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[Extra-oral implants: indications and contraindications].

Osseointegrated facial prostheses are an interesting solution for maxillofacial rehabilitation when reconstructive surgery cannot be proposed. Progress in epithesis materials and in implantation techniques have renewed interest in maxillofacial prostheses. The best indications are for rehabilitation of nasal, auricular and orbitopalpebral defects. Another indication is complex loss of facial tissue. Endo-osseous epitheses are recommended mainly when there is no possibility of reasonable and satisfactory surgical reconstruction, when local carcinologic prognosis is uncertain, and to respond to the patient's demands. We detail here the precautions necessary when irradiation has been performed previously and finally present the contraindications against epitheses on osseointegrated implants.

Biocompatible Materials↗

[Extra-oral implants: surgical procedures].

The different extra-oral implant systems (screw and plate fixation) are not compatible. Rigorous surgical procedure (detailed and illustrated here) is mandatory to obtain the best implant osseointegration and epithesis loading 3 months later. Besides surgical procedure, careful bone and peri-abutment suture are required for success.

Bone Plates↗

[Extra-oral implants and irradiation: current trends].

Recommended treatment for head and neck cancer associates surgery and radiotherapy. Indication for bone-anchored epitheses in irradiated patients is also a common situation. The outcome of the implant appears to be improved with a special protocol for hyperbaric oxygen therapy, antibiotic therapy and calcitherapy. The problem of radiotherapy in patients with titanium osseointegrated implants is also discussed.

Anti-Bacterial Agents↗

[Gustave Ginestet (1897-1966), doctor general. Life and work of a pioneer of cosmetic and reconstructive maxillofacial surgery].

Gustave Ginestet, pratician and surgeon of two world wars in Europe, military medical in Lebanon and Syrian French Protectorat (1925-1931), countries where his works are not forgotten, was an admired and respectable master, pioneer of the maxillo facial and stomatologic French school of surgery, chief, between 1936 and 1966, and now, spiritual father of the referent services for head and neck surgery in France.

Dentistry, Operative↗

Clinicoanatomic study on the craniofacial bones used for cranio- and maxillofacial implants.

PURPOSE: To clarify basic clinico-anatomic factors associated with cranio-maxillofacial rehabilitation using implants. MATERIALS AND METHODS: Morphometrically evaluated were items such as the length and width of bone and the thickness of cortical bone at important sites for implant placement into cranial and maxillofacial bones in 30 cadavers at autopsy. RESULTS: At sites corresponding to potential placement sites for implants as the fixation source for ocular epitheses, the mean length of bone was 7.8 mm, and the mean width was 8.3 mm. CONCLUSION: Useful data have been obtained for the selection of the placements sites, direction, length, and external diameter of cranio- and maxillofacial implants.

Adult↗

[Prosthetic reconstruction after oncological surgery in the head and neck region].

The aim of maxillofacial prosthetics is the treatment of patients with head and neck disease in a multidisciplinary way. Intraoral and facial defects are preferably reconstructed by surgical transplantation methods. Patient factors and oncologic factors determine the indication of prosthetic reconstructions. The treatment of patients with an intraoral or facial defect should be based on a close cooperation between maxillofacial prosthetist and MFP technician. The rehabilitation process and the specific role of each are described.

Dental Technicians↗

[Surgical correction of facial asymmetry].

It is not possible to group the facial asymmetries in one single nosological entity. However, whatever the origin of these malformations, their surgical treatment is governed by the same principles. In this article, the author attempts to define certain aetiologies:genetic, congenital and developmental, of the minor assymmetries of the face. He then reviews the different techniques in current use, in plastic and reconstructive surgery:autogenic or homogenic tissue grafts (bone, cartilage, derm, fascia, etc.), implants of plastic material, osteotomies. He stresses the use of simple techniques which cause little mutilation, as well as the simultaneous correction of the profile which greatly enhances the aesthetic appearance and the psychological well-being of these patients.

Adolescent↗

Effect of opacifiers on color stability of pigmented maxillofacial silicone A-2186 subjected to artificial aging.

