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.

9-year follow up on maxillofacial implant-supported framework designed to accommodate childhood growth

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.

[Total nasal defect reconstruction with nasal prosthesis. Two case reports]

Total nasal defects after injures or surgical interventions can negatively affect patient's quality of life. Maxillofacial prosthesis is a contemporarily and reliable solution. This method gives us opportunity to restore missing tissues and helps patients to overcome social and psychological difficulties. In this article we demonstrated advantages and disadvantages of the method in two clinical cases. The application of magnetic and adhesive retention in different cases is described. Also, we outlined clinical and technological steps of maxillofacial prosthesis manufacture. Modified procedure of impression obtaining is offered.

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.

Maxillofacial rehabilitation of nasal defect with nasal prosthesis using donor method: A case report

Maxillofacial prosthetics is the branch of prosthodontics which involves rehabilitation of the defects in the maxillofacial region involving the hard and soft tissue with the prosthesis. Facial defects that occur in the midfacial regions are commonly due to trauma and neoplasms like basal cell carcinoma which involves the nose. Reconstruction of the nose is an important esthetic challenge due to its esthetic and retention problems. This article emphasis rehabilitation of the nasal defect of a patient with nasal prosthesis using donor method.

Prosthetic rehabilitation of the geriatric oncologic rhinectomy patient utilizing a craniofacial implant-retained nasal prosthesis

This clinical report describes the expeditious treatment of a geriatric patient with squamous cell carcinoma of the nose treated with total rhinectomy, craniofacial implant placement, and a nasal prosthesis.

Health utility of rhinectomy, surgical nasal reconstruction, and prosthetic rehabilitation

OBJECTIVES

Advanced nasal malignancies may require rhinectomy, which can have profound psychosocial impacts. Rhinectomy defects can be rehabilitated through surgery or prosthetics. We seek to understand the health utility of the rhinectomy defect, surgical, and prosthetic reconstruction, which have not been previously studied.

STUDY DESIGN

Prospective clinical study METHODS: Adult naïve observers (n = 273) ranked the utility of five randomized health states (monocular blindness, binocular blindness, post-rhinectomy nasal defect, postsurgical reconstruction, and post-prosthetic rehabilitation). Health utilities were measured using visual analogue scale (VAS), standard gamble (SG), and time trade-off (TTO). One-way analysis of variance (ANOVA) with post hoc Scheffe's test and the independent samples T-test for a priori comparisons were performed. Multiple linear regression was performed using participant demographics as independent predictors of utility scores.

RESULTS

Health utilities (VAS, SG, TTO) were reported as follows (mean ± SD): monocular blindness (0.71 ± 0.21, 0.84 ± 0.20, 0.85 ± 0.19), binocular blindness (0.48 ± 0.25, 0.68 ± 0.28, 0.63 ± 0.28), post-rhinectomy nasal defect (0.59 ± 0.24, 0.74 ± 0.24, 0.74 ± 0.24), postsurgical reconstruction (0.88 ± 0.16, 0.90 ± 0.18, 0.89 ± 0.13), and post-prosthetic rehabilitation (0.67 ± 0.22, 0.80 ± 0.23, 0.82 ± 0.20). Both surgical reconstruction (P < .001) and prosthetic rehabilitation (P < .001) significantly improved health utility. SG and TTO utility scores were inversely associated with observer age (P < .001) and participants who identified themselves as non-Caucasians (P < .05) in post-rhinectomy nasal defect, post-nasal surgical reconstruction, and post-nasal prosthetic rehabilitation health states, while higher levels of education were directly associated with SG scores (P < .05), respectively.

CONCLUSION

This is the first study to demonstrate the significant negative impact of the rhinectomy nasal defect on health utility. Rehabilitation by surgical or prosthetic techniques significantly increases health utility as rated by naïve observers. Laryngoscope, 130:1674-1679, 2020.

