Influence of maxillary obturator prostheses on facial morphology in patients with unilateral maxillary defects

The Submental Artery Island Flap for Reconstruction of Acquired Maxillary and Palatal Defects After Tumor Ablation: Reversed Flow Versus the Extended Antegrade Design

BACKGROUND

The submental artery island flap (SIF) is a valid option for palatal reconstruction. However, the main limitation for its application for palatal defects is the arc of rotation. A novel modification for tunneling of the antegrade design of SIF that allows a compliant easy reach to the defect is described.

METHODS

Eighteen patients with Brown class II maxillectomy defects were included. Reconstruction started using reversed flow SIF in five patients then shifted to the modified antegrade technique in the remaining patients. Speech, swallowing, chewing, other parameters, and oncological outcomes were assessed.

RESULTS

The reversed flow group has high complications. In the antegrade SIF group, all flaps survived. One developed marginal flap necrosis that healed spontaneously. The follow-up period ranged from 1 to 4.2 years with favorable functional outcome and with no evidence of recurrence.

CONCLUSION

The modified SIF antegrade design is a reliable option for palate reconstruction that allows favorable functional and oncological outcome.

Comparison of the accuracy of different handheld-type scanners in three-dimensional facial image recognition

PURPOSE

Handheld-type scanners are widely used in clinical practice. This study examined the accuracy of handheld-type scanners using plaster statues to assess their performance in facial recognition.

METHODS

Twelve 4-mm zirconia balls as measuring points were attached to the facial portions of three types of plaster statue. Six digital facial images of each plaster statue were obtained using one of the following five handheld-type scanners: Artec Eva, Artec Spider, Bellus 3D FaceApp, SNAP, and Vectra H1. Four-millimeter spherical objects were manually placed at the measurement points on the scanned data generated using computer-aided design software and coordinate positions were measured using a contact-type high-resolution three-dimensional measurement device. Consequently, the discrepancy between the distance measured using the contact-type device and that measured using the handheld-type scanner was calculated. The scanning time, processing time, and deviation of the distance between the measuring points were analyzed using two-way analysis of variance and t-test with Bonferroni correction.

RESULTS

The scanning and processing times ranged from 15.2 to 42.2 s and 20.7 to 234.2 s, respectively. Overall, 97% of all measured distances by Spider were within ±1.00% deviation; 79%, Vectra; 73%, Eva; 70%, Bellus; and 42%, SNAP.

CONCLUSIONS

The performance of handheld-type scanners using plaster statues varied among the different scanners. The scanning time of Eva and the processing time of Bellus were significantly shorter than those of other scanners. Furthermore, Spider exhibited the best accuracy, followed by Eva, Vectra, Bellus, and SNAP.

Obturator Prosthesis Rehabilitation after Maxillectomy: Functional and Aesthetical Analysis in 25 Patients

The number of patients undergoing a surgical resection of the maxilla for oncological reasons is constantly increasing, the most common complication of which remains the communication between oral and nasal cavities. On the basis of data arising from the literature regarding the treatment options of maxillary oncological post-surgical defects, obturator prosthesis remains the most used worldwide. We studied 25 patients (with at least 1-year follow up) rehabilitated by obturator prosthesis after maxillary resection leading to oro-nasal communication, providing data on the objective/subjective evaluation of such rehabilitation and mastication performance measured by a two-color chewing gum test. The type of defect was classified according to the classification system proposed by Aramany. Among the patients in our study, 72% rated a higher score for either stability and retention than for aesthetic appearance, as confirmed by the Kapur score rated by clinicians. The two-color chewing gum test shows similar results as only one patient had insufficient chewing function. Interestingly, we found no correlation between the masticatory function and residual denture, confirming that the maxillary obturator remains a predictable solution in such patients regardless of the anatomical alterations following surgery.

Age- and Sex-Related Morphometric Changes and Asymmetry in the Orbito-Zygomatic Region

ABSTRACT

The aims of this study were to obtain cephalometric data of orbito-zygomatic skeleton using CT axial images and to determine the presence of sexual dimorphism, normal range of facial asymmetry, and the age-related changes.This study used data from 315 CT scan series of skeletally normal subjects (159 males and 156 females) between the ages of 18 to 90. Two different levels of axial sections were used. In total, 11 measurements were performed and 5 of them were bilateral.The mean values and standard deviations were calculated. Gender and age related changes and asymmetry degree were investigated.Mean values of measurements except left medial orbital wall length, right and left medial orbital wall protrusion, right and left lateral orbital wall angle were significantly larger in males for all age groups. Majority of the measurements was formed by the individuals with larger right side. Similar tendencies were observed for craniofacial asymmetry in both sexes and in different age groups. There were no significant craniofacial asymmetries between age and gender groups in terms of the cephalometric measurements. Mid-interorbital distance had a negative correlation (r = -0.11 and P = 0.043) and interzygomatic buttress distance had a positive correlation (r = 0.15 and P = 0.005) with age.Morphological properties such as sexual dimorphism, symmetry, age related changes are important parameters especially for plastic surgery discipline. The authors hope the data can be helpful in diagnosis and surgical treatment of craniofacial diseases, estimating the prognosis and preparation of the facial prosthesis.

