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PubMed1984

Maxillofacial prosthetics and the head and neck cancer patient.

The rehabilitation of cancer patients has been an important aspect of patient care in recent decades. Disabilities resulting from acquired surgical defects in the head and neck area frequently are corrected by using nonliving substitutes or prostheses. A number of specialists in the prosthetic reconstruction of head and neck patients, namely maxillofacial prosthodontists, have been trained over the past 20 years. Now more large metropolitan areas have these services available for cancer patients. In addition, pertinent research in materials and design has resulted in a whole array of possible prostheses that can be constructed to meet specific patient needs. Both the current state of the art in maxillofacial prosthetics and recent advances are highlighted in this paper. The areas covered are: extraoral (facial) prostheses, intraoral prostheses, implant prostheses, and treatment prostheses. The multidisciplinary nature of head and neck cancer patient rehabilitation is also reviewed.

Dentures↗
PubMed2003

Combined modality treatment of Ewing's sarcoma of the maxilla.

BACKGROUND: Primary bone sarcomas arising in osseous structures of the head and neck are rare. These tumors are often incompletely resected and treated with radiotherapy for local control. METHODS: We report a case of a 9-year-old girl with a maxillary Ewing's sarcoma. This patient was successfully treated with neoadjuvant chemotherapy followed by surgical resection and prosthetic reconstruction of the primary site. The surgical approach that was used consisted of a subtotal maxillectomy by means of a facial degloving approach, sparing the orbital contents and the inferior orbital rim and orbital floor. RESULTS: This approach produced excellent cosmetic, functional, and oncologic outcome. The patient remains without evidence of disease recurrence more than 4 years after surgery. CONCLUSIONS: This case illustrates a novel surgical approach to the resection of a maxillary Ewing's sarcoma and highlights the need for a multidisciplinary team approach to the management of head and neck sarcomas in children.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

Hard palate resection, microvascular reconstruction, and prosthetic restoration: a 14-year retrospective analysis.

BACKGROUND: This retrospective analysis was conducted to evaluate self-reported patient and clinician assessed functional outcomes of patients who have undergone ablative hard palate oncologic resection and microvascular free-flap reconstruction with and without maxillofacial prosthetic intervention. METHODS: All Head and Neck Surgery Service, Plastic and Reconstruction Surgery Service, and Dental Service charts and progress notes entered into the Institutional Health Care Information System of 57 patients who underwent hard palate resection and microvascular reconstruction at Memorial Sloan-Kettering Cancer Center (MSKCC) between January 1, 1988, and December 31, 2001 were reviewed retrospectively by three maxillofacial prosthodontists (BJB, JMH, IMZ). Prosthetic and nonprosthetic rehabilitation outcomes for each patient were reported as having normal; limited; or poor esthetics and function according to each prosthodontist's clinical evaluations; patients' self-perceptions; and feedback from friends, family members, and/or spouse. Speech intelligibility was determined in the same manner but reported as normal, hypernasal, and hyponasal. RESULTS: Most of the 26 prosthetically rehabilitated patients were reported as having normal esthetics (81%), normal function (77%), normal speech (96%), and were able to return to per oral full diets (81%) without any restrictions. CONCLUSIONS: Acceptable oral rehabilitation outcomes were reported for most prosthetically rehabilitated free-flap patients. Normal speech can be anticipated with a high degree of certainty, and a high percentage of prosthetically restored free-flap patients achieved per oral diets.

Adolescent↗
PubMed2003

Maxillary obturators: the relationship between patient satisfaction and speech outcome.

BACKGROUND: Patient satisfaction with a maxillary obturator has been studied in relation to extent of surgical defect, sociodemographic characteristics, scores on mental health inventories, and psychosocial adjustment to illness scales. However, review of the literature reveals limited study of the relationship between patient satisfaction with an obturator and clinical speech outcome measures. The purpose of this study is to relate patient satisfaction scores obtained by questionnaire with those obtained by means of clinical speech measurements. METHODS: Acoustical, aeromechanical, and perceptual measurements of speech were collected for 20 patients after receiving a definitive obturator. Patient satisfaction with their obturator was later measured with the Obturator Functioning Scale (OFS). RESULTS: Results reveal that poorer aeromechanical speech results were associated with patient-reported avoidance of social events, whereas lower speech intelligibility outcomes were related to overall poorer perception of speech function on the OFS. Several background patient characteristics were significantly related to several responses on the OFS and to the aeromechanical assessment outcomes. CONCLUSIONS: Results from instrumental assessments of speech seem to be informative regarding not only speech outcome but also a patient's satisfaction with the obturator. Consideration of background patient characteristics is important when interpreting both clinically obtained and patient-perceived outcomes.

Adolescent↗
PubMed1979

Evaluation of sunlight stability of polyurethane elastomers for maxillofacial use. II.

The effect of selected UV stabilizers on the stability of mechanical properties of a polyurethane material, Calthane ND2300, was evaluated. The addition of UV stabilizers prolonged the service life of the systems studied but did not achieve completely satisfactory results. The tensile strength and modulus of elasticity decreased after extended exposure to UV. The rate of decrease, however, was much less for the specimens with UV stabilizers. The polyurethane system that contains a mixture of a UV stabilizer and an antioxidant is considered to be the best of the groups tested, in terms of the percentage of retention of tensile strength and modulus of elasticity. It was also found that elongation at break was increased when the duration of UV aging was increased. This phenomenon occurred in all the systems, with or without UV stabilizers, and can be understood in terms of the concepts of the fragmentation of macromolecules that resulted from UV aging. The physical appearance in conjunction with mechanical property tests are needed to ensure the successful performance of any UV stabilizer.