PURPOSE: This study was designed to determine the effect of opacifiers used at different ratios on the color stability of pigmented A-2186 silicone maxillofacial elastomers and to evaluate the color spectrophotometrically before and after artificial aging. MATERIALS AND METHODS: Sixty experimental groups of elastomers were made using various concentrations (5%, 10%, and 15%) of 4 opacifiers (Georgia kaolin powder neutral, kaolin powder calcined, Artskin white, and dry pigment titanium white) with 1 of 5 dry earth cosmetic pigment groups (no pigment [control], red, yellow ochre, burnt sienna, and a mixture of all pigments). Five specimens of each elastomer were tested, for a total of 300 specimens. All specimens were placed in an aging chamber and artificially aged by exposure to light, water spray, fluctuating temperatures, and humidity. CIE L*a*b* values were measured by spectrophotometer. The color differences (Delta E*) at various exposure energies (150, 300, and 450 kJ/m(2)) were subjected to 4-way analysis of variance with repeated measures (super ANOVA). Mean values were compared with Tukey-Kramer intervals calculated at the 0.05 significance level. RESULTS: The trained human eye can detect color changes (Delta E*) greater than 1.0. Adding all pigments to any of the kaolin groups did not protect silicone A-2186 from color degradation over time. Mixing red pigment in all groups at all times drastically increased DeltaE* values ranging from 0.1 to 1.3 up to 16.6 to 49.6. Yellow ochre had an effect only with 10% and 15% concentrations of kaolin powder calcined, increasing the value of Delta E* to greater than 1.0. Burnt sienna had an effect only with a 15% concentration of kaolin powder calcined, increasing the value of Delta E* at 300 and 450 kJ/m(2) to greater than 11.0. At the 5% concentration, kaolin powder calcined had the smallest color changes, followed by, in order, dry pigment titanium white, Artskin white, and Georgia kaolin. At the 10% concentration, Artskin white had the smallest color changes, followed by, in order, dry pigment titanium white, kaolin powder calcined, and Georgia kaolin. At the 15% concentration, Artskin white again had the smallest color changes, followed by, in order, dry pigment titanium white, Georgia kaolin, and the kaolin powder calcined. The smallest color changes in each kaolin group were at the 10% concentration for Artskin white, dry pigment titanium white, and kaolin powder calcined and at the 5% concentration for Georgia kaolin. CONCLUSIONS: Mixing dry earth cosmetic pigments with opacifiers did not protect silicone A-2186 from color degradation over time, especially in the case of red pigment. The group in which pigments were mixed with 10% Artskin white had the smallest color changes over time, followed by, in order, the groups in which pigments were mixed with 10% dry pigment titanium white, 10% kaolin powder calcined, and 5% Georgia kaolin. Red pigment had a significant effect on all opacifiers, especially Georgia kaolin and kaolin powder calcined. Yellow ochre and burnt sienna had an effect only on 15% kaolin powder calcined. Among all the pigment groups tested, yellow ochre remained the most color stable over time.

Analysis of Variance↗

Facial restoration.

Medical science has demonstrated that fiction can be turned into fact. It is prophesied that man will be able to liver longer due to the development of synthetic organs. Sophisticated facial prostheses will be included in this progressive field. Perhaps the next century will make synthetic substitutes past history with the transplantation of organs as established practice. Or, perhaps some of the latest developments of growing skin or the use of carbonated teflon inserts will replace currently used plastics. In the meantime, we must continue to work within the limitations of our present technology.

Ear, External↗

Prosthetic rehabilitation of a patient following maxillectomy with orbital exenteration.

The maxillectomy patient despite the drastic nature of the procedure can often be restored to an acceptable aesthetic and functional condition. The treatment of maxillectomy patient presents an excellent opportunity for the surgeon and the prosthodontist to coordinate their efforts to enhance the patient's rehabilitation. This clinical report describes the prosthetic rehabilitation of a patient with squamous cell carcinoma of the right maxilla requiring maxillectomy with orbital exenteration.

Adult↗