Quality of Life and Maxillary Defects: A Cross-Sectional Study / Calidad de Vida y Defectos Maxilares: Un Estudio Transversal

ABSTRACT: There has been little discussion about the quality of life of patients with maxillary defects. This article evaluates the issues related to the condition. We performed a cross-sectional study of patients with maxillary defects from referral centers in Brazil. To avoid subject burden, a questionnaire was developed, based on questions from seven instruments, which dealt with domains and conclusions that were similar to those from other studies. The predictor variable was the patients' score for each question. The outcome measure was the presence of the best-ranked items on the questionnaire as the impact factor. Six experts assessed these items and suggested which questions to include or exclude. Patients scored each item according to its occurrence and importance. Descriptive statistics and the items' rank according to the impact factor were computed to determine whether there is a comprehensive instrument available. Thirteen patients and six professionals were included in this study. The patients' age ranged from 24 to 72 years (mean (standard deviation, SD), 50.41 (14.46) years). We obtained a 60-item instrument from the selected questionnaires and subject interviews. Only 12 (37.5 %) out of the 32 best-rated items were verified by the existing instruments, two (6.25 %) were suggested by professionals and 18 (56.25 %) were conclusions from other studies. To the best of our knowledge, this is the first study to provide many features related to the quality of life in patients with maxillary defects.

RESUMEN: Existe escasa discusión en la literatura sobre la calidad de vida de los pacientes con defectos maxilares. Este artículo evalúa los problemas relacionados con esta condición. Realizamos un estudio transversal de pacientes con defectos maxilares de centros de referencia en Brasil. Se desarrolló un cuestionario basado en preguntas de siete instrumentos, que trataba sobre dominios y conclusiones similares a las de otros estudios. La variable de estimación fue la puntuación de los pacientes para cada pregunta. La medida de resultado fue la presencia de los elementos mejor clasificados en el cuestionario como factor de impacto. Seis expertos evaluaron estos ítems y sugirieron qué preguntas incluir o excluir. Los pacientes puntuaron cada ítem según su ocurrencia e importancia. Se calcularon las estadísticas descriptivas y la clasificación de los ítems según el factor de impacto, para determinar si existe un instrumento completo. Trece pacientes y seis profesionales fueron incluidos en este estudio. La edad de los pacientes osciló entre 24 y 72 años [media (desviación estándar), 50,41 (14,46) años]. Obtuvimos un instrumento de 60 ítems de los cuestionarios y entrevistas de temas seleccionados. Solo 12 (37,5 %) de los 32 ítems mejor calificados se verificaron de acuerdo a los instrumentos existentes, dos (6,25 %) fueron sugeridos por profesionales y 18 (56,25 %) fueron conclusiones de otros estudios. De acuerdo a nuestro conocimiento, este es el primer estudio que proporciona características relacionadas con la calidad de vida en pacientes con defectos maxilares.

Proposition of integrated electrical mechanism and facial prosthesis for eyelid motion on prosthetic oculopalpebral rehabilitation: technical note / Proposta de mecanismo elétrico integrado e prótese facial para movimentação da pálpebra na reabilitação protética oculopalpebral: nota técnica

Surgical reconstruction of large facial defects may not be always possible, therefore extraoral maxillofacial prosthesis is a good restorative option. The oculopalpebral prosthesis has a natural appearance however it can be easily noticed because its eyelids do not move. For esthetic purposes, it is desirable that the prosthetic eyelids open and close synchronously with the contralateral eye, which provides a challenge to the prosthetic reconstruction of the oculopalpebral region. To improve the esthetic outcome, an oculopalpebral prosthesis prototype with mechanical and electric features allowing synchronization of the eyelid motion with the sound eye was planned, designed, and built. An oculopalpebral prosthesis was made in thermoactivated acrylic resin. A gap was created to accommodate an electrical system and allow free motion of a thin eyelid made of silicone attached to the appliance. The movable eyelid was made with medical grade silicone (SILASTIC® MDX4-4210) and connected to an electrical and electronic system responsible to command the opening and closing movements. This mechanical and electrical prototype with the system connected to a sensor, successfully captured the eyelid motion of the contralateral sound eye. The proposed mechanical and electrical system attached to an oculopalpebral prosthesis could successfully establish and synchronize the eyelid movements with the sound eye.

A reconstrução cirúrgica de grandes defeitos faciais pode não ser sempre possível, portanto, a prótese bucomaxilofacial extra-oral é uma boa opção restauradora. A prótese oculopalpebral tem uma aparência natural, mas pode ser facilmente notada pois as pálpebras não se movimentam. Para fins estéticos, é desejável que as pálpebras protéticas se abram e se fechem em sincronia com o olho contralateral, o que representa um desafio para a reconstrução protética da região oculopalpebral. Para melhorar o resultado estético, um protótipo de prótese oculopalpebral com características mecânicas e elétricas permitindo a sincronização do movimento da pálpebra com o olho sadio foi planejado, projetado e construído. Uma prótese oculopalpebral foi confeccionada em resina acrílica termoativada. Um nicho foi criada para acomodar umsistema elétrico e permitir o movimento livre de uma pálpebra fina confeccionada em silicone preso ao sistema. A pálpebra móvel foi confeccionada com silicone de grau médico (SILASTIC® MDX4-4210) e conectada a um sistema elétrico e eletrônico responsável por comandar os movimentos de abertura e fechamento. Esteprotótipo mecânico e elétrico com o sistema conectado a um sensor capturou com sucesso o movimento das pálpebras do olho acústico contralateral. O sistema mecânico e elétrico proposto, fixado a uma próteseoculopalpebral, conseguiu estabelecer e sincronizar os movimentos da pálpebra com o olho sadio.