Purpose: Autologous reconstruction is the gold standard for restoration of form and function of facial defects and is applied in the vast majority of cases. There are cases however, where such reconstruction is not feasible or desirable due to the size and location of a defect, poor quality of surrounding tissues, failed previous reconstruction, patient's age and general condition. For these difficult cases, reconstruction with an implant-retained prosthesis may provide a good alternative modality or an addition to the reconstructive efforts. We present our 16-year experience with this approach.

Materials and Methods: 103 patients underwent reconstruction for auricular (56), orbital (38) and nasal (9) defects   . Eighteen patients underwent auricular reconstruction after failed autologous procedures, while the remaining 40 presented after trauma, burns or tumor extirpation. All patients with orbital and nasal defects had undergone tumor extirpation. 57 of these patients had received radiation therapy and underwent hyperbaric oxygen therapy prior to implant placement. An average of three implants was used for each defect. Extensive planning was necessary prior to each procedure for precise placement of the implants. Recently we have started to use a cone beam CT scanner to better evaluate bone density and to determine the ideal location for implants . From this, a surgical guide was then computer generated and used intraoperatively for more accurate placement of implants.

Results:  9 out of 164 implants were lost in the mastoid area, 15/98 in the periorbital area and 5/27 in the paranasal area. All losses occurred in previously radiated areas and most during our initial experience with the technique. Additional implants were placed as needed and all patients ultimately achieved a successful prosthetic rehabilitation.

Conclusions: Reconstruction with implant-retained prostheses provides a very good alternative for management of difficult facial defects and should be incorporated into our reconstructive armamentarium. This modality may be used alone or in combination with autologous tissue reconstruction to enhance the final functional and aesthetic results. Close cooperation between the surgeon and members of the prosthetic team and extensive preoperative planning are prerequisite for success. Caution is required when implants are used in radiated areas. With accumulated experience, better patient selection and 3-D scan planning we have achieved high rates of success even for traditionally difficult cases. Our protocols, indications, techniques, analysis of results and cost related issues will be presented in detail.