Professional Documents
Culture Documents
Use Only: Nasal Prosthesis After Partial Rhinectomy. A Case Report
Use Only: Nasal Prosthesis After Partial Rhinectomy. A Case Report
ly
Maxillofacial defects can result from provides the respiratory function. Also, a
several reasons, including neoplasia, con- the sticking of the impression material. Wet
on
prosthesis offers the clinician and the
genital malformations, trauma, oral infec- patient the means to observe the healing gauze was packed into the defect to prevent
tions, etc. This kind of defects can be wound for recurrence of disease.5 the flow of material into the undesired
severely debilitating to the patients. To areas. To minimize tissue bed distortion, an
e
The purpose of this case report is to
improve the quality of life of these patients, describe a custom-made silicon nasal pros-
us impression was made of the defect and
the options include surgical reconstruction thesis with anatomic and spectacle retention adjacent tissues using a Hydrophilic vinyl
and maxillofacial prosthesis. However, sur- after partial rhinectomy due to carcinoma. polysiloxane light body elastomeric impres-
gical approaches have many inherent disad- sion material (Make Reprosil Tubes
al
vantages and limitations. This case report Standard Light Body, Dentsply Caulk) in a
ci
rhinectomy secondary to basal cell carcino- The cast was then poured with the type
ma. The case was planned with a silicone A 28-year-old female patient was III dental stone.(KALSTONE, Kalabhai
m
prosthesis with anatomic and spectacle referred from the Department of oral and
Karson Private Limited, MUMBAI INDIA)
retention. A non-surgical method of rehabil- maxillofacial surgery for the nasal prosthe-
(Figure 2C).
om
itation was followed owing to the patient’s sis to the Department of Prosthodontics
A heat cure clear acrylic (DPI HEAT
choice and financial constraints. The final Sharad Pawar Dental College, Sawangi
CURE MUMBAI, INDIA) stent was made
prosthesis was aimed at enhancing the (Megeh) Wardha. Maharashtra , DMIMS
as a base of the prosthesis to engage the
-c
prosthesis. A nose pin was added to the ala ic and spectacle retention was planned. ment the support of the spectacles at the
of the nose at patient’s request (Figure 4A). Furthermore, it has been extensively bridge of the nose and to increase skin sur-
The prosthesis was delivered to the opined that a postoperative healing period face contact thereby strengthen the reten-
patient after demonstration of placement of of 3 to 5 months may be required before tion of the prosthesis. Also, minimizing the
the prosthesis (Figure 4B). Detailed instruc- commencing fabrication of a definitive load on the prosthesis increases retentive
tions were given regarding care and use of nasal prosthesis to allow for contraction and time the patient can enjoy and prevents fre-
the prosthesis. organization of the tissue bed.5 quent replacement of adhesives.1
The first post-insertion adjustment was Additionally, literature also indicates the A challenge that a clinician faces while
scheduled the next day after the insertion to removal of nasal bones in surgical resection fabricating a maxillofacial prosthesis is
ensure the health of the underlying tissues. of the nose even if they are unaffected by obtaining a proper skin color match. A skin
At the follow-up evaluation after four the disease.4 However, in the present clini- color match is achieved by adding suitable
weeks, the prosthesis appeared to be func- cal case, the nasal bones and adjoining soft pigments to translucent silicone elastomers
tioning within normal limits. A patient satis- tissues were intentionally left intact to aug- until an acceptable color match under
faction questionnaire indicated the patient’s
contentment with the prosthesis. The patient
was recalled every three months for evalua-
tion.
Discussion
The present case reports the fabrication
of a custom-made nasal prosthesis for
ly
patient rehabilitation post a partial rhinecto-
my due to basal cell carcinoma. The pros-
on
thetic rehabilitation aims at improved func-
tion and esthetic of patients with facial
deformations resulting in considerable cos-
e
metic impairment. Surgical reconstruction
in such cases is generally technically
demanding and often leads to unsatisfactory
us
results.13,14 On the other hand, facial pros-
al
theses enable early recuperation as well as
allow periodic inspection of the site, elimi-
ci
and help in the patients’ timely psychosocial Figure 1. A) Post-operative frontal view; B) Post-operative lateral view (clinical photo
rehabilitation.15 published with patients permission).
m
Figure 3. A) Acrylic stent trial; B) Wax up trail frontal view; C) Wax up trial lateral view (clinical photo published with patients permission).
ly
facial prosthetics is longevity. The primary
reasons for the replacement of facial pros-
on
theses are degradation and discoloration of
the material. Literature reports the replace-
ment of facial prostheses every 1.5 to 2
e
years, which can be a considerable burden
to the patient.8,22 Hence, this area that needs
attention in current and future research.
us
An ideal prosthesis should simulate the
al
missing facial contours as accurately as
possible, thereby allowing the patients to
ci
prosthesis.