Direct 3D Printing of Flexible Nasal Prosthesis: Optimized Digital Workflow from Scan to Fit

A maxillofacial prosthesis is a successful treatment modality to restore missing facial parts. Digital technologies and 3D printing are employed in constructing facial prostheses such as ears; however, their application is still partial, and final prostheses are usually manufactured conventionally using stone molds. This report aims to introduce a complete digital workflow to construct a nasal prosthesis and compare it to the conventional workflow of a patient requiring a nasal prosthesis. A computer tomography scan showing the defect was exported to specialized software to create 3D reconstructions of the patient's face and underlying bone. The nose was digitally designed restoring facial esthetics, anatomy, shape, and skin color. Different skin tones were digitally matched to skin tissues adjacent to the defect area using the Spectromatch system. The design was 3D printed in flexible and colorful material at 16 μm resolution using a 3D printer. External color pigmentations were applied to the nose for optimum esthetics, and the prosthetic nose was sealed in silicone and left to heat polymerize for 15 minutes. The prosthetic nose was retained in place using biomedical adhesive, and the patient was pleased with it. This report proposes a complete digital workflow to directly design and fabricate a prosthetic nose of acceptable esthetics. Such a workflow can lead to enhanced prosthesis reproducibility and acceptability and may become an effective treatment option for treatment of patients with facial defects.

Nasal reconstruction with silicone using customised impression technique

Facial defects can result from a variety of reasons including trauma, burns, infections, congenital disorders, and neoplasms which require surgical correction or prosthetic rehabilitation or both. Prosthetic replacement using various materials is the treatment of choice when other surgical options are not possible. This report presents a case of acquired nasal defect secondary to a surgically operated adenoid cystic carcinoma using silicone as the material of choice.

Prosthodontic rehabilitation of combined oronasal defect in patients with non-Hodgkin's lymphoma using two different attachments: Two case reports

Debridement of affected parts in patients with non-Hodgkin's lymphoma leads to large mid facial defects leading to poor quality of life due to cosmetic disfigurement and various functional comorbidities. Therefore, a surgeon should refer the patients to a prosthodontist for replacement of lost tissues to improve their function and esthetics. Two cases have been presented here with a history of non-Hodgkin's lymphoma having large, continuous defects involving nose, cheeks, and maxilla. Retaining large facial prosthesis and intraoral obturator was a challenge as supporting hard and soft tissues were less. Two-piece lightweight prostheses were fabricated and retained with the use of very economical titch buttons used (used in clothes) in case 1 due to financial constraints and slightly expensive iron boron neodymium magnets in case 2. Functional and esthetic rehabilitation was successfully achieved with intraoral and facial prostheses attached to each other.

Aesthetic and functional outcomes in patients with a nasal prosthesis

The aim was to evaluate the aesthetic and functional outcomes in patients with a nasal prosthesis after radical tumour resection. A questionnaire with 15 domains was created to evaluate the satisfaction of patients with their nasal prosthesis. Correlations with the results of the University of Washington Quality of Life (UWQOL) questionnaire, which was also completed by the patients, were analyzed. Forty-three patients with a partial or total nasal prosthesis completed the questionnaire. Twenty-seven patients were male and 16 were female; their median age was 62 years. The median follow-up time after tumour resection was 33 months. The best result was obtained for overall function (85.5) and the worst result for nasal crusts (58.5). The average daily duration of prosthesis use was 17.4h. There were sex-dependent and age-dependent differences in the domain 'self-confidence', age-dependent differences in the domain 'stability during sporting activities', and differences in the domain 'nose bleed' depending on the time since tumour resection. All patients would recommend this rehabilitation after rhinectomy. 'Satisfaction with function' had the most influence on UWQOL domains. The nasal prosthesis is a well-accepted rehabilitation after rhinectomy. The results for appearance are comparable to those obtained for nasal reconstruction, and high scores were found for the functional domains.

