Multi-purpose Use of Nasal Stents for Prosthetic Rehabilitation of Facial Defect: A Case Report

@#Basal cell carcinoma is the most common cause of nasal defects. For large lesions with deep tissue extensions a total rhinectomy may be indicated followed by adjunctive therapies, such as radiotherapy or chemotherapy. Subsequent surgical reconstruction of these defects poses a challenge due to the compromised tissue bed and may require rehabilitation with facial prosthesis. In current case report, patient had basal cell carcinoma, which had involved the nasal cartilages, right inferior turbinate, nasolabial fold, upper lip and adjacent vascular and perineural tissues. Basal cell carcinoma was surgically excised, followed by postoperative radiotherapy. The resulted nasal defect was closed by forehead pedicle flap. Nasal stents were inserted postoperatively to prevent stenosis of nostrils. Prosthetic rehabilitation of a complete nasal defect was done by utilising nasal stents to prevent nasal stenosis, improved stability and precision, in placement of prosthesis over flat nasal defect. Skin adhesive was applied on margins to enhance the retention of prosthesis and to blend the margins of prosthesis with adjacent skin.

Rehabilitación protésica híbrida en un defecto orofacial. Presentación de un caso / Prosthetic hybrid rehabilitation in orofacial defect. Case presentation

Los procesos tumorales que comprometen la región de cabeza y cuello, pueden afectar particularmente la identidad del ser humano. Para la eliminación de estas neoplasias existen diferentes alternativas terapéuticas, que generan secuelas de tipo funcional, afectando: la fonación, deglución y masticación, además de defectos estéticos y alteraciones psicológicas. Por consiguiente, el enfoque para el tratamiento de pacientes con cáncer se basa no solamente en el control de la enfermedad, sino también en la supervivencia, rehabilitación y su reintegración a la sociedad. A continuación se presenta el caso de un paciente con defecto orofacial, resultado del tratamiento ante un carcinoma basocelular, con radioterapia y su posterior resección quirúrgica tras recidiva tumoral. Se rehabilita mediante la elaboración de una prótesis híbrida (obturador intraoral y prótesis facial) con el objetivo de compensar parcialmente las pérdidas funcionales, estéticas, incidiendo positivamente en su estado psicosocial.

Tumor processes compromising the head and neck region can particularly affect the identity of the human being. There are different therapeutic alternatives to remove these dysplasias, which generate functional sequels affecting phonation deglutition and mastication. Therefore, approach for cancer patients is not only based on control of the disease, but additionally in patient's survival, rehabilitation and reinsertion in society. We hereby present the case of a patient with an orofacial defect resulting from treatment of basal cell carcinoma with X-ray therapy and later surgical resection after tumor recurrence. The patient was rehabilitated with manufacture of a hybrid prosthesis (intraoral obturator and facial prosthesis) which was achieved with the purpose of partially compensating functional and aesthetic losses and thus improving the patient's psychosocial circumstances.

Rehabilitación protésica de órbita implantosoportada en paciente con secuela de meduloepitelioma teratoide maligno / Implant-supported orbit prosthetic rehabilitation in patient with malignant teratoid medulloepithelioma

La prótesis maxilofacial es «la especialidad odontológica que se dedica a la rehabilitación estética de las estructuras intraorales y extraorales por medios artificiales¼.¹ Una prótesis orbital es un dispositivo artificial que reemplaza la ausencia del ojo y sus anexos (párpados, pestañas y cejas). Ésta es una alternativa a la rehabilitación cuando la reconstrucción quirúrgica no sea viable, o se prefiere por el paciente. Hoy en día, con el avance de la investigación, podemos contar con el uso de los implantes de oseointegración, los cuales hasta el momento han evidenciado ser el medio de fijación óptimo en la rehabilitación protésica craneofacial. El caso clínico que se presenta corresponde a un paciente masculino con secuelas postquirúrgicas orbitofaciales de un carcinoma derivado del sistema nervioso central (meduloepitelioma teratoide maligno), que tiene como principal tratamiento la exenteración del globo ocular y áreas circunscritas que se encuentren afectadas, dejando un defecto orbitofacial, el cual se rehabilitó con una prótesis maxilofacial retenida por implantes integrados al hueso del reborde supraorbitario. El objetivo de este trabajo es dar a conocer el tipo de tratamiento integral que se da a un paciente con estos antecedentes, desde el diagnóstico de la afección, el tratamiento de la misma, así como la rehabilitación protésica del defecto resultante, con lo que se demuestra las ventajas del uso de implantes de oseointegración como medio de retención de la prótesis, y finalmente se observa cómo este tipo de rehabilitación incrementa la apariencia estética del paciente con secuelas quirúrgicas faciales, logrando su reintegración a la sociedad con más confianza y seguridad. Para lograr un tratamiento exitoso y brindarle al paciente el bienestar físico y mental, debemos trabajar en conjunto con un equipo multidisciplinario que resuelva el caso en su totalidad, para finalmente ofrecer los beneficios reales de la rehabilitación protésica con un medio de retención que ha sido, sin duda, una ventaja más que ofrecer para el paciente portador de la prótesis orbitaria. El uso de implantes ha tenido un gran impacto en estos pacientes, dándoles una favorable reintegración a la sociedad, disimulando sus defectos faciales y brindándoles comodidad y seguridad en el ejercicio de sus actividades cotidianas, sin el temor de un posible desprendimiento de su prótesis.