Recently, CAD/CAM (computer aided
N
Conclusions
It can be inferred from the present case
report that silicone is one of the most
acceptable materials for the fabrication of
maxillofacial prosthesis. A custom made
Figure 4. A) Final prosthesis with spectacles; B) Pre and post prosthesis comparison (clin-
ical photo published with patients permission).
nasal prosthesis can dramatically improve granuloma - a clinical report. J Oral 1992;68:327-30.
the appearance and the quality of life of Rehabil 2006;33:863-67. 17. Zemnick C, Asher ES, Wood N, Piro
patients with significant nasal defects asso- 8. Ariani N, Visser A, van Oort RP, et al. JD. Immediate nasal prosthetic rehabil-
ciated with cancer. Current state of craniofacial prosthetic itation following cytomegalovirus ero-
rehabilitation. Int J Prosthodont sion: A clinical report. J Prosthet Dent
2013;26:57-67. 2006;95:349-53.
9. Wilkes GH, Wolfaardt JF. 18. Goiato MC, AUR Fernandes, dos
References Osseointegrated alloplastic versus auto- Santos DM, et al. Positioning magnets
genous ear reconstruction: criteria for
1. Lemon JC, Kiat-amnuay S, Gettleman on a multiple/sectional maxillofacial
treatment selection. Plast Reconstr Surg
L, et al. Facial prosthetic rehabilitation: prosthesis. J Contemp Dent Pract
1994, 93:967-79.
preprosthetic surgical techniques and 2007;7:101-7.
10. Van der Lei B, Dhar BK, Van Oort RP,
biomaterials. Curr Opin Otolaryngol Robinson PH. Nasal reconstruction 19. Mancuso DN, Goiato MC, de Carvalho
Head Neck Surg 2005;13:255-62. with an expanded forehead flap after Dekon SF, Gennari-Filho H. Visual
2. Gritz ER, Hoffman A. Behavioral and oncological ablation: results, complica- evaluation of color stability after accel-
psychosocial issues in head and neck tions and a review of the English–lan- erated aging of pigmented and nonpig-
cancer. Maxillofacial rehabilitation: guage literature. FACE 1996;3:139-46. mented silicones to be used in facial
prosthodontic and surgical considera- 11. Leonardi A, Buonaccorsi S, Pellacchia prostheses. Indian J Dent Res
tions. St. Louis;1996. pp 1-4. V, et al. Maxillofacial prosthetic reha- 2009;1;20:77-80.
3. Seilmis A, Oztucrk AN. Nasal prosthe- bilitation using extraoral implants. J 20. Ethunandan M, Downie I, Flood T.
sis rehabilitation after partial rhinecto- Craniofac Surg 2008;19:398-405. Implant-retained nasal prosthesis for
my: a clinical report. Eur J Dent 12. Ciocca L, Maremonti P, Bianchi B, reconstruction of large rhinectomy
2007;1:115-8.
ly
Scotti R. Maxillofacial rehabilitation defects: the Salisbury experience. Int J
4. Jain S, Maru K, Shukla J, et al. Nasal after rhinectomy using two different Oral Maxillofac Surg 2010;39:343-9.
on
prosthesis rehabilitation: A case report. treatment options: clinical reports. J 21. Parel SM. Diminishing dependence on
J Indian Prosthodont Soc 2011;11:265- Oral Rehabil 2007;34:311-5. adhesives for retention of facial pros-
9. 13. Goiato MC, Pesqueira AA, da Silva CR, theses. J Prosthet Dent 1980;43:552-60.
e
5. Qiu J, Gu XY, Xiong YY, Zhang FQ. et al. Patient satisfaction with maxillo-
us 22. Visser A, Raghoebar GM, Van Oort RP,
Nasal prosthesis rehabilitation using facial prosthesis. Literature review. J
Vissink A. Fate of implant-retained
CAD-CAM technology after total Plast Reconstr Aesthet Surg
rhinectomy: a pilot study. Support Care craniofacial prostheses: life span and
2009;62:175-80.
aftercare. Int J Oral Maxillofac
al
Cancer 2011;19:1055-9. 14. Brent B. A personal approach to total
6. Roumanas ED, Freymiller EG, Chang auricular reconstruction: case study. Implants 2008;23:89-98.
ci
TL, et al. Implant-retained prostheses Clin Plast Surg 1981;8:211-21. 23. Klein M, Menneking H, Spring A, Rose
for facial defects: an up to 14-year fol- M. Analysis of quality of life in patients
er
7. Guttal SS, Patil NP, Shetye AD. Effects of environmental factors on Rehabilitation of nose using silicone
Prosthetic rehabilitation of a midfacial maxillofacial elastomers: part I - litera- based maxillofacial prosthesis. J Coll
defect resulting from lethal midline ture review. J Prosthet Dent Physicians Surg Pak 2010;20:65-7.
-c
on
N