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 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.
.
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.
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