Prosthetics in Facial Reconstruction

Clinical and social success in epithetic ear rehabilitation - Retrospectively evaluating the long-term survival of auricular implants

PURPOSE

The aim of this study was to evaluate existing staging recommendations for peri-implantitis and its applicability for auricular bone anchoring.

MATERIALS AND METHODS

In this cross-sectional study, 44 patients treated with 47 ear epitheses and 128 implants were analyzed over 191.6 months (mean). Peri-implant sulcus depth, sulcus fluid flow rate, and peri-implant skin reaction, as well as cleaning habits and patients' quality of life, were analyzed. Mixed effect linear and mixed effect ordered logistic regression models were used.

RESULTS

Two of the 128 implants were lost (1.6 %). A total of 14.5 % of all patients presented light erythemas, 19.4 % showed stage 2, 4.8 % stage 3, and 12.9 % an acute infection according to Holgers. A correlation between skin reaction and sulcus fluid flow rate was observed, when grouping patients with acute signs of inflammation. Concerning patient satisfaction, 58.1 % of the patients were highly satisfied with their epitheses, 39.5 % very satisfied, and one patient was just satisfied. Younger age correlated with lower satisfaction rates.

CONCLUSION

Implant-retained auricular epitheses are a safe, highly sufficient and satisfying way of extending ear reconstruction. Sulcus depth and skin reaction are quick and valuable assessment tools in auricular implants, but skin reaction alone was clinically insufficient to predict peri-implant pocket inflammation.

A statistical shape model for estimating missing soft tissues of the face in a black South African population

PURPOSE

Facial disfigurement may affect the quality of life of many patients. Facial prostheses are often used as an adjuvant to surgical intervention and may sometimes be the only viable treatment option. Traditional methods for designing soft-tissue facial prostheses are time-consuming and subjective, while existing digital techniques are based on mirroring of contralateral features of the patient, or the use of existing feature templates/models that may not be readily available. We aim to support the objective and semi-automated design of facial prostheses with primary application to midline or bilateral defect restoration where no contralateral features are present. Specifically, we developed and validated a statistical shape model (SSM) for estimating the shape of missing facial soft tissue segments, from any intact parts of the face.

MATERIALS AND METHODS

An SSM of 3D facial variations was built from meshes extracted from computed tomography and cone beam computed tomography images of a black South African sample (n = 235) without facial disfigurement. Various types of facial defects were simulated, and the missing parts were estimated automatically by a weighted fit of each mesh to the SSM. The estimated regions were compared to the original regions using color maps and root-mean-square (RMS) distances.

RESULTS

Root mean square errors (RMSE) for defect estimations of one orbit, partial nose, cheek, and lip were all below 1.71 mm. Errors for the full nose, bi-orbital defects, as well as small and large composite defects were between 2.10 and 2.58 mm. Statistically significant associations of age and type of defect with RMSE were observed, but not with sex or imaging modality.

CONCLUSION

This method can support the objective and semi-automated design of facial prostheses, specifically for defects in the midline, crossing the midline or bilateral defects, by facilitating time-consuming and skill-dependent aspects of prosthesis design.

Mechanical properties of tissue adhesives used for retaining extraoral silicone prostheses in maxillofacial defects: A systematic review

STATEMENT OF PROBLEM

Different tissue adhesives are available for retaining extraoral silicone prostheses in maxillofacial defects. Comparative assessment of their mechanical properties will help the clinician select the right product for a specific clinical situation, but a systematic review is lacking.

PURPOSE

The purpose of this systematic review was to analyze the existing data in the literature regarding 5 mechanical properties of tissue adhesives for extraoral silicone prostheses: peel strength, tensile strength, shear strength, torsional strength, and tack.

MATERIAL AND METHODS

A manual and electronic search was performed in appropriate databases to identify relevant publications with specific inclusion and exclusion criteria. The retrieved studies were screened for eligibility using the title, abstract, and published full texts. To evaluate the risk of bias, a methodological quality assessment was performed using the Joanna Briggs Institute Critical Appraisal Checklists for Randomized Controlled Trials. A custom data extraction template was used, and the results pooled using descriptive methods.

RESULTS

After screening, 15 articles, 5 in vitro studies, and 10 clinical studies were eligible for data extraction. In vitro studies assessed tack and peel bond strength. In contrast, clinical studies assessed peel strength, tensile strength, shear strength, and torsional strength through direct comparisons and in diverse settings.

CONCLUSIONS

The assessed studies showed considerable methodological heterogeneity. When silicone-based tissue adhesives (Secure2 Medical Adhesive; Factor II, Hollister Colostomy Adhesive; Hollister Inc, Dow Corning 355 Medical adhesives; Dow Corning Europe Inc) were compared with water-based adhesives (Pros-Aide Adhesive; ADM Tronics Inc, PSA 1; Cosmedica Ltd, Daro adhesive; Factor II, Epithane-3; Daro Products), the silicone-based adhesives showed a higher peel bond strength (PBS), while double-sided medical adhesive tapes showed lower PBS. A few studies evaluated variations in the PBS as being affected by the addition of stone wool fibers, immersion in water, application of skin protective dressings and adhesive removers, application of multiple layers of adhesive, and usage of urethane liner.

