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Jablonski RY, Veale BJ, Coward TJ, Keeling AJ, Bojke C, Pavitt SH, Nattress BR. Outcome measures in facial prosthesis research: A systematic review. J Prosthet Dent 2021; 126:805-815. [PMID: 33581868 PMCID: PMC8664412 DOI: 10.1016/j.prosdent.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 11/25/2022]
Abstract
STATEMENT OF PROBLEM Facial prosthesis research uses a wide variety of outcome measures, which results in challenges when comparing the effectiveness of interventions among studies. Consensus is lacking regarding the most appropriate and meaningful outcome measures to use in facial prosthesis research to capture important perspectives. PURPOSE The purpose of the systematic review was to identify and synthesize outcome measures used in facial prosthesis research. MATERIAL AND METHODS Electronic searches were performed in 11 databases (including nonpeer-reviewed literature). The citations were searched, and expert societies were contacted to identify additional studies. Inclusion criteria comprised studies of participants with facial defects who required or had received prosthetic rehabilitation with an external facial prosthesis. Exclusion criteria comprised participants with ocular prostheses, case reports, case series with fewer than 5 participants, laboratory-based studies, and studies published before 1980. Study selection was performed independently by 2 reviewers. Discrepancies were resolved through discussion or by a third reviewer. Outcome measures were synthesized with a categorization approach based on the perspective, theme, and subtheme of the outcome measures. Quality assessment was performed with an appraisal tool that enabled evaluation of studies with diverse designs. RESULTS Database searching identified 13 058 records, and 7406 remained after duplications were removed. After initial screening, 189 potentially relevant records remained, and 186 full texts were located (98% retrieval rate). After full-text screening, 124 records were excluded. Citation searches and contact with expert societies identified 4 further records. In total, 69 articles (grouped into 65 studies) were included. Studies were categorized as per the perspective of their outcome measures, with the following findings: patient-reported (74% of studies), clinical indicators (34%), clinician-reported (8%), multiple viewpoints (6%), and independent observer-reported (3%). Patient-reported outcome measures included tools to assess satisfaction, quality of life, and psychologic health. Variability in the choice of outcome measures was evident among the studies, with many self-designed, unvalidated, condition-specific questionnaires reported. A greater number of outcome measure themes emerged over time; themes such as service delivery and health state utility have recently been evaluated. CONCLUSIONS Over the past 40 years, facial prosthesis research has focused on patient-reported outcome measures. Outcome measures relating to other perspectives have been used less frequently, although new themes appear to be emerging in the literature. Future research should use outcome measures with appropriate measurement properties for use with facial prosthetics.
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Affiliation(s)
- Rachael Y Jablonski
- Specialty Registrar in Restorative Dentistry and NIHR Doctoral Fellow, Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, UK.
| | - Benjamin J Veale
- Medical Student, Hull York Medical School, University of York, York, UK
| | - Trevor J Coward
- Reader and Honorary Consultant in Maxillofacial and Craniofacial Rehabilitation, Academic Centre of Reconstructive Science, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Andrew J Keeling
- Clinical Associate Professor, Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, UK
| | - Chris Bojke
- Professor of Health Economics, Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Sue H Pavitt
- Professor of Translational and Applied Health Research, Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK
| | - Brian R Nattress
- Clinical Professor and Honorary Consultant, Department of Restorative Dentistry, School of Dentistry, University of Leeds, Leeds, UK
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Implant prognosis in irradiated versus non-irradiated nasal, orbital and auricular sites. Int J Oral Maxillofac Surg 2019; 49:636-648. [PMID: 31668784 DOI: 10.1016/j.ijom.2019.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 07/06/2019] [Accepted: 09/12/2019] [Indexed: 01/08/2023]
Abstract
The purpose of this systematic review was to evaluate implant survival in irradiated nasal, auricular, orbital sites and to compare them with non-irradiated respective sites. Four electronic databases and seven related journals were searched until December and March 2018, respectively. A total of 7892 articles were identified, 18 of which were included in this review; one non-randomized clinical trial, two prospective cohort, eight retrospective cohort and seven cross-sectional studies. Using the ROBIN-I Cochrane tool for risk assessment, 13 studies were judged at serious, one at moderate and four at critical risk of bias. Thirteen were included in 18 meta-analyses, the results of which showed a significant difference between irradiated and non-irradiated sites, favouring non-irradiated with risk ratio (RR) = 0.93, 95% confidence interval (CI) 0.89-0.97, P=0.001. Comparisons among nasal, auricular and orbital sites revealed no significant differences, whether in irradiated or non-irradiated patients at P<0.05. Hence, it was concluded that, within the limitations of this review, survival of craniofacial implants is negatively affected by radiotherapy, especially in orbital sites. Level of evidence is moderate. Therefore, further prospective cohort studies with calculated sample sizes, restricted or properly managed confounders and no deviations from intended interventions might produce different results.
