Experience with prefabricated silicone implants for reconstruction in facially deformed patients.
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After being thoroughly tested on animals, a composite polymer material based on poly(2-hydroxyethyl methacrylate) and calf skin collagen has been allowed in a limited clinical trial in the Czech Republic. Up to now, the medical use of the biomaterial comprises implants for maxillo-facial surgery, i.e. augmentation of soft tissues (seven cases); reparation of fractured eye sockets (12 cases) and in special indications (two cases). The clinical results obtained so far are presented here as case reports. These preliminary results are very encouraging for a broader utilization of this type of biomaterial in the surgical fields of human medicine.
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The ability to penetrate skin permanently with posts of pure titanium has led to a dramatic breakthrough in the attachment of facial prostheses. The posts are attached to screws of titanium that are completely integrated in the underlying bone, without any intervening soft tissue. This precise and rigid fixation permits rehabilitation of patients with complex defects that would be otherwise untreatable.
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Endosteal implants are part of the reconstructive armamentarium used by head and neck surgical teams in cases of trauma or tumor ablation when inadequate residual anatomy prevents the fabrication of a traditional prosthesis. Three cases of implant supported prosthesis have been presented. Use of endosteal implants is an additional step toward functional reconstruction.
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In the paper, technical and tactical features while using reconstructive surgery and orthopedic therapy for liquidation of vast tissue defects in the adoral region and anterior mandibular portion are discussed. The importance of planning plastic operative procedures with optimum utilization of local tissues, especially in labioplasty, is substantiated, and some definite recommendations on using the pedicled graft tissue are given. A sequence of stages in replacement of soft tissues is described, as well as some features of elimination of the anterior mandibular defect by the iliac bone graft. It is for the first time that the importance of joint efforts of surgical and orthopedic specialists for providing a large scale complex therapy is emphasized, that may contribute to favourable anatomical, cosmetic and functional results in liquidation of vast tissue defects of the adoral region and anterior mandible.
Passage through the skin of an abutment anchored on an implant fixed on the underlying one constitutes a Permanent Percutaneous Connection of which the principal applications are stabilization of maxillofacial prosthesis (MFP) or bone anchored hearing aid (BAHA) support. The long-term outcome of a PPC depends on a variety of different parameters. We analyzed the influence of the most important factor: osseointegration.
The use of silicone implants to correct an acquired or congenital abnormality of the face involves the use of:--blocks of foam, though these retract and the volume implanted must therefore be overestimated.--compact blocks of elastomer, which tend to migrate and to produce inaesthetic bumps with disturbances in the vascularisation of the skin. The authors therefore had the idea of making "to measure" implants similar to breast implants: envelope of silicone elastomer enclosing a gel of chosen viscosity, absorbing forces applied to the envelope and therefore tending to prevent migration of the implant. The latter has dacron patches to facilitate its adherence to deep layers. This description of manufacturing methods and operative techniques, despite a short follow-up, reports encouraging results from which it is possible to determine the indications of this type of procedure.
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Trauma in the maxillary-facial region can causes loss of mucous, dental and bone tissues, particularly in cases of ballistic trauma in which the explosive force disperses the affected tissues to some distance. This circumstance greatly complicates functional rehabilitation, a process requiring not only the construction of prostheses to replace the lost dental structures, but also the reconstruction of the mucous and bone tissues that will support the prostheses. Using methods involving the formation of pedicle bone grafts and the use of implantation techniques, it has been possible to guarantee a satisfactory functional rehabilitation, and in addition good results from the point of view of appearance have been obtained.
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