Maxillofacial prosthesis can be described as «the specialty in dental science devoted to the aesthetic rehabilitation by artificial means of intra-and extra-oral structures¼.¹ Orbit prostheses are artificial devices used to substitute the absence of the eye and annex structures (eyelids, lashes and eyebrows). They represent a rehabilitation alternative when surgical reconstruction is either unviable or not preferred by the patient. In our days, in the light of recent research advances, we can make use of bone-integrated implants. To this date they have proven to be the best fixation means in craniofacial prosthetic rehabilitation cases. The clinical case introduced in the present study is that of a male patient exhibiting postsurgical orbital-facial sequels after a carcinoma derived from the central nervous system (CNS) (malignant teratoid medulloepithelioma). Main treatment for this type of carcinoma is ocular globe and circumscribed affected areas exenteration. In this case, this procedure left an orbital-facial defect which was rehabilitated with a maxillofacial prosthesis, fixated to the supraorbital ridge by bone-integrated implants. The aim of the present study was to describe the comprehensive treatment administered to a patient exhibiting this kind of history, from the moment when the condition was diagnosed, its treatment, and the prosthetic rehabilitation of the resulting defect. This study shows the advantages obtained when using bone-integrated implants as a means for prosthesis retention. It is equally observed how this type of rehabilitation greatly improves the aesthetic appearance of patients afflicted with surgical facial sequels, thus achieving a more confident and self-assured reinsertion into society. In order to achieve successful treatment and offer mental and physical welfare to the patient we must work alongside a multi-disciplinary team, to comprehensively solve the case. We can then finally offer the real advantages of prosthetic rehabilitation with a retention means which has proved to be an additional advantage for patients wearing orbital prostheses. Implant usehas bornea great impact in these patients, fostering favorable reinsertion into society, since facial defects are dissimulated and patients can exhibit comfort and security in their day-to-day activities, without fear of a possible prosthesis displacement.

Accuracy of face castings employing thermoplastic custom trays for facial molding

AIM: To evaluate the dimensional stability of a new facial molding technique using thermoplastic custom molding tray. METHODS: The designs established demarcation of facial anthropometrics landmarks, making linear measurements with a digital caliper. Facial molding was carried out using thermoplastic custom trays, constructing a facial plaster cast with the anthropometric landmarks already transferred by measuring the linear dimensions on the plaster cast and statistical analysis. RESULTS: All linear measurements in the palpebral and labial regions presented statistically significant distortions. Only one of the linear measurements from the orbital region did not demonstrate any significant distortion. The nasal region presented the least amount of distortion. CONCLUSIONS: Although statistically significant, distortions were due to the method of breathing and were considered to be clinically irrelevant. The reduction in the working time, the comfort provided to the patient and the dimensional accuracy of the plaster cast obtained by the facial molding technique using custom perforated molding tray suggest that this technique should be employed for making facial prostheses.

Maxillofacial prosthetic rehabilitation of a cancer patient at terminal stage.

Face is the forefront of aesthetics. Surgical resection of the maxillae and facial structures for treatment of cancer, trauma, congenital deformities or infection causes maxillofacial defect that has serious impact on the individual’s esthetic and has great psychological trauma of social outcast. When the presented defect is extensive and supporting structures is lacking, the rehabilitation and restoring functions is a challenging task. Rehabilitation becomes even more difficult when the problems at defect site are associated with the complications. An attempt has been made to rehabilitate of a patient at terminal stage having extensive maxillofacial defect with inoperable carcinoma, infections, and restricted mouth opening.

A modified technique for retention of orbital prosthesis.

An orbital defect (congenital or acquired) causes severe facial asymmetry and disfigurement, which results in psychological and social disturbances to the patient. It becomes a challenging task for a maxillofacial prosthodontist to fabricate a prosthesis that replicates the healthy side of the face. Success of the prosthesis depends primarily on satisfactory retention of the same. This clinical report illustrates rehabilitation of a patient with an orbital defect by fabricating a hollow orbital prosthesis, utilizing anatomical undercuts for retention using an acrylic resin template relined by a resilient denture liner.

