Biomedical Engineering Reference
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performed to evaluate the bone and the soft tissues (Figs 10 and 11). After the clinical and
radiologic evaluation and the patient's agreement, 4 fixtures with corresponding abutments
were placed to support the anchor of the orbital epithesis. Nasal and orbital scars were
corrected by little flaps (Figs 12 and 13).
Clinical Case 4 F.M., a 61-year-old man, was referred with a nose extirpation for a
squamocellular cancer on the nasal tip, involving all nasal structure, 7 years before (Fig
14).The patient and his family declined any kind of reconstructive operative interventions,
so the patient underwent nasal movable prosthesis resting. Based on this situation,wehad
proposed tohimnasal removable prosthesis fixed with bone paranasal implants. For this
reason, the patient had undergone computed tomography scan of the head and neck to
study bone density and then 2 implants (4 mm) were placed. Follow-up at 3, 6, and 12
months with clinical visits and computed tomography scan revealed correct implant bone
integration (Fig 15).
Clinical Case 5 P.D., a 25-year-old woman, underwent surgical exenteration orbitae
because of retinoblastoma. The orbital cavity was restored by temporal muscle flap and
dermal-free flap. The patient underwent many reconstructive surgical treatments through
the use of fillers of biomaterials in frontal-temporal-cheek side, to reconstitute the
anatomic structure. She arrived in our observation with a moving orbital prosthesis (Fig
16). Clinical and radiologic examinations with three-dimensional computed tomography
were performed to evaluate the bone and the soft tissues. In accordance with the patient's
desire, 3 titanium fixtures with abutments were implanted to position the orbital
prosthesis (Fig 17).
Clinical Case 6 M.N., a 56-year-oldwoman,was referred with a partial auricular extirpation
for a basocellular cancer on the auricular left elice. The 2/3 superiors of the auricular
pavilion have been removed, with a partial deficit of the pavilion itself, which has caused
psychologic problems to the patient. In agreement with the patient, a second surgical
treatment was performed, modeling porous polyethylene peace with Nagata technique and
covered by temporoparietal fascia and dermo-epidermic flap to fill the auricular fault. The
biomaterial is not osteointegrated, so it has been removed. For such reason, in agreement
with the patient justified strongly to an immediate and no invasive aesthetic rehabilitation, 2
fixtures with abutments have been positioned that support auricular epithesis (Figs 18Y20).
The clinical and radiologic follow-up has shown a correct osteointegration of the implants
reaching psychologic stability of the patient.
Clinical Case 7 G.B., a 68-year-old woman, with epatotrasplanting and hepatitis C virus
has arrived in our observation with a necrotic lesion of the nasal tip resulting to
immunosuppressive therapy. She was referring to have noticed the appearance of the
necrosy and his progressive growth soon after the end of the therapy. The patient was
presenting exposure of the cartilaginous septum with erosion and cutaneous necrosy to
the nasal base (Fig 21). Because of the clinical conditions of the patient, a fixture's implant
has been made for the positioning of an epithesis in order to obtain an effective
reconstruction. Three fixtures with abutments have been applied. A fixture was removed
approximately 2 months after the installing because it is not integrated. The other 2
implants seemed to be well supplemented to allow the positioning of the bar that
supports the epithesis, but after 2months, 1 fixture has been removed because of missed
osteointegration. Therefore, it was decided to position some magnets to anchorage the
epithesis (Fig 22).
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