Prosthetic Rehabilitation of Composite Hemi-Facial Defects – A Case Report

Introduction: Rehabilitation of severe hemi-facial defectsposes a challenge to the Prosthodontist. Defects involvingmore than one facial part with asymmetry of contra lateralside require careful planning and technical skills to providethe prostheses.Case Report: This article presents a case of of hemi-facialdefect due to chemical burn injury rehabilitated with custommade silicone prosthesis. It also highlights a technique offlasking used for the fabrication of the prosthesis combiningorbital and nasal defects.Conclusion: The technique used for the rehabilitation ofconventional silicone prostheses can be well utilized whenimplants are not feasible.

Prótesis nasal implantosoportada. Reporte de un caso clínico / Implant-supported nasal prosthesis. Clinical case report

Un reto en el tratamiento integral de pacientes con defectos faciales, es la reconstrucción con fines funcionales y estéticos, que conlleva a la elección de la rehabilitación y material a utilizar en cada caso. Los implantes extraorales juegan un papel importante en el soporte protésico, influyendo en los aspectos psicológicos, funcionales y estéticos, aportando al paciente una mejor calidad de vida. El objetivo de este trabajo es rehabilitar estética y funcionalmente, y mejorar la calidad de vida del paciente ofreciéndole, una prótesis nasal implantosoportada.

In our days, functional and esthetic reconstruction is one of the problems most frequently encountered when treating patients with facial defects. This reconstruction entails to choose among rehabilitation materials to use in each case. Extra-oral implants play an important role in prosthetic support, they bear influence into esthetic, functional and psychological aspects, granting better quality of life to the patient. The aim of the present study was to functionally and esthetically rehabilitate the patient as well as improve his quality of life with the use of an implant-supported nasal prosthesis.

Usefulness of Full-thickness Skin Graft from Anterolateral Chest wall in the Reconstruction of Facial Defects

PURPOSE: Full thickness skin grafts are useful in the reconstruction of facial skin defects when primary closure is not feasible. Although the supraclavicular area has been considered as the choice of donor site for large facial skin defect, many patients are reluctant to get a neck scar and some patients do not have enough skin to cover the defect owing to the same insult occurred to the neck such as burn accident. We present several cases of reconstruction of facial skin defects by freehand full-thickness skin graft from anterolateral chest wall resulting aesthetically acceptable outcome with lesser donor site morbidity. METHODS: Retrospective review was performed from March, 2007 to September, 2009. 15 patients were treated by this method. Mean age was 31.5 years. The ethiology was congenital melanocytic nevus in 7 cases, capillary malformation in 5 cases and burn scar contracture in 3 cases. Mean area of lesion was measured to 67.3 cm2 preoperatively. The lesion was removed beneath the subcutaneous fatty tissue layer. The graft was not trimmed to be thin except defatting procedure. For the larger size of defect, two pieces of grafts were harvested from both anterolateral chest wall in separation and combined by suture. RESULTS: The mean follow up period was 9.7 months. All the grafts survived without any problem except small necrotic areas in 4 cases, which healed spontaneously under conventional dressings in 6 weeks postoperatively. Color match was relatively excellent. There were 2 cases of hyperpigmentation immediately, but all of them disappeared in a few months. CONCLUSION: In cases of large facial skin defects, the anterolateral chest wall may be a good alternative choice of full-thickness skin graft.

The rhombotrapezius myocutaneous flap: Surgical innovation for closure of wide and deep temporo-facial defects

OBJECTIVE: To present two cases in which an improved rhombotrapezius flap design was utilized maximally to cover a wide and deep surgical defect after extirpation of a malignant tumor in the temporo-facial area. SETTING: Tertiary Hospital. PATIENTS AND METHODOLOGY: Two cases of malignancy involving the temporo-facial area of the head are presented. Surgical design for the reconstruction of this defect using rhombotrapezius flap is presented. RESULTS AND DISCUSSION: Large and deep temporo-facial defects are adequately closed by rhombotrapezius flap with adequate tissue coverage. Surgical design proved to be acceptable with good flap take and overall cosmetic result. CONCLUSION: Rhombotrapezius flap can be used to cover a large deep defect and can provide more than adequate tissue coverage and bulk to any temporo-facial defects. (Author)