Soft Tissue Trauma: Critical Recognition and Timing of Intervention in Emergency Presentations

The facial trauma surgeon will see a variety of facial injuries. Recognition of emergency cases and proper intervention is and this article aims to highlight those cases and the respective proper interventions.

Natural Polymer-Based Thin Film Strategies for Skin Regeneration in Lieu of Regenerative Dentistry

Wound healing (WH) is a complex and dynamic process that comprises of a series of molecular and cellular events that occur after tissue injury. The injuries of the maxillofacial and oral region caused by trauma or surgery result in undesirable WH such as delayed wound closure and formation of scar tissue. Skin tissue engineering (TE)/regeneration is an emerging approach toward faster, superior, and more effective resolution of clinically significant wounds effectively. A multitude of TE principles approaches are being put to action for the fabrication of hydrogels, electrospun sheets, 3D scaffolds, and thin films that can be used as wound dressings materials, sutures, or skin substitutes. Thin films are advantageous over other materials owing to their flexibility, ability to provide a barrier against external contamination, easy gaseous exchange, and easy monitoring of wounds. This review focuses on wound-dressing films and their significance and discusses various fabrication techniques. In addition, we explore various natural biopolymers that can be used for fabrication of skin TE materials. Impact Statement In this review article, critical evaluations of natural polymers used in skin regeneration were discussed. Further, the fabrication technology of the 2D and 3D material in wound healing were discussed.

An extensive squamous cell carcinoma of the auricle: From curative to reconstructive treatment. A case report

Squamous cell carcinoma (SCC) of the auricle is a rare and aggressive entity of cell carcinomas. It is mostly identified in older males with history of sun exposure. After histopathological confirmation, the initial assessment which consists of clinical and radiological evaluation will determine the therapeutic strategy. We report the case of a neglected SCC of the left pinna with parotid and temporo-mandibular infiltration. After surgical resection, the patient underwent a two staged reconstructive surgery. This was followed later on with radiotherapy and chemotherapy. The evolution was favourable for our patient during an 18 months follow-up. This case report underlines the importance of both curative and reconstructive surgery in successfully treating locally advanced tumors of the temporal bone.

[Application of a universal system of epitesis fixation in the rehabilitation of patients with maxillofacial defects]

OBJECTIVE

The aim of the study was the creation of a universal epithesis fixation system that increases the reliability of its functioning in prosthetics of patients with maxillofacial defects of various genesis.

MATERIAL AND METHODS

After the surgical preparation of patients, in accordance with the indications of the underlying disease, epithesis was made from rigid silicone elastomers using CAD/CAM technologies. For the production of attachments, the VT1-0 titanium alloy common in medicine was used.

RESULTS

A universal epithesis fixation system was used for prosthetics of various parts of the patient's face. Depending on the clinical situation and the size of the prosthetics area, an intermediate lattice plate (mesostructure) of the appropriate size and configuration was selected. Two types of attachments were used to fix epithets: magnetic with a counterpart and non-magnetic mushroom-shaped. The universal epithesis attachment system is distinguished by the possibility of using each hole of the lattice, both for attaching it to the bone structure and for installing attachments, which makes it easy to fix the lattice to residual bone fragments and center the position of the transition elements and attachments depending on the aesthetic and functional needs of the structure in whole.

CONCLUSION

The success of prosthetics largely depends on the epithesis attachment system. The proposed universal epithesis fixation system allows its use in various clinical situations and also reduces the cost of prosthetics for patients with maxillofacial defects.

Biomaterials in Craniomaxillofacial Reconstruction: Past, Present, and Future

ABSTRACT

Deformity and tissue loss involving the craniomaxillofacial region occurs frequently as a result of trauma, oncologic resection, or a congenital malformation. In order to maximize the patient's quality of life, reconstruction of the craniomaxillofacial skeleton must seek to restore aesthetics as well as function. Advances in diagnostic technology, surgical technique, instrumentation, and innovative biomaterials used have transformed the way reconstructive surgeons approach their patients' needs. From the advent of alloplastic reconstruction, surgeons have sought the ideal material for use in craniomaxillofacial surgery. Substances such as metals, ceramics, glasses, and more recently resorbable polymers and bioactive materials have all been utilized.While autologous bone has remained widely-favored and the gold standard, synthetic alternatives remain a necessity when autologous reconstruction is not readily available. Today, alloplastic material, autografting via microvascular tissue transfer, hormone and growth factor-induced bone formation, and computer-aided design and manufacturing of biocompatible implants represent only a fraction of a wide range of options used in the reconstruction of the craniomaxillofacial skeleton. We present a brief review of the materials used in the repair of deformities of the craniomaxillofacial skeleton as well as a look into the potential future direction of the field.

