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[Maxillary prosthesis for better QOL--early setting and faster construction of maxillary prosthesis].

The maxillofacial prosthesis (MFP) is well accepted as one of the modalities to ameliolate the postsurgical crippling in the patients with maxillary malignancy. In this report, we analyzed 55 primary cases of MFP out of 100, from July, 1981 to July, 1987 in terms of the time of start after operation, and the duration and procedure of the MFP-making. MFP-making set about within 4 weeks in 35% of patients, 8 weeks in 25%, 12 weeks in 22%, and more than 12 weeks in 18%. The completion of MFP-making averaged 10 days. As a result of simplifying of MFP-making, we shortened a period requiring MFP-making within 3 days in recent 10 cases. There were no adverse effects of early wear of MFP after operation. We believe that early wear of MFP after operation improve the quality of life of patients with maxillary malignancy and considered that wear of MFP is not the completion of treatment, but is one of the procedures of treatment for the patients undergone maxillectomy.

Adolescent↗

Residual facial disfigurement after the ablative surgery of a lachrymal gland carcinoma: a clinical report of the prosthetic rehabilitation.

Facial disfigurement after ablative surgery of a massive adeno-carcinoma of the lachrymal gland is described. A rehabilitation with a maxillofacial prosthesis was proposed to restore the aesthetic appearance of the patient without inserting craniofacial implants. Retention of a maxillofacial prosthesis, that is not anchored to implants, depends on the use of adhesives or on mechanical devices like glasses. This clinic report describes a residual anatomic defect which allowed for the double choice of wearing the facial prosthesis both with or without glasses. A retentive backside of the prosthesis was developed to engage the facial defect undercuts, which enhanced retention when the patient used the skin glue without glasses. A unique foam silicone was utilized to reduce the weight of the prosthesis and to permit its retention only by skin adhesive.

Adenocarcinoma↗

[Maxillo-facial prostheses: an issue in public health].

BACKGROUND: Acquired or congenital loss of structure can cause facial deformity. This can destroy identity and lead to certain forms of exclusion. Surgical and sometimes prosthetic reconstruction is required. The Maxillofacial Prosthesis (P.M.F) can be defined as the art and science of artificial reconstruction of facial bones. There is a continual increase in patient demand for this type of prosthesis with the development of new materials, methodologies and techniques. METHODS: In Toulouse, the Rangueil University Hospital houses a maxillofacial prosthesis consultation facility linked to the Odontology Service. An exhaustive descriptive study carried out retrospectively on the basis of the files of all patients examined between July 1996 and July 2002 will provide us with an understanding of patient characteristics and also enable us to quantify the level of satisfaction of requirements for rehabilitation of these losses of maxillofacial structure. RESULTS: 215 patient files were processed between July 1996 and July 2002. Separating the patients by sex shows a male prevalence of 66%. An analysis of variations between male and female patients for different aetiologies shows that tumour pathologies are more common in men and that this distinction is all the more marked as regards traumatic facial injuries and in particular suicide attempts. In total, 401 maxillofacial prostheses were carried out, including 116 facial epitheses (new prostheses or renewal of prosthesis). CONCLUSION: Loss of facial structure, whatever its aetiology constitutes a real public health issue. The maxillofacial prosthesis will allow cancer monitoring of the site while at the same time offering out patient treatment. Above and beyond its crafted or empirical aspect, it should find its place in medicine thanks to the overall scope of the rehabilitation that it can offer from both an aesthetic point of view but also a the psychological one, but above all from a functional perspective.

Face↗

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

The evaluation of the efficiency of polymer additives with special emphasis on uv absorbers and antioxidants in polyurethane elastomers has been completed. Aliphatic polyurethanes were chosen for this study because their properties closely relate to the requirements of maxillofacial prosthesis. The polyurethane elastomers were either synthesized by ourselves or formulated according to the manufacturer's recommendation. Eleven different types of uv absorbes, coupled with one antioxidant, were incorporated into the polyurethane systems. The Atlas twin-lamp carbon arc Weatherometer was used as the source of uv. The samples were periodically withdrawn for examination of yellowing and tackiness. It was found that, although the incorporation of uv stabilizers enhanced the uv resistance of polyurethanes, the problem of tackiness resulting from uv aging was not solved satisfactorily. The phenomenon of yellowing, however, was significantly improved, mainly due to the aliphatic structure of polyurethanes. The most promising uv absorbers are Tinuvin 770 and the combination of Tinuvin 328, ZnO, and an antioxidant. Their effectiveness in other polyurethane systems is not known and further research is underway to explore this field. Hopefully, these findings will greatly assist the successful application polyurethane elastomers in maxillofacial prosthesis.

