Biomedical Engineering Reference
In-Depth Information
Fig. 22. Postoperative frontal view of the patient.
3. Conclusion
The facial prosthetic rehabilitation is a valid alternative when the conventional
reconstructive surgical techniques cannot be applied either because of the psychophysical
conditions of the patient or because of an excessive substance loss. The surgical technique
with prosthesis has several applications: malformative, infective, traumatic pathology,
results of oncologic surgery and radiant therapy, and particular clinical conditions such as
diabetes, leukemia, and others. The position of epithesis, as described in the literature5,6
and confirmed by the experience of our epithesis Center, is suitable in selected cases:
reconstruction with patient's own tissue, which is uneventful or impossible;
''Reversible'' intervention to operate clinically;
Surveillance in oncologic patients;
Advanced age or poor health; and poor tissues quality patient's choice
The described technique presents absolute limits such as osteolitic process, leukemia-
lymphoma, and terminal cirrhosis and relative limits such as ending life, hygienic
deficiency, and psychological refuse. Another important limit is the radiotherapy treatment;
the skeletal structure of persons who undergone radiotherapy react to the osteointegration
process with a lower success percent. It goes, in fact, to consider that if the combined
application of the chemotherapy and radiotherapy treatments with demolitive surgery
increases the life on average, the survival of the subject with surgical cancerYablation
increases, compromising the quality of life.7 The results of the osteointegration in patients
who have underwent chemotherapy are very variable, approximately 60% and 100%.8 In
accordance with the literature, we can affirm that the radiotherapy compromises the human
tissues, hindering the osteointegration process, when the irradiation is around 5000 Gy.
Besides the site and the radiation dose, the time existing between the radiant treatment and
the positioning of the implant is another determinant factor for the success of
osteointegration process. In particular, 6 months should exist between the term of the
radiant treatment and the positioning of the implant period in which the tissue alteration
produced by the radiations are in regression. According to the oncologic guideline, it would
