Development and application of a rapid rehabilitation system for reconstruction of maxillofacial soft-tissue defects related to war and traumatic injuries

Fully digital workflow for ear defect rehabilitation with an immediate implant-retained auricular prosthesis

The fully digital workflow for an immediate implant-retained auricular prosthesis procedure included computer-aided treatment planning, flapless surgery, and the prefabricated auricular prosthesis rehabilitation. This technique also encompassed the presurgery fabrication of the substructure of the implants and the definitive auricular prosthesis to ensure the smooth insertion of the ear prosthesis.

Revolutionizing Maxillofacial Rehabilitation for Ocular Defects: The Impact of Three-Dimensional Printing and Sublimation Transfer Technique on Changing Horizons

An absence or any disfigurement to the eye leads to psychological handicap for the patient. An ocular defect is a defect of an eye because of a cyst, road traffic accident, or enucleation of an eye due to infection. While correcting this type of defect, maxillofacial prosthodontists should consider all aspects such as esthetics, comfort, and functions of the ocular prosthesis, which gives a lifelike appearance to the prosthesis. A prosthetic eye wearer patient complained of asymmetry and opaque appearance of the ocular prosthesis. The patient had lost his eye in a road traffic accident and has been wearing a prosthesis for 8-12 months but is not pleased with how the prosthesis looks. A novel prosthesis created by the use of sublimation transfer technology and three-dimensional printing to improve the esthetics exactly replicates the contralateral normal eye. In a proposed case report, an algorithm for the fabrication of customized ocular prostheses was improved. A smooth blend of conventional as well as digital methods is used to optimize the results.

IMproving facial PRosthesis construction with contactlESs Scanning and Digital workflow (IMPRESSeD): study protocol for a feasibility crossover randomised controlled trial of digital versus conventional manufacture of facial prostheses in patients with orbital or nasal facial defects

BACKGROUND

Facial prostheses can have a profound impact on patients' appearance, function and quality of life. There has been increasing interest in the digital manufacturing of facial prostheses which may offer many benefits to patients and healthcare services compared with conventional manufacturing processes. Most facial prosthesis research has adopted observational study designs with very few randomised controlled trials (RCTs) documented. There is a clear need for a well-designed RCT to compare the clinical and cost-effectiveness of digitally manufactured facial prostheses versus conventionally manufactured facial prostheses. This study protocol describes the planned conduct of a feasibility RCT which aims to address this knowledge gap and determine whether it is feasible to conduct a future definitive RCT.

METHODS

The IMPRESSeD study is a multi-centre, 2-arm, crossover, feasibility RCT with early health technology assessment and qualitative research. Up to 30 participants with acquired orbital or nasal defects will be recruited from the Maxillofacial Prosthetic Departments of participating NHS hospitals. All trial participants will receive 2 new facial prostheses manufactured using digital and conventional manufacturing methods. The order of receiving the facial prostheses will be allocated centrally using minimisation. The 2 prostheses will be made in tandem and marked with a colour label to mask the manufacturing method to the participants. Participants will be reviewed 4 weeks following the delivery of the first prosthesis and 4 weeks following the delivery of the second prosthesis. Primary feasibility outcomes include eligibility, recruitment, conversion, and attrition rates. Data will also be collected on patient preference, quality of life and resource use from the healthcare perspective. A qualitative sub-study will evaluate patients' perception, lived experience and preference of the different manufacturing methods.

DISCUSSION

There is uncertainty regarding the best method of manufacturing facial prostheses in terms of clinical effectiveness, cost-effectiveness and patient acceptability. There is a need for a well-designed RCT to compare digital and conventional manufacturing of facial prostheses to better inform clinical practice. The feasibility study will evaluate key parameters needed to design a definitive trial and will incorporate early health technology assessment and a qualitative sub-study to identify the potential benefits of further research.

TRIAL REGISTRATION

ISRCTN ISRCTN10516986). Prospectively registered on 08 June 2021,  https://www.isrctn.com/ISRCTN10516986 .

Digital Workflow in Maxillofacial Prosthodontics—An Update on Defect Data Acquisition, Editing and Design Using Open-Source and Commercial Available Software

Background: A maxillofacial prosthesis, an alternative to surgery for the rehabilitation of patients with facial disabilities (congenital or acquired due to malignant disease or trauma), are meant to replace parts of the face or missing areas of bone and soft tissue and restore oral functions such as swallowing, speech and chewing, with the main goal being to improve the quality of life of the patients. The conventional procedures for maxillofacial prosthesis manufacturing involve several complex steps, are very traumatic for the patient and rely on the skills of the maxillofacial team. Computer-aided design and computer-aided manufacturing have opened a new approach to the fabrication of maxillofacial prostheses. Our review aimed to perform an update on the digital design of a maxillofacial prosthesis, emphasizing the available methods of data acquisition for the extraoral, intraoral and complex defects in the maxillofacial region and assessing the software used for data processing and part design. Methods: A search in the PubMed and Scopus databases was done using the predefined MeSH terms. Results: Partially and complete digital workflows were successfully applied for extraoral and intraoral prosthesis manufacturing. Conclusions: To date, the software and interface used to process and design maxillofacial prostheses are expensive, not typical for this purpose and accessible only to very skilled dental professionals or to computer-aided design (CAD) engineers. As the demand for a digital approach to maxillofacial rehabilitation increases, more support from the software designer or manufacturer will be necessary to create user-friendly and accessible modules similar to those used in dental laboratories.