Effect of submental flap reconstruction versus obturator rehabilitation after maxillectomy on quality of life: a randomized clinical trial

The surgical removal of a maxillary tumour will result in an oronasal communication, which can negatively affect the patient's life and daily functions. Following maxillectomy, the defect can be treated with a prosthetic obturator or microvascular flap. However, the gold standard technique remains controversial. The aim of this study was to evaluate and compare quality of life (QoL) outcomes of submental island flap versus maxillary obturator reconstruction after partial maxillectomy. Sixty patients indicated for maxillectomy were allocated randomly to two equal-sized groups. Control group patients underwent reconstruction with a surgical obturator, while intervention group patients underwent submental island flap reconstruction. Patient QoL was evaluated at the 6-month follow-up using the University of Washington Quality of Life Questionnaire. Statistically significant differences in QoL were found between the two groups. Chewing (P = 0.034), swallowing (P < 0.001), speech (P = 0.009), taste (P = 0.04), mood (P = 0.01), and anxiety (P = 0.003) domains showed a statistically significant improvement in the submental group compared to the obturator group. However, the obturator group showed a greater improvement in appearance (P < 0.001). The masticatory function scores in the obturator group were significantly higher after obturator rehabilitation (P < 0.001). In conclusion, this study found that submental flap reconstruction provided better function and QoL than the obturator. This reconstruction was associated with less pain and better pronouncing of words, chewing, swallowing food, and psychosocial adjustment.

The role of non-contact digitizer in geometrical evaluation of mandibular prostheses effect on facial asymmetry of mandibulectomy patients

PURPOSE

This study sought to geometrically evaluate the effect of a mandibular prosthesis on facial asymmetry in patients with one of two different types of mandibulectomy defect.

METHODS

Facial data from 20 participants (9 men and 11 women; mean age 68 years) with either a reconstructed segmental defect (segmental group,n = 10) or a marginal mandibulectomy defect (marginal group, n =10) were acquired with a non-contact three-dimensional (3D) digitizer. Facial asymmetry was evaluated by superimposing a facial scan onto its mirror scan using 3D evaluation software. Facial scans with and without the mandibular prosthesis in place were also superimposed to evaluate the effect of the mandibular prosthesis.

RESULTS

Facial asymmetry differed significantly between subjects with and without the prosthesis in the segmental group (P = 0.005) but not in the marginal group (P = 0.16). There was no significant difference in the effect of the prosthesis on facial appearance between the two groups (P = 0.052). The ratio of 3D deviation of facial asymmetry without the prosthesis and in the mirror scan with the prosthesis differed significantly between the two groups (P = 0.01).

CONCLUSIONS

Placement of a mandibular prosthesis has a notable effect on facial asymmetry in patients with segmental mandibulectomy defects.

Obturator prostheses versus free tissue transfers: A systematic review of the optimal approach to improving the quality of life for patients with maxillary defects

STATEMENT OF PROBLEM

Patient perspectives on the treatment options for maxillary defects, which include free tissue transfers or obturator prostheses, may help eliminate current uncertainty as to the best choice of treatment plan.

PURPOSE

The purpose of this systematic review was to evaluate the quality of life (QoL) of patients with maxillary defects who had undergone restoration with obturator prostheses and/or free tissue transfers.

MATERIAL AND METHODS

A systematic search of Medline/PubMed and Web of Science databases for articles published before April 2015 was performed by 2 independent reviewers. A manual search of articles published from January 2005 to March 2015 was also conducted. Studies published in English that evaluated the QoL in patients with head and neck cancers were included. The Cohen kappa method was used to calculate inter-reviewer agreement.

RESULTS

Ten studies were included. The University of Washington Head and Neck Questionnaire (UW-QOL) was most commonly used to measure QoL. The majority of maxillary defects were Class IIa-b. Two studies reported that the global QoL for patients with obturator prostheses is equivalent to or even better than that of other chronic disease populations. One study revealed no significant difference in QoL when the 2 treatment options were compared.

CONCLUSIONS

The limited data indicate that the QoL of patients treated with obturator prostheses and that of patients free of tumors is similar. Well-designed clinical studies are necessary to draw definitive conclusions about how obturator prostheses compare with free tissue transfers in terms of affecting patient QoL.