Orbital exenteration: an updated review with perspectives

Orbital exenteration is a radical and disfiguring surgery mainly performed in specialized tertiary care centers. Orbital exenteration has long been considered the treatment of choice for managing periocular tumors invading the orbit or primary orbital malignancies. Over the past decades, attention has been directed toward reducing the perioperative morbidity by developing new surgical devices and new strategies and promoting cosmetic rehabilitation by providing adequate facial prostheses. Despite these advances, several studies have questioned the role of orbital exenteration in improving overall survival. The last decade has been marked by the emergence of a new paradigm: the "eye-sparing" strategies based on conservative surgery with or without adjuvant radiotherapy and/or targeted therapies and immunotherapies. We summarize the data on orbital exenteration, including epidemiology, etiologies, use of surgical ablative and reconstructive techniques, complications, outcomes, and the related controversies.

Management of a late presentation of bear mauling with a complex maxillofacial defect in a tertiary care hospital - A case report

Rationale:

Patient Concerns:

Diagnosis and Treatment:

Outcome:

Take-away Lessons:

The challenge of managing oral maxillofacial rehabilitation with quality and cost-benefit

Although orofacial cancer leads to substantial functional, esthetic, and psychosocial deficits for patients, reconstructive plastic surgeries may not be indicated for large facial defects. The high costs of prosthetic oral maxillofacial rehabilitation may hamper such treatment, which commonly involves virtual planning, craniofacial implants, and computer-aided design and computer-aided manufactured prostheses. This report shows the treatment of 2 patients with large facial defects from surgical resection of cancerous tissue who were rehabilitated with implant-supported bar-clip overdentures and facial prostheses fabricated by using low-cost straightforward methods.

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.

Use of Dermaflage®, a silicone-based skin camouflage product, for treatment of medial canthal fistula

Medial canthal fistulas present a therapeutic challenge, given that the risk factors for development of this and similar complications also contribute to their difficulty to treat. Following surgical, chemotherapy and radiation treatment of a poorly differentiated sinonasal carcinoma, a 61 year old man failed internal and external rotational flap repair and declined further operative procedures; he was satisfied with a novel conservative treatment. This report describes use of Dermaflage®, a silicone-based skin camouflage and topical cutaneous filler product, to both resolve the symptoms of tearing and discharge through the fistula and mask the defect from the casual observer.

Prosthetic Reconstruction of Orbital Defects

Orbital and craniomaxillofacial defects, in general, are best approached preoperatively by a multidisciplinary team with a clear reconstructive plan in place. Orbital defects result from a myriad of underlying diseases and injuries, and reconstruction after orbital evisceration, enucleation, or exenteration can pose a challenge to the reconstructive team. Reconstruction of orbital injuries with orbital implants and prostheses can lead to acceptable aesthetic outcomes, and the reconstructive surgeon should be familiar with current orbital implants and prostheses. Herein, the authors review terminology and classifications of orbital defects, different types of orbital implants, advantages and disadvantages of different orbital implant reconstructive options, types of orbital prostheses, and pros and cons of different prosthetic options.

Pore architecture effects on chondrogenic potential of patient-specific 3-dimensionally printed porous tissue bioscaffolds for auricular tissue engineering

OBJECTIVE

This study aims to determine the effect of auricular scaffold microarchitecture on chondrogenic potential in an in vivo animal model.

METHODS

DICOM computed tomography (CT) images of a human auricle were segmented to create an external anatomic envelope. Image-based design was used to generate 1) orthogonally interconnected spherical pores and 2) randomly interspersed pores, and each were repeated in three dimensions to fill the external auricular envelope. These auricular scaffolds were then 3D printed by laser sintering poly-l-caprolactone, seeded with primary porcine auricular chondrocytes in a hyaluronic acid/collagen hydrogel and cultured in a pro-chondrogenic medium. The auricular scaffolds were then implanted subcutaneously in rats and explanted after 4 weeks for analysis with Safranin O and Hematoxylin and Eosin staining.

RESULTS

Auricular constructs with two micropore architectures were rapidly manufactured with high fidelity anatomic appearance. Subcutaneous implantation of the scaffolds resulted in excellent external appearance of both anterior and posterior auricular surfaces. Analysis on explantation showed that the defined, spherical micropore architecture yielded histologic evidence of more robust chondrogenic tissue formation as demonstrated by Safranin O and Hematoxylin and Eosin staining.

CONCLUSIONS

Image-based computer-aided design and 3D printing offers an exciting new avenue for the tissue-engineered auricle. In early pilot work, creation of spherical micropores within the scaffold architecture appears to impart greater chondrogenicity of the bioscaffold. This advantage could be related to differences in permeability allowing greater cell migration and nutrient flow, differences in surface area allowing different cell aggregation, or a combination of both factors. The ability to design an anatomically correct scaffold that maintains its structural integrity while also promoting auricular cartilage growth represents an important step towards clinical applicability of this new technology.