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Dings JPJ, Merkx MAW, de Clonie Maclennan-Naphausen MTP, van de Pol P, Maal TJJ, Meijer GJ. Maxillofacial prosthetic rehabilitation: A survey on the quality of life. J Prosthet Dent 2019; 120:780-786. [PMID: 30414646 DOI: 10.1016/j.prosdent.2018.03.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 03/18/2018] [Accepted: 03/19/2018] [Indexed: 11/30/2022]
Abstract
STATEMENT OF PROBLEM Maxillofacial prostheses, especially those supported by endosseous implants, are regarded as a viable, secure treatment for the reconstruction of facial defects to restore quality of life. The long-term quality of life of patients treated with facial prostheses with different retentive systems is unclear. PURPOSE The purpose of this clinical study was to assess the long-term quality of life of patients treated with facial prostheses with different retentive systems over a 14-year period at a Dutch oral and maxillofacial surgery unit. MATERIAL AND METHODS A total of 66 patients with facial prostheses were inventoried and categorized based on anatomic location and type of retention. A 62-item questionnaire was designed to survey the daily prosthetic use, care, quality, durability, longevity, and reliability of retention. Furthermore, issues relating to general satisfaction, self-image, and socialization frequency were addressed. RESULTS Completed validated questionnaires were returned by 52 patients. Of the prosthetic replacements, 23% (n=12) were orbital, 33% (n=17) nasal, and 44% (n=23) auricular prostheses. The survey showed that a prosthetic reconstruction led to high satisfaction scores with regard to wearing comfort, anatomic fit, color, and anatomic form. A significant difference was shown for implant-retained facial prostheses, which provided enhanced retention and increased ease of placement and removal (Fisher exact test P=.01 and P=.04). Patients with nasal prostheses were less satisfied with the junction of their prostheses to the surrounding soft tissue and more aware of others noticing their prosthetic rehabilitation. Patients with auricular defects were less embarrassed (P=.01) by their prostheses. Although auricular prostheses were less frequently cleaned (P=.01), no significant difference was found in minor soft tissue complications between different anatomic locations and the various retentive systems. CONCLUSIONS Implant-retained prostheses have advantages over adhesive-retained prostheses in terms of ease of handling. However, improvements in prosthetic material properties, including color stability and durability, are needed to increase the longevity of facial prostheses.
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Affiliation(s)
- Jeroen P J Dings
- Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
| | - Matthias A W Merkx
- Professor, Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | - Pascal van de Pol
- Maxillofacial Prosthodontist, Department of Dentistry, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Thomas J J Maal
- Coordinator 3D Laboratory, Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Gert J Meijer
- Professor, Department of Implantology and Periodontology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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Conical Modification of Forearm Free Flaps for Single-Stage Reconstruction After Total Orbital Exenteration. J Craniofac Surg 2017; 28:e767-e769. [DOI: 10.1097/scs.0000000000003944] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hofstede TM, Jacob RF, Montgomery P, Wesley P. Surgical preparation of nasal defects to enhance the implant-retained facial prostheses: A case report. Head Neck 2016; 39:E4-E11. [PMID: 27618726 DOI: 10.1002/hed.24574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/26/2016] [Accepted: 07/25/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Skin cancers requiring nasal resection may be surgically reconstructed and/or prosthetically reconstructed. Singular surgical reconstruction may be ideal for smaller defects in which the nasal bone and cartilaginous portions of the nose are maintained, but surgical reconstruction falls short of providing acceptable aesthetic results for more extensive nasal defects. Prosthetic rehabilitation, or a combination of surgical and prosthetic rehabilitation, is more appropriate for larger defects, but prosthesis retention can be challenging when adhesives are required on adjacent mobile and secreting skin. METHODS We report 2 cases of patients with extensive nasal defects who were successfully rehabilitated with nasal prostheses. The nasal defects were surgically optimized with immediate preparation of the surgical margins, placement of a split-thickness skin graft (STSG) within the nasal cavities and exposed maxillary sinuses, and immediate placement of osseointegrated implants. RESULTS Excellent prosthetic retention can be achieved without the need for adhesives. A skin graft-lined defect has minimal secretions and allows for improved defect cleansing. CONCLUSION The success of a nasal prosthesis depends on appropriate surgical management of the defect, and, thus, collaboration between the various surgical and prosthetic teams is essential. © 2016 Wiley Periodicals, Inc. Head Neck 39: E4-E11, 2017.