Efeitos da pigmentação e do envelhecimento acelerado na estabilidade de cor de um silicone médico com potencial de uso nas próteses maxilofaciais / Effects of pigmentation and accelerated aging on color stability of a medical silicone with potential for use in maxillofacial prosthetics

Este estudo avaliou a alteração de cor do silicone Ortho Pauher, tendo como padrão ouro o silicone MDX 4 - 4210, frente ao envelhecimento e à pigmentação. Foram obtidos sessenta espécimes para cada material, os quais receberam pigmentação intrínseca ou pigmentação intrínseca e extrínseca. Como pigmento, foi utilizado pó de maquiagem. Os espécimes foram distribuídos aleatoriamente em três grupos e submetidos ao envelhecimento ou por termociclagem, luz ultravioleta ou para compor o grupo controle. Como controle, espécimes foram mantidos em um recipiente hermeticamente fechado na ausência de luz. O envelhecimento simulou um período de uso de 12 meses. Os testes ANOVA e Tukey (p < 0,05) indicaram diferença significante entre o grupo controle e osgrupos envelhecidos por termociclagem e luz ultravioleta, sendo que estes se mostraram iguais. Em relação aos materiais, não houve diferença entre eles. Houve diferença entre as pigmentações. Na interação, o Ortho Pauher sofreu maior variação de cor causada pela luz ultravioleta, enquanto o MDX, pela termociclagem. Comparando-seos materiais com pigmentação intrínseca, nos três grupos de envelhecimento houve diferença entre o controle e a luz ultravioleta, sendo que a maior alteração foi encontrada para o Ortho Pauher. Para os materiais com pigmentação intrínseca e extrínseca, houve diferença nos três grupos de envelhecimento, com maior variação para o MDX.Notam-se comportamentos distintos dos materiais em função da pigmentação e do envelhecimento, devendo-se considerar a associação entre material, tipo de pigmento e tipo de exposição para que se faça a indicação clínica corretamente, podendo-se considerar o Ortho Pauher na confecção de próteses maxilofaciais.

This study evaluated the color change of the silicone Ortho Pauher, with the standard gold silicone MDX 4 - 4210, facing the aging and pigmentation. Sixty specimens were obtained for each material, which received intrinsic or intrinsic and extrinsic pigmentation. Powder makeup was used as pigment. The specimens were randomly dividedinto three groups and subjected to aging or thermal cycling, ultraviolet light or to compose the control group. As control, specimens were kept in an airtight container in the absence of light. Aging simulated a period of 12 months. ANOVA and Tukey tests (p < 0.05) indicated a significant difference between control group and the groups aging by thermal cycling and ultraviolet light, which were equal. In relation to materials, there was no difference between them. There was a difference between pigmentation. In the interaction, Ortho Pauher suffered major color changescaused by ultraviolet light, while the MDX, by thermocycling. Comparing the materials with intrinsic pigmentation, the aging in the three groups was difference between control and ultraviolet light, and the greatest change was found for the Ortho Pauher. For materials with intrinsic pigmentation and extrinsic, there were differences between the three groups of the aging, with greater variation for the MDX. Note the different behavior of materials as a function of pigmentation and aging, one should considered the relationship between material, pigment type and type ofexposure in order to do properly the clinical indication, and may be considered silicone Ortho Pauher in making of the maxillofacial prosthesis.

Modified technique to fabricate a hollow light-weight facial prosthesis for lateral midfacial defect: a clinical report

Large oro-facial defects result from cancer treatment consequences in serious functional as well as cosmetic deformities. Acceptable cosmetic results usually can be obtained with a facial prosthesis. However, retention of a large facial prosthesis can be challenging because of its size and weight. This article describes prosthetic rehabilitation of a 57-year-old man having a right lateral mid-facial defect with intraoral-extraoral combination prosthesis. A modified technique to fabricate a hollow substructure in heat-polymerizing polymethyl-methacrylate to support silicone facial prosthesis was illustrated. The resultant facial prosthesis was structurally durable and light in weight facilitating the retention with magnets satisfactorily. This technique is advantageous as there is no need to fabricate the whole prosthesis again in case of damage of the silicone layer because the outer silicone layer can be removed and re-packed on the substructure if the gypsum-mold is preserved.

Importância da reabilitação protética da região óculo-palpebral: relato de caso / Importance of rehabilitation of the prosthetic region óculo-palpebral: case report

As perdas buco-maxilo faciais causam grande constrangimento e sofrimento aos seus portadores, especialmente aquelas passíveis de reabilitação somente através da prótese. Este trabalho relata o caso de um paciente, sexo feminino, leucoderma e com 66 anos de idade, atendido na Clínica de Prótese Buco-Maxilo Facial da Faculdade de Odontologia de Pernambuco da Universidade de Pernambuco (FOP/UPE), portador de uma mutilação na região óculo-palpebral que teve como fator etiológico um câncer da região orbitária, descrevendo-se a técnica e a importância da reabilitação protética facial nos aspectos estéticos e psicossociais.

The maxillofacial losses cause great constraint and sadness especially those with need of rehabilitation only through prosthesis. This work present a case of a patient, feminine, leucoderm and 66 years of age, seeking for treatment at Clinic of Maxillofacial Prosthetic of the Dental School of the University of Pernambuco (FOP/UPE). The patient had a mutilation in the oculo-palpebral region and the etiologic factor was a cancer on the orbital region. This case report aimed also to describe its technique and the importance of the facial prosthetic rehabilitation to aesthetic and psicossociais aspects.