Biocompatible Materials↗

Use of the infra hyoid musculo-cutaneous flap in soft palate reconstruction.

AIMS: To review a series of 23 consecutive patients with squamous cell carcinomas arising from oropharynx who underwent infra hyoid musculo-cutaneous flap reconstruction including soft palate in alternative to free radial forearm flap or maxillofacial prosthesis. Post operative radiotherapy was performed for all patients. RESULTS: Every reconstruction healed quickly without major wound complications. The functional results evaluated by speech and swallowing capacities, were good for 17 patients, fair for 4 patients and bad for 2. CONCLUSIONS: The infra hyoid musculo-cutaneous flap is a versatile, reliable and convenient flap suitable for repairing small and medium sized defects; it can be used in combination with other flaps, and in selected cases obviates the need for a microvascular free radial forearm flap or maxillofacial prosthesis.

Adult↗

Home care maintenance protocol for ear prostheses.

Hygienic home care maintenance for patients who have received a maxillofacial prosthesis is very important in order to secure a long-term success of a facial rehabilitation. Craniofacial implant therapy requires a specific protocol to care for the peri-implant tissues and material used for the prosthesis. This article presents the maintenance and care protocol for proper follow-up management of a maxillofacial ear prosthesis. Home care methods for the prosthesis hygiene are described, including: the insertion and the disconnection of the ear prosthesis, hygiene of the bar abutments before and after postdefinitive connection to the craniofacial fixtures, washing of the device, professional follow-up.

Humans↗

Designing a prosthesis to simulate the elastic properties of skin.

The materials which are currently used to make maxillofacial prostheses are far from ideal and require considerable improvement with respect to their ability to mimic the properties of skin. To this aim, a novel three-layered maxillofacial prosthesis has been designed consisting of a silicone rubber base layer, an inner gel layer and an outer polymeric coating (to simulate the elastic properties of skin). The aim of the work in this study was to develop the inner silicone gel layer which displays similar properties to facial skin. Through the use of unique linear extensometry testing, in vivo measurements for the Area under the Curve (AUC), Hysteresis (viscoelastic behaviour), Fmax (maximum force), F30 and F60 (force after 30 and 60 seconds) were obtained from the facial skin of 15 volunteers. The results were used as a basis for developing silicone gel formulations for the inner layer, to closely resemble those of facial skin. Gels were made by the addition of both low and high molecular weight unreactive silicone fluids and were further tested for compression, water absorption and dehydration. Testing showed that a gel has been produced that closely simulates the elastic properties of skin when bonded to a base silicone rubber layer. Further testing will need to deduce whether these properties will be affected by the addition of the outer polymeric layer.

Biocompatible Materials↗

Implant prosthodontic procedures for a completely edentulous patient with cleft palate.

Prosthodontic treatment of the edentulous cleft palate patient presents the dentist with numerous challenges for achieving a satisfactory result for the patient. A technique is described for prosthodontic rehabilitation of a completely edentulous cleft palate patient using bone augmentation procedures, root-form dental implants, and a removable maxillofacial prosthesis. Dental implants may improve prosthesis retention, stability, and occlusal function when used in carefully selected cases.

Adult↗

[Retention and rehabilitation of complex maxillofacial defects based on bar-clip and stud attachment].

PURPOSE: To evaluate the application of precise attachment in restoration of complicated maxillofacial defect. METHODS: A framework with bar-clip and stud attachment was designed and fabricated. Maxillofacial prosthesis with this framework was applied to treat a patient with defects of nose, entire upper lip and the corresponding maxillofacial areas. The retention force was tested with Universal Testing Device. RESULTS: After treatment, the patient got a better appearance, normal function of mastication and clear pronunciation. The dislodgement test showed the retention force was 40N. CONCLUSION: Application of precise attachment in complicated maxillofacial defects can get satisfactory result.