Chemical Phenomena↗
PubMedDate not supplied

Auger electron spectroscopic studies of stainless-steel implants.

Auger electron spectroscopy together with scanning electron microscopy has been used to study the interface between stainless-steel implants and human tissue. The thickness and nature of the oxide layer on the implants have been found to depend on the location of the implants in the body. Before implantation, the oxide layer is about 50 A thick, consisting mainly of chromium oxide. For implants located in cortical bone the thickness of the interfacial oxide layer remains unaffected, while it increases by a factor of three to four on samples located in bone marrow. In both these cases calcium and phosphorus are incorporated in the oxides. Implants located in soft tissue have an interfacial oxide layer with a thickness of about one and one-half times that on an unimplanted sample. On these samples, calcium and phosphorus are not found, but occasionally sulfur is found in the oxide layer. All these samples originated from the oral region of the body; the reason for this finding, however, is not known at present time. The interactions between the implants and human tissues resulting in the observed changes of the implant surfaces are discussed in terms of oxygen pressures and metabolic activity.

Humans↗
PubMed2003

Development of a new poly(dimethylsiloxane) maxillofacial prosthetic material.

Maxillofacial prosthetic materials are used to rehabilitate patients suffering from acquired or congenital facial disfigurement. Silicone rubber materials [poly(dimethylsiloxane) rubbers] are the materials of choice. However, current formulations have inadequate mechanical properties, in particular, tear strength. The purpose of this study was to formulate a new poly(dimethylsiloxane) material with improved mechanical properties in comparison to commercially available materials. The formulations developed were based on condensation chemistry containing a hydroxy-end-blocked poly(dimethylsiloxane), hydrophobic silica filler, silane cross-linking agents, and a tin catalyst. The following parameters were varied in order to formulate improved materials: (a) bimodal polymeric mix (i.e., ratio of high- and low-molecular-weight polymers); (b) silica filler type and quantity. By varying these parameters a formulation was developed with a base polymer mix of 80%:20% high- to low-molecular-weight polymers into which 20% w/w filler was added. This formulation had a tear strength of 22.23 +/- 1.6 m N/mm compared to the commercial materials having tear strengths in the range 4.53-17.63 N/mm.

Biocompatible Materials↗
PubMed1988

Surgical considerations in maxillofacial prosthetic rehabilitation of the maxillectomy patient.

The radical maxillectomy performed for cancer of the paranasal sinuses has as its sequella some of the potentially most devastating functional losses in the field of head and neck oncology. The patient is left after surgical management with a defect that often prevents effective speech, deglutition, and mastication. This paper addresses the surgical considerations involved in the performance of a radical maxillectomy that can result in a favorable defect allowing subsequent optimal prosthetic rehabilitation of the patient.

Dentition↗
PubMed1993

Clinical experience with the Medpor porous polyethylene implant.

The Medpor porous polyethylene implant is a highly stable and somewhat flexible porous alloplast that has been shown to exhibit rapid tissue ingrowth into its pores. A total of 116 Medpor implants were placed in 70 patients over a four-year period. Implants were used for the chin, malar area, nasal reconstruction, ear reconstruction, orbital reconstruction, and the correction of craniofacial contour deformities. Many of these implants were placed in areas long considered problematic such as areas of thin soft tissue coverage, extensive scarring, and severe facial burns. Nine complications occurred including seven exposures, all of which occurred in areas of minimal soft tissue coverage. Because of the rapid vascularization of the implants, only two implants were removed, both from the columella. On the basis of our results, it is felt that the Medpor implant is an excellent alternative to existing implant materials. The implant is easy to shape; it is strong yet somewhat flexible; it is remarkably stable; and it exhibits tissue ingrowth into its pores.

Face↗
PubMed1989

Carcinoma of the face: aspects of tumor surgery and operative technique.

Free grafts, regional or myocutaneous flaps, microvascular tissue transfer and prosthetic rehabilitation are essential techniques required for modern reconstruction of defects in the head and neck. The myocutaneous flaps and the microvascular grafts especially offer a wide variety of tissues useful for reconstruction. It is our belief that a microsurgical team should be organized in every major ENT department for interdisciplinary cooperation depending on the local situation.

Basal Cell Carcinoma↗
PubMed1989

Effects of intraoral prosthetics on swallowing in patients with oral cancer.

The swallowing patterns of four patients with oral cancer with intraoral palate reshaping/lowering protheses were studied with and without their prostheses 3 months postoperatively. The prostheses resulted in improved swallow efficiency, increased duration of tongue contact to the pharyngeal wall, and improved speed of movement of the bolus from the valleculae to the pyriform sinus. These results emphasize the effects of the tongue on the pharyngeal as well as oral stage of the swallow.

Deglutition↗
PubMed1997

[Osteoinduction and -reparation].

Traumata, diseases, developmental deformities, and tumor resections frequently cause bone defects and atrophies. In general, three different mechanisms exist by which bone restoration can be achieved: (1) osteogenesis initiated by vital, osteoblastic cells of autografts; (2) osteoconduction (or creeping substitution); and (3) osteoinduction. The latter mechanism means the differentiation of pluripotent, mesenchymal-type cells (located in a recipient bed with strong regenerative capacity) into cartilage- and bone-forming progenitor cells under the influence of inductive bone morphogenetic proteins (BMPs). Some BMPs are physiologically included in low concentrations as organic components in bone tissue. They can diffuse from demineralized bone implants into the recipient bed and induce a differentiation into new bone tissue. Nine different BMPs have been isolated, characterized, and cloned. Some of these possess inductive properties and can initiate new bone formation in muscle tissue or in bone defects. In the future recombinant BMPs will be available in unlimited quantities. This will lead to completely new therapeutic concepts in reconstructive bone surgery.

Animals↗