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[Orbito-maxillo-facial rehabilitation with osteointegrated prostheses].

This investigation was conducted to evaluate 20 cases of implant-retained prosthetic rehabilitation (mean follow-up of 35 months). Ear, nose, orbit and complex defects of the face have been restored. Our main indication was reconstruction in cancer patients after tumor surgery (n = 14). Rehabilitation was also performed in traumatic disorders (n = 3) and congenital aural malformations (n = 3). Fifty seven titanium fixtures have been implanted with an integration success rate of 98%. We also report 6 cases of maxillary or mandibulary functional rehabilitation. The use of osteointegrated implants to provide support for maxillo-facial prosthesis is a new and valuable technique when reconstructive plastic surgery is not envisageable.

Adult↗

A two-stage impression technique for custom facial prostheses.

A two-stage impression technique that uses polyvinyl siloxane and irreversible hydrocolloid in a custom impression tray is described. The technique records the tissues to be contacted by the facial prosthesis with minimal distortion with the patient in an upright position and facial musculature at rest. The procedure is simple, accurate, and it eliminates some of the shortcomings of other techniques.

Acrylic Resins↗

A custom impression tray made with the aid of an existing prosthesis: a clinical technique.

Prostheses for patients with intraoral defects usually have complex contours. The replacement of a successful prosthesis is more readily accomplished with the aid of a custom impression tray that reproduces the contours of the existing prosthesis. In the technique presented, an irreversible hydrocolloid impression is made of the intaglio surface of the prosthesis to be replaced. Autopolymerizing acrylic resin tray material is poured into the impression, creating a custom impression tray. This procedure can simplify the impression process and reduce the need for multistep impression techniques.

Acrylic Resins↗

Maxillary reconstruction with a fibula osteoseptocutaneous free flap and simultaneous insertion of osseointegrated dental implants.

The fibula osteoseptocutaneous flap is a good option for reconstruction of three-dimensional composite maxillary defects. This flap provides both bone and soft-tissue reconstruction and allows osseointegrated dental implantation, either simultaneously or in a second-stage procedure. Simultaneous placement of osseointegrated dental implants reduces operative sessions and allows faster oral rehabilitation for properly selected patients. The defects may result from trauma or resection of benign tumors or low-grade malignancies. Between August of 1999 and July of 2001, three patients underwent maxillary reconstruction with the fibula osteoseptocutaneous flap and simultaneous osseointegrated dental implants. The cause of the defect was trauma in two cases and resection of an adenoid cystic carcinoma in the other. The mean length of the fibula used for bony reconstruction was 4.7 cm. One osteotomy was performed in one case and no osteotomy was necessary in the other two. Skin islands of 8 x 2.5 cm and 16 x 3.5 cm were used for two patients. For the other patient, a double skin island was used for both nasal (6 x 4 cm) and oral (6 x 5 cm) reconstructions. Two osseointegrated implants were inserted into the fibular bone for each patient. Six months after the first-stage procedure, palatal rotation flaps or mucosa grafts were used to cover the exposed implant necks and prepare the implants for prostheses. One month after the second-stage procedure, prostheses were placed. An implant-supported prosthesis was used for one patient and implant/tissue-supported prostheses were used for the others. At a mean follow-up time of 30 months (range, 16 to 38 months), all patients were able to use the dental prosthesis for chewing (beginning 6 weeks after the final procedure) and all patients were satisfied with the cosmetic results.

Adult↗

Modified technique for preparing a polyurethane lining for facial prostheses.

A simplified technique for preparing, under a vacuum, a polyurethane lining for a facial prosthesis is described. A previously presented technique strengthened the prosthesis and allowed it to be attached with a water-based adhesive. This technique eliminates wrinkling, simplifies bonding, allows multiple linings to be made at the same time, conserves time and cost, and improves predictability of the results.

Ear, External↗

[Defect prosthesis following total upper jaw resection].

Using the method described, a defect prosthesis can be fastened with the help of operatively prepared retention sites and transnasal anchorage after total upper jaw resection. The technical process of manufacture is outlined and the result demonstrated in photographs.

Carcinoma, Squamous Cell↗

Comparison of maxillectomy patients with immediate versus delayed obturator prosthesis placement.

OBJECTIVE: To compare maxillectomy patients with immediate versus delayed placement of an obturator prosthesis in terms of patient outcomes. DESIGN: Retrospective review. OUTCOME MEASURES: The outcomes of 23 maxillectomy patients seen between 1975 and 1993 at St. Joseph's Health Centre in London, Ontario, were analyzed. METHODS: For 17 patients, a prosthesis was placed immediately as part of the operative procedure, and for 6 patients, an occlusive dressing only was placed. RESULTS: In all parameters studied (length of stay, i.v. requirements, swallowing, clear fluid diet and ambulation), the prosthesis group progressed more quickly and had a more rapid return to normal function. CONCLUSION: This study demonstrates the benefits of immediate prostheses for maxillectomy patients and justifies their continued use.

Adult↗

Transmolar pin and magnetic carrier for midfacial reconstruction: a clinical report.

With previous prosthetic restorations of bilateral maxillary resections, tissue erosion and bleeding on the cephalic parts of the cavity have been caused by movement and pressure from the prosthesis. Retention of a prosthesis is a major determinant in its successful use. Physical and psychologic stresses are common when one is unable to use a prosthesis comfortably. The use of a musculocutaneous flap and an obturator prosthesis had provided near-immediate reconstruction of a massive midfacial defect. This method of reconstruction resulted in soft tissue replacement for appearance and functional rehabilitation of the upper lip while maintaining sound oncologic principles.

Adult↗

[Maxillary prosthesis for better QOL--analysis of maxillary prosthesis stability].