Surgical treatment of giant mediastinal tumors

Background

This study aims to evaluate the surgical treatment outcomes of giant mediastinal tumors.

Methods

Between July 2013 and July 2018, medical data of a total of 31 patients (26 males, 5 females; mean age 27.7±8.2 years; range, 18 to 56 years) who underwent radical surgery for a giant mediastinal tumor in our center and 47 cases (26 males, 21 females; mean age 45.4±16.7 years; range, 19 to 62 years) of giant mediastinal tumors retrieved from the National Center for Biotechnology Information database were retrospectively reviewed. Two-year overall survival and disease-free survival rates of the patients were evaluated.

Results

All patients underwent radical surgery (R0 resection). Symptoms caused by giant mediastinal tumors were relieved after radical surgery during follow-up. The two-year overall survival and disease-free survival rates were 100% and 86.7%, respectively, indicating a good prognosis. The surgical procedures for malignancies were more difficult than those for benign pathologies.

Conclusion

Radical surgery is the mainstay for treatment of giant mediastinal tumors to relieve symptoms in a short period of time and to achieve a good prognosis for up to two years, regardless of adjuvant therapy. The surgical route should be cautiously planned before radical surgery to reduce complications.

Accuracy Evaluation of a Three-Dimensional Model Generated from Patient-Specific Monocular Video Data for Maxillofacial Prosthetic Rehabilitation: A Pilot Study

PURPOSE

To evaluate if the combination of a monoscopic photogrammetry technique and smartphone-recorded monocular video data could be appropriately applied to maxillofacial prosthesis fabrication.

MATERIALS AND METHODS

Smartphone video and laser scanning data were recorded for five healthy volunteers (24.1 ± 0.7 years). Three-dimensional (3D) facial models were generated using photogrammetry software and a laser scanner. Smartphone-recorded video data were used to generate a photogrammetric 3D model. The videos were recorded at two resolutions: 1080 × 1920 (high resolution) and 720 × 1280 pixels (low resolution). The lengths of five nasal component parts (nose height, nasal dorsum length, nasal column length, nasal ala length, and nose breadth) were compared in the photogrammetric 3D models (as the test model) and the laser scanned 3D models (as the validation model) using reverse engineering software.

RESULTS

There was a significant difference in the nasal dorsum length between the test model and the validation model (high resolution; 95% confidence interval, 2.05-5.07, Low resolution; confidence interval, 2.19-5.69). In contrast to the nasal dorsum length, there were no significant differences in nose height, nose breadth, nasal ala length, and nasal column length.

CONCLUSION

Using smartphone-recorded video data and a photogrammetry technique may be a promising technique to apply in the maxillofacial prosthetic rehabilitation workflow.

Classification, History, and Future Prospects of Maxillofacial Prosthesis

This review presents a classification system for maxillofacial prostheses, while explaining its types. It also aims to describe their origin and development, currently available materials, and techniques, predicts the future requirements, and subsequently discusses its avenues for improvement as a restorative modality. A literature search of the PubMed/Medline database was performed. Articles that discussed the history, types, materials, fabrication techniques, clinical implications, and future expectations related to maxillofacial prostheses and reconstruction were included. Fifty-nine articles were included in this review. Maxillofacial prostheses were classified as restorative or complementary with subclassifications based on the prostheses finality. The origin of maxillofacial prostheses is unclear; however, fabrication techniques and materials have undergone several changes throughout history. Currently, silicones and acrylic resins are the most commonly used materials to fabricate customized prostheses. Maxillofacial prostheses not only restore several types of orofacial defects but also improve the patients' quality of life. Although the current clinical scenario concerning the field of maxillofacial prostheses is promising, improvements in material quality and techniques for maxillofacial prostheses may be expected in the future, to produce better results in the treatment of patients.

Digital Workflow of Auricular Rehabilitation: A Technical Report Using an Intraoral Scanner

Prosthodontic rehabilitation of a congenital or acquired defect of the ear is considered a challenging and skill-dependent procedure. This technical report describes a novel approach for direct digital scanning of the unaffected contralateral ear using an intraoral scanner and external markers. The obtained digital data of the ear was exported, digitally mirrored, and successfully positioned to a virtual model of a human head with a missing ear. This technique demonstrates the potential application of CAD/CAM in the design and fabrication of an auricular prosthesis for patients with a unilateral ear defect.

Development of three-dimensional facial expression models using morphing methods for fabricating facial prostheses

PURPOSE

It is essential to fabricate a best-fit three-dimensional (3D) facial prosthesis model capable of facial expressions. In order for the facial prosthesis to remain in position, especially around marginal areas subject to movement, a new method of making 3D facial expression models using time-series data allowing changes in facial expression by morphing technique was developed.

