[A new implant system for orbital prosthetic rehabilitation: "epiplating mono"]

[Prosthetic rehabilitation in the head and neck region]

Implant-retained craniofacial prostheses (or epitheses) made of silicone are state of the art for prosthetic rehabilitation of facial defects. With the modern extraoral implant systems, prostheses may be securely anchored to the bone regardless of size and location of the defect. Prerequisite for successful implantation is the classical atraumatic surgical technique with avoidance of any thermal trauma to the bone. The treatment intention may be a temporary measure, a rescue procedure after failed (re)construction, or a definitive treatment option. This article gives an overview of the strategies in various facial regions stratified according to the age of the patient and the etiology of the defect. Moreover, prosthetic rehabilitation offers additional options for septal perforations, distorted and leaky tracheostomies, and treatment