We report here an analysis of 100 cases of maxillary prosthesis, experienced from July, 1981 through June, 1989, with special reference to stability. Sixty-four percent of prostheses were partial denture type and complete denture type comprised thirty-two percent. Eighty-six percent of cases were estimated to have defects exceeding 2/6 and 3/6 of the surface width of the palate. Ninety percent of prostheses weighed less than 15 gm. The stability of these prostheses was estimated to be good in 85% of cases, the stability of the denture type being good in 95% of partial denture type cases, and 62% of complete denture type cases. According to type distinctions among maxillary defects as a whole, in the smaller 1/6 and 2/6 defect cases, good stability can be expected, and in 3/6 and 4/6 defect cases, 80% achieve good stability. According to prosthesis weight, 80% of those weighing less than 15 gm were considered to have shown good stability. Thus, these maxillary prostheses can remain in place and functional ameliorating disability and contributing to the patient's quality of life.

Adult↗

A multiple tray technique for implant-retained orbital prostheses.

The use of implants in retaining orbital prostheses has gained favor in recent years. Not all patients may be candidates for use of medical adhesives or anatomic retention as advocated by some. Osseointegrated implants offer an alternative method for retaining an orbital prosthesis. Because of the confining nature of an orbital defect, it may be difficult to reproduce the spatial arrangement of implants accurately with one impression. The technique presented here accomplishes the objectives of minimal trauma to the tissues, accuracy, and elimination of consecutive impression technique.

Humans↗

Impressions for oculofacial prosthetics.

Primary to the development of an acceptable and functional facial prosthesis is the impression procedure. The fabrication of a facial prosthesis combines the art and science of anatomy, cosmesis, and function, to develop a nonliving substitute to replace altered, missing, or defective regions of the head and neck area. Success depends on patient's cooperation, motivation, and commitment to treatment as well as the technical and artistic scope of the facial prosthetic service.

Colloids↗

A quick method for processing MDX-4-4210 silicone rubber.

An alternative method for processing MDX-4-4210 silicone elastomer that eliminates the recommended de-airing phase has been described. As a result, it is possible to have the processed prosthesis in hand in 30 minutes or less (in small prostheses). In addition, the use of a relatively large and costly vacuum machine is avoided. No clinical differences with respect to stability, strength, or duration between prostheses processed in this manner or the standard method have been noted.

Chemical Phenomena↗

Technique for superimposing a color slide onto a facial cast to sculpt a facial prosthesis.

A precise and uncomplicated technique for superimposing a color slide onto a facial cast for sculpting a facial prosthesis of the periorbital region is described. This technique allows making a facial impression with the eye closed. The superimposed slide in full-face and profile views provide a natural appearance to the facial cast. Properly selected dental and photographic materials are essential to the success of this imaginative procedure.

Humans↗

Modified bar superstructure for an implant-retained orbital prosthesis.

The success of a bar superstructure for an orbital prosthesis may be compromised by the placement and angulation of implants. The following technique describes a modification to a bar superstructure that provided the advantages of convenience, security, and consistent positioning even though one implant was lost and the angulation of implants limited accuracy.

Eye, Artificial↗

Successful upper alveolar reconstruction for gingival cancer using a fibular osteoadipofascial flap without osseointegrated implants.

An upper alveolar skeletal reconstruction with closure of the palatal fistula using an osteocutaneous free flap is considered an ideal reconstructive strategy after curative surgery for cancer of the lower maxilla. Although installation of osseointegrated implants into the bone has advantages for utilizing a dental prosthesis, it is often time and cost prohibitive. In the case of 1 patient, we reconstructed and fit the patient with a conventional denture, eliminating the need for installation of osseointegrated implants. The patient underwent upper alveolar reconstruction using a fibular osteoadipofascial flap, followed by a skin graft for creation of an alveololabial sulcus. It was then possible for the patient to wear a conventional denture without implants. One explanation for this success is that the regenerated mucosa on the adipofascial flap and skin graft was immobile, which allowed it to serve as a base for the dental prosthesis. The alveololabial sulcus that had been constructed kept the denture in place. This reconstruction confirmed that a fibular osteoadipofascial flap might be a useful choice in restoring a natural upper alveolar osseous and soft tissue structure.

Adipose Tissue↗

Prosthetic complications of extraoral implants.

The use of tissue-integrated fixtures for the retention of an extraoral prosthesis has simplified the placement, removal, and cleaning of the prosthesis by the patient. Tissue evaluation, structural designs, and retention mechanisms, combined with patient compliance and the ability to perform hygiene around retentive substructures, has produced an array of new problems. Clinical and technical problems are presented with techniques used in their resolution.

Eye, Artificial↗

[Surgical prosthetic approach to sequelae of a case of noma involving half the face].

In this study, the authors discuss a prosthetic rehabilitation case resulting from loss of substance due to Noma. The dental prosthesis is made from tinted acrylic resin with a combination of two means of retention. The lower mean of retention is composed of a hook leaning on a handle which has been attached to that end on a metal armature and the upper mean of retention is connected to the bridge of spectacles.

Adolescent↗

Early rehabilitation of facial defects using interim removable prostheses: report of two clinical cases.

Postsurgical facial defects often pose a challenge to patient rehabilitation. Such defects can have a severe adverse effect on patient perceptions of body image and self-esteem. When immediate surgical repair of the defect is not feasible, an interim removable facial prosthesis may be considered. This prosthesis can be fabricated and placed as soon as several days after surgery to provide a cosmetically acceptable appearance, permitting the patient to more comfortably and confidently resume social interactions during the postoperative healing period. This article presents two case reports describing the use of interim facial prostheses to provide rapid patient rehabilitation.

Aged↗