Biomedical Engineering Reference
In-Depth Information
2. Our experience
From May 2002 to December 2010, 415 facial prosthesis (1117 implants) have been
positioned in our Ephitesy Center. Defects were congenital (N = 142), consequent to trauma
(N = 95) and to demolitive surgery for malignant tumors (N = 95), and infection (N = 83). In
40 patients, implants were placed in previously irradiated areas. A total of 1117 titanium
implants were placed to support 187 auricular prostheses (bilateral in 29 cases), 126 orbital
prostheses, 89 nasal prostheses, and 13 complex midfacial prostheses.
Clinical Case 1U.G., 57-year-old patient, came to our observation with ethmoidal-
sphenoidal-orbital-hemimaxillary resection and reconstruction with pectoral flap
complicated in the same year by cerebral abscess of Eikenella. The patient was presenting
the absence of the skeleton structures and the soft tissues of the third middle of the right
emi-face with involvement of the nose and of the hard palate. The pectoral flap was causing
deficit in the movements of extent and left rotation of the head. As a consequence of a
cerebral ictus and for the detachment of septic carotid plaque embolus, the patient presented
with hemiplegy. Heavy deficits were furthermore present to deglutition and masticatory
function. The patient was arriving to our observation in order to restore the symmetry of
the face and the integrity of the hard palate and to recover the motility of the cervical stroke.
A surgical intervention of positioning of epithesis to rebuild the third middle and superior
of the face and of the revision of the pectoral flap was therefore planned. Four fixtures with
related abutments were placed to support anchoration for the midfacial prosthesis (Figs 3
and 4). In addition, a dental implant was placed in the right tuber maxillae to support a
palatal obturator (Fig 5). Finally, a surgical revision of the pectoral flap was performed. Ten
months after surgery, a palatal obturator was placed so that it was possible to remove
percutaneous endoscopicgastrectomy (PEG).
Clinical Case 2, R.A., a 40-year-old man affected by the Goldenhar syndrome, underwent
different reconstructive surgical treatments to restore the normal symmetry of the face soft
tissues. The patient came to our center presenting a facial asymmetry characterized by
atrophy of the right hemifacial soft tissues, associated to auricular agenesy and to esterior
uditive conduct and ''anteroposizione'' of the left auricular (Figs 6 and 7). Clinical and
radiologic examinations with computer tomography dental scan and Telecranium x-ray in 2
projections with cefalometric study were performed to evaluate the bone and the soft
tissues. After 1 month, a surgery has been performed to remove the residual cartilage
planted in the site corresponding to porous polyethylene prosthesis, positioned during the
previous surgical treatment. In addition, 2 fixtures with abutment have been positioned in
the right mastoid bone. Then the left auricular was positioned to reestablish the normal
structures of the face. In the same surgical time, 2 porous polyethylene prostheses were
implanted in the malar region to restore the sagittal diameter of the middle third of the face;
then 2 porous polyethylene prostheses were implanted in the mandibular angle, and 1
prosthesis was implanted on the mandibulae, to restore the transversal and sagittal diameter
of the third inferior of the face. After 3 months, an auricular prosthesis associated to
polyacrylamide implant was positioned in bilateral preauricular area (Figs 8 and 9). Clinical
and radiologic follow-up demonstrated a good integration of implants and the biomaterial
Clinical Case 3 A.S., a 51-year-old man affected with posttraumatic anophthalmia, sequelae
of left orbit exenteration and reconstruction of the eye socket with a titanium mesh covered
by dermo-adipose flap, came to our observation with anophthalmia O.S. and fibrotic scars.
Clinical and radiologic examinations with three-dimensional computed tomography were