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Affiliation(s)
- Theresa M Hofstede
- Department of Head and Neck Surgery, Section of Oral Oncology and Maxillofacial Prosthodontics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Rhonda F Jacob
- Department of Head and Neck Surgery, Section of Oral Oncology and Maxillofacial Prosthodontics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Patricia Montgomery
- Department of Head and Neck Surgery, Section of Oral Oncology and Maxillofacial Prosthodontics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peggy Wesley
- Department of Head and Neck Surgery, Section of Oral Oncology and Maxillofacial Prosthodontics, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Chrcanovic BR, Nilsson J, Thor A. Survival and complications of implants to support craniofacial prosthesis: A systematic review. J Craniomaxillofac Surg 2016; 44:1536-1552. [PMID: 27591092 DOI: 10.1016/j.jcms.2016.07.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 06/17/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To assess the survival rate of craniofacial implants (CIs) to support facial prosthesis/epithesis and the prevalence of surgical/biological complications based on previously published studies. METHODS An electronic search was undertaken in March/2016. Only studies with a minimum of 5 patients were included. Untransformed proportions of implant failures for different regions were calculated. A meta-analysis evaluated the influence of radiotherapy on the failure rates. A meta-regression was performed considering the follow-up period as covariate. RESULTS Seventy publications included 2355 patients and 8184 CIs (545 failures). The probability of a failure was 5.5% for all CIs (95%CI 4.5-6.5, P < 0.001), 1.2% for CIs in the auricular region (95%CI 0.8-1.5, P < 0.001), 12.2% for the nasal region (95%CI 9.0-15.5, P = 0.017), and 12.1% for the orbital region (95%CI 9.3-15.0, P < 0.001). Radiotherapy statistically affected the CIs rates (OR 5.80, 95%CI 3.77-8.92, P < 0.00001). There was no statistically significant influence of the follow-up time on the proportion of implant failures (P = 0.814). Soft tissue adverse reactions were the most common complications. CONCLUSIONS Implants placed in the auricular region have a lower probability of failure than those in the nasal and orbital regions. Soft tissue adverse reactions were the most common complications. Radiotherapy significantly affected the CIs failure rates.
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Affiliation(s)
- Bruno Ramos Chrcanovic
- Department of Prosthodontics, Faculty of Odontology (Head: Dr. A. Wennerberg, DDS, PhD), Malmö University, Carl Gustafs väg 34, SE-205 06, Malmö, Sweden.
| | - Johanna Nilsson
- Department of Oral and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark; Department of Surgical Sciences, Oral and Maxillofacial Surgery (Head: Dr. Per Hellman, MD, PhD), Uppsala University, Uppsala, Sweden.
| | - Andreas Thor
- Department of Surgical Sciences, Oral and Maxillofacial Surgery (Head: Dr. Per Hellman, MD, PhD), Uppsala University, Uppsala, Sweden.
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Nemli SK, Aydin C, Yilmaz H, Bal BT, Arici YK. Quality of life of patients with implant-retained maxillofacial prostheses: a prospective and retrospective study. J Prosthet Dent 2013; 109:44-52. [PMID: 23328196 DOI: 10.1016/s0022-3913(13)60010-4] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
STATEMENT OF PROBLEM Clinical studies on implant-retained maxillofacial prostheses have focused on biological outcomes. An assessment of the effect of prostheses on patients' quality of life (QOL) by using specific questionnaires developed for this patient population provides important information on treatment outcomes from the patients' perspectives. PURPOSE The purpose of this study was to report patient-based outcomes of implant-retained maxillofacial prostheses and to evaluate the effect of implant-retained maxillofacial prostheses on QOL of participants in a prospective study. MATERIAL AND METHODS Eighty-two participants were treated with implant-retained maxillofacial prostheses. Participants were divided into 2 groups: a retrospective group (participants treated and under care) and a prospective group (participants willing to be treated). The posttreatment patient satisfaction scores for each question were statistically analyzed by 2-way ANOVA with variables of defect type and retention type. The Student-Newman-Keuls test was used to determine any significant differences among the groups. In the prospective group, mean scores before and after prosthetic treatment were compared with the paired t test (α=.05). RESULTS The details of 54 retrospective and 28 prospective participants were reviewed. The posttreatment results of 82 patients showed that patient satisfaction with implant-retained maxillofacial prostheses was significantly different for cleaning the prostheses and recommending treatment to other people, depending on the defect and retention type. In the prospective group, participants reported significant increases in satisfaction for all questions. CONCLUSIONS Implant-retained prostheses were considered highly satisfactory, indicating good QOL for patients with maxillofacial defects. A comparison of pretreatment and posttreatment assessments revealed that implant-retained maxillofacial prostheses increased patient QOL.
