designing of retentive attachments, and printing of silicone prostheses. Digital technology has been claimed to reduce the clinical and laboratory time; however, the equipment cost is still one of the limitations.

Considerations in Free Flap Reconstruction of the Midface

Midface reconstruction has been a consistent challenge for reconstructive surgeons even with the significant advances in technology and technique achieved over the recent years. A meticulous preoperative assessment of the patient is required to properly assess the defect or anticipated defect, determine proper reconstructive surgical plan, and discuss expected functional and aesthetic outcomes with the patient. For years we have employed local flaps, regional flaps, obturators, alloplastic implants, free flaps, or a combination of the previously mentioned techniques to address complex midface reconstruction. Free flap reconstruction in the midface requires special considerations for the pedicle, flap selection, and flap design to ensure an optimal outcome. The introduction of virtual surgical planning for reconstruction has enhanced patient outcomes to include advances in immediate dental rehabilitation at the time of free flap surgery. Postoperative considerations including quality of life, functional and aesthetic outcomes, and management of complications will also be discussed.

Past, Present, and Future of Soft-Tissue Prosthetics: Advanced Polymers and Advanced Manufacturing

Millions of people worldwide experience disfigurement due to cancers, congenital defects, or trauma, leading to significant psychological, social, and economic disadvantage. Prosthetics aim to reduce their suffering by restoring aesthetics and function using synthetic materials that mimic the characteristics of native tissue. In the 1900s, natural materials used for thousands of years in prosthetics were replaced by synthetic polymers bringing about significant improvements in fabrication and greater realism and utility. These traditional methods have now been disrupted by the advanced manufacturing revolution, radically changing the materials, methods, and nature of prosthetics. In this report, traditional synthetic polymers and advanced prosthetic materials and manufacturing techniques are discussed, including a focus on prosthetic material degradation. New manufacturing approaches and future technological developments are also discussed in the context of specific tissues requiring aesthetic restoration, such as ear, nose, face, eye, breast, and hand. As advanced manufacturing moves from research into clinical practice, prosthetics can begin new age to significantly improve the quality of life for those suffering tissue loss or disfigurement.