Humans↗

Color stability and colorant effect on maxillofacial elastomers. Part I: colorant effect on physical properties.

STATEMENT OF PROBLEM: The average clinical life span of a maxillofacial prosthesis is approximately 6 months, at which point it needs to be refabricated, mainly because of degradation of the color and physical properties of the prosthesis. PURPOSE: This first part of a 3-part study evaluated the effect of coloring agents on the physical properties of maxillofacial elastomers. METHODS AND MATERIAL: Five dumbbell-shaped and 5 trouser-shaped specimens were fabricated for each of the combinations of the 3 elastomers (Silastic medical adhesive type A, Silastic 4-4210, and Silicone A-2186) and 6 colorants (dry earth pigments, rayon fiber flocking, artist's oil paints, kaolin, liquid cosmetics, and no-colorants), for a total of 180 specimens. Evaluations of hardness and tear strength were made with the trouser-shaped specimens. Evaluations of the ultimate tensile strength and the percentage elongation were made with the dumbbell-shaped specimens. A within elastomer analysis compared the 6 colorants using a 1-way analysis of variance for each of the 4 physical properties. When significant differences were observed, the Student-Newman-Keuls multiple range test was used to identify differences between groups at a significance level of.05. RESULTS: Physical properties of maxillofacial elastomers were changed by the incorporation of coloring agents. Dry earth pigments, kaolin, and rayon flocking acted as a solid filler without bonding to the Silicone, and artists' oils and liquid cosmetics acted as a liquid phase without bonding to the silicone matrix. CONCLUSION: No clearly superior colorant-elastomer combination was demonstrated in all the tests in this study.

Analysis of Variance↗

Usefulness of dental implants in maxillofacial reconstruction.

Fabricating maxillofacial prosthesis can be challenging. Placement of implants can have a dramatic effect on the stability and retention of the prosthesis in patients. This article provides clinical retrospective analysis of osseointegrated implants used for maxillofacial reconstruction. Patient charts and radiographs were reviewed to determine implant status, stability of prosthesis, and masticatory and speech function. Of the 104 implants placed, there were 4 implant failures. The overall survival rate for implants in this patient population was 96.1%. The stability of maxillofacial prostheses demonstrated significant improvement after anchorage to implants. Implant-borne maxillofacial prostheses are better stabilized and retained than non-implant-borne prostheses, providing an improved quality of life to patients requiring prosthesis rehabilitation of maxillofacial defects.

Adult↗

Ultraviolet radiation-induced color shifts occurring in oil-pigmented maxillofacial elastomers.

STATEMENT OF PROBLEM: Oil-based pigments are added to a maxillofacial prosthesis either as base colorants present within the elastomer or as surface tints that are painted on with an adhesive. Color stability of the pigments and pigmented prosthetic materials on exposure to ultraviolet radiation are unknown. PURPOSE: This study measured DeltaE* color changes caused by ultraviolet radiation for materials colored with 5 oil pigments, applied either as base colorants (intrinsic) or surface tints (extrinsic) to a silicone elastomer. MATERIAL AND METHODS: One of 5 oil pigments was added to polydimethyl siloxane disks to serve as a base colorant (0.2 weight percent present throughout a 2 mm thick disk) or as a concentrated surface tint (2.0 weight percent concentrated in upper 0.3 mm thickness). Pigmented disks, along with pigment-only and elastomer-only control disks, were exposed to ultraviolet radiation for 400, 600 and 1800 hours. DeltaE* color changes were measured at baseline and for each time interval. RESULTS: Control samples underwent minimum color changes after 1800 hours (DeltaE* </= 2.0), whereas samples containing oil pigments as base colorants demonstrated a wide range of susceptibility to ultraviolet radiation, with the greatest changes occurring for pigments cadmium red, cadmium yellow, and yellow ochre (7.1 </= DeltaE* </= 9.4). Elastomers coated with the same oil pigments as concentrated surface tints demonstrated significantly lower color shifting after 1800 hours of radiation exposure (maximum DeltaE* = 4.2, P </= .05). CONCLUSION: Customizing a prosthesis with an oil-pigmented surface tint may reduce the incidence of color change, provided a sufficient amount of pigment is present.

Coloring Agents↗