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Affiliation(s)
- Secil Karakoca Nemli
- Department of Prosthodontics, Faculty of Dentistry, Gazi University, Ankara, Turkey
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Dings JPJ, Maal TJ, Muradin MS, Ingels KJ, Klevering BJ, Koole R, Merkx MA, Meijer GJ. Extra-oral implants: insertion per- or post-ablation? Oral Oncol 2011; 47:1074-8. [PMID: 21835682 DOI: 10.1016/j.oraloncology.2011.07.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 07/14/2011] [Accepted: 07/18/2011] [Indexed: 11/30/2022]
Abstract
Although the benefit of extra-oral implants in the reconstruction of maxillofacial oncological defects is undisputable, some relevant issues need to be clarified. The purpose of this retrospective study was to evaluate the relationship between implants placed during ablation (DA-implants) and after ablation (AA-implants) of the tumor with respect to implant survival. In total, 103 implants were assessed: 44 nasal implants (17 patients) and 59 orbital implants (18 patients). All patients received their implant-retained maxillofacial epithesis between 1997 and 2010, with a mean follow-up of 35 months (range 8-156 months). The survival rate of DA-implants was 90.0% for the orbital region and 93.5% for the nasal region. The survival rate of the AA-implants for the orbital and the nasal region was 82.8% and 61.5%, respectively. This study shows a significant higher survival rate of extra-oral implants placed during ablative surgery compared to implants in a later stage (p=0.044), thereby stressing the importance of installing extra-oral implants during the ablative surgical session.
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Affiliation(s)
- J P J Dings
- Dept. of Oral and Maxillofacial Surgery 590, Radboud University Nijmegen Medical Center, PO Box 9101, NL 6500 HB Nijmegen, The Netherlands.
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Radiation-induced leiomyosarcoma of the maxillofacial region: facial reconstruction with implant-retained prosthesis. J Craniofac Surg 2010; 21:262-6. [PMID: 20098194 DOI: 10.1097/scs.0b013e3181c5a392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Radiation-induced sarcoma represents an exceptional rarity in the head and neck region. The treatment is surgical excision with negative margins and follow-up. After surgery, reconstruction of the defects can be accomplished either surgically or prosthetically. Implant-retained maxillofacial prostheses may offer an acceptable solution. In this report, a large facial defect resulting from radiation-induced leiomyosarcoma was reconstructed with implant-retained prosthesis. A patient with a large facial defect resulting from tumor surgery presented for reconstructive treatment. The primary tumor was fibrous histiosarcoma. Four years after the patient was treated with surgical resection and subsequent irradiation, leiomyosarcoma was diagnosed in the defect site. Leiomyosarcoma was treated with complete surgical resection, and the defect was reconstructed with implant-retained prosthesis. The patient was evaluated every 6 months. Implants provided secure retention to the prosthesis. The patient was satisfied with the appearance of the prosthesis. At 12 months' examination, functioning implants were successful; however, color fade of the prosthesis was observed. Radiation-induced leiomyosarcoma, which is an uncommon tumor in the head and neck region, was treated by means of large surgical resection. Implant-retained prosthetic rehabilitation of the patient resulted in acceptable functional and cosmetic results, and the patient has resumed social activities.
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Clinical evaluation of a newly designed single-stage craniofacial implant: A pilot study. J Prosthet Dent 2008; 100:375-83. [DOI: 10.1016/s0022-3913(08)60240-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Materials and techniques in maxillofacial prosthodontic rehabilitation. Oral Maxillofac Surg Clin North Am 2002; 14:73-93. [DOI: 10.1016/s1042-3699(02)00018-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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