METHODS

Seven normal subjects and seven patients with nasal defects or nasal deformities participated in this study. Three distinct facial expressions (i.e., a neutral expression, smiled, and open mouthed) were digitally acquired with a facial scanner. Prepared template models were transformed to homologous models, which can represent the form as shape data with the same number of point cloud data of the same topology referring to the scanning data. Finally, 3D facial expression models were completed by generating a morphing image based on two sets of homologous models, and the accuracy of the homologous models of all subjects was evaluated.

RESULTS

3D facial expression models of both normal subjects and patients with nasal defects were successfully generated. No significant differences in shape between the scanned models and homologous models were shown.

CONCLUSIONS

The high accuracy of this 3D facial expression model in both normal subjects and patients suggests its use for fabricating facial prostheses.

Identification and Documentation of Auricle Defects using Three-dimensional Optical Measurements

Auricle defects are important and common occurrences in forensic medicine. The accurate measurement and assessment of auricle defects is key to identifying and evaluating injury, and the currently available methods are known to be labor intensive and inaccurate. In this paper, we introduce an identification and documentation of auricle defects solution, which consists of an optical three-dimensional (3D) method and an effective algorithm to calculate the maximum projection area and identify auricle defects. In this study, three separate examiners measured 40 auricles of 20 adults using 3D optical measurement and two other commonly used methods to investigate the validity and representative reliability of 3D optical measurement for auricle defect identification. Based on the statistical analysis, the 3D measurement method is valid and showed a better reliability than the reference methods. We also present a representative auricle defect identification case using the proposed 3D optical measurement method. The study concludes that the optical 3D measurement method is a reliable and effective tool for auricle defect identification.

Maxillofacial prostheses challenges in resource constrained regions

BACKGROUND

This study reviewed the current state of maxillofacial rehabilitation in resource-limited nations.

METHOD

A rigorous literature review was undertaken using several technical and clinical databases using a variety of key words pertinent to maxillofacial prosthetic rehabilitation and resource-limited areas. In addition, interviews were conducted with researchers, clinicians and prosthetists that had direct experience of volunteering or working in resource-limited countries.

RESULTS

Results from the review and interviews suggest rehabilitating patients in resource-limited countries remains challenging and efforts to improve the situation requires a multifactorial approach.

CONCLUSIONS

In conclusion, public health awareness programmes to reduce the causation of injuries and bespoke maxillofacial prosthetics training programmes to suit these countries, as opposed to attempting to replicate Western training programmes. It is also possible that usage of locally sourced and cheaper materials and the use of low-cost technologies could greatly improve maxillofacial rehabilitation efforts in these localities. Implications for Rehabilitation More information and support needs to be provided to maxillofacial defect/injuries patients and to their families or guardians in a culturally sensitive manner by governments. The health needs, economic and psychological needs of the patients need to be taken into account during the rehabilitation process by clinicians and healthcare organizations. The possibility of developing training programs to suit these resource limited countries and not necessarily follow conventional fabrication methods must be looked into further by educational entities.

CAD/CAM-Assisted Auricular Prosthesis Fabrication for a Quick, Precise, and More Retentive Outcome: A Clinical Report

Auricular defects comprise a large proportion of maxillofacial deformities. Most patients with acquired deformities have psychosocial ineptness and seek cosmetic rehabilitation. Although minor defects can be corrected surgically, extensive deformities are difficult to reconstruct with plastic surgery. Contrary to that, prosthetic restoration can provide excellent esthetic results. The conventional methods of maxillofacial prosthesis fabrication are time consuming and the outcome depends on the technician's skill. The advent of CAD/CAM technology in the field of dentistry has brought enormous improvement in the quality of health care provided. In the past decade, several methods have been described employing CAD/CAM techniques for the cosmetic rehabilitation of auricular defects. This clinical report details the integration of multiple digital technologies of CT scanning, computer aided design, and rapid prototyping to construct an ear prosthesis with limited number of appointments.

Complete resection of a giant mediastinal teratoma occupying the entire right hemithorax in a 14-year-old boy

Background

Mature teratomas are the most common histological type of germ cell tumors.

Case Presentation

A 14-year-old boy was referred to our hospital with a giant mature teratoma occupying the entire right hemithorax compressed the superior vena cava (SVC) and total atelectasis of the right lung. He was misdiagnosed as malignant teratoma by a fine-needle biopsy in a hospital. After 4-cycle of chemotherapy without effect, he underwent an unsuccessful exploratory thoracotomy. Venous conduit bypass between the right jugular vein and right femoral vein was established in the operating room for superior vena cava (SVC) replacement if needed. En bloc resection of the huge tumor, wedge resection of the dense adhesions of the right lung and partial pericardectomy were successfully performed, and lung function was recovered.

Conclusion

To the best of our knowledge, this is the first report of complete resection of the teratoma occupying the whole right hemithorax combined with wedge resection of the right upper, middle and lower lobes and partial resection of the pericardium.