The use of zygomatic implants for the retention of nasal prosthesis following rhinectomy: the Morriston experience

Reconstruction and rehabilitation following rhinectomy remains controversial and presents a complex problem. Although reconstruction with local and microvascular flaps is a valid option, the aesthetic results may not always be satisfactory. The aesthetic results achieved with a nasal prosthesis are excellent; however patient acceptance relies on a secure method of retention. The technique used and results obtained in a large series of patients undergoing rhinectomy and receiving zygomatic implants for the retention of a nasal prosthesis are described here. A total of 56 zygomatic implants (28 patients) were placed, providing excellent retention and durability with the loss of only one implant in 15 years.

Recommendations for implant-retained nasal prostheses after ablative tumor surgery: Minimal surgical aftercare, high implant survival, and satisfied patients

BACKGROUND

Nasal defects resulting from tumor resection are preferably rehabilitated with implant-retained nasal prostheses. Aftercare, clinical outcome of the implants, and patients' satisfaction with implant-retained nasal prostheses were assessed.

METHODS

Twenty-eight consecutive patients needing total rhinectomy because of tumor resection between 1998 and 2013 were treated according to a standardized protocol with 2 implants in the nasal floor. Surgical and prosthetic aftercare was scored using patient records. Finally in 2014, skin reaction, peri-implant bone loss, and patients' satisfaction were assessed in all 13 still living patients.

RESULTS

In total, 56 implants were inserted (median follow-up, 35.1 months; interquartile range [IQR], 8.9-63.3). Implant survival was 96.4%. Implant survival was independent of radiotherapy. Peri-implant skin was healthy and patients' satisfaction high. Longevity of the prostheses was limited.

CONCLUSION

Rehabilitation of nasal defects resulting from total rhinectomy with implant-retained nasal prostheses, according to our protocol, resulted in high patient satisfaction and favorable treatment outcome. © 2015 Wiley Periodicals, Inc. Head Neck 38: E-E, 2016.

Rehabilitation of a partial nasal defect with facial prosthesis: a case report

>Malignancies of the midface result in cosmetic deformities that make maxillofacial prosthesis as an integral part of the treatment plan. Facial defects can be devastating in their impact on physical structure and function of the affected individual, leading to potentional compromises in quality of life. Reconstruction of nasal defects is a challenge for the prosthodontist because of esthetic and retention problems associated with the facial prosthesis. This paper reports the rehabilitation of a partial nasal defect caused by basal cell carcinoma treatment using a nasal prosthesis made with silicone elastomers and mechanical and anatomical retentive aids. The patient had no problem with the prosthesis, except for a partial loss of extrinsic coloration in the two-year follow-up.

Prosthetic reconstruction of a patient with an acquired nasal defect using extraoral implants and a CAD/CAM copy-milled bar

Traditionally, patients with maxillofacial defects have been challenging to treat. A multitude of challenges associated with maxillofacial prosthetic treatment are not typically seen with patients who need conventional prosthodontic treatment. These types of patients generally require replacement of significant amounts of hard and soft tissues than do conventional prosthodontic patients. Most maxillofacial patients also warrant more emotional support than do conventional prosthodontic patients. Successful maxillofacial prosthetics still need to embrace the traditional goals of prosthodontic treatment: stability, support, retention, and esthetics. It is unlikely that a maxillofacial prosthesis will exactly duplicate the anatomy and function of missing or damaged structures. Although craniofacial implants (CFI's) have lower cumulative survival rates (CSR's) than intraoral endosseous implants, osseointegrated CFI's have proven to be significant adjuncts to improving retention of maxillofacial prostheses. However, CSR's of CFI's have been reported to be lower than CSR's for intraoral endosseous implants. Lately, computer-assisted design and computer-assisted machining (CAD/CAM) has been used in dentistry to facilitate fabrication of implant-supported frameworks. CAD/CAM protocols have numerous advantages over conventional casting techniques, including improved accuracy and biocompatibility, and decreased costs. The purpose of this paper is to review the literature on cumulative survival rates (CSR's) reported for CFI's and to illustrate the treatment of a maxillofacial patient using CFI's and a CAD/CAM copy-milled framework for retention and support of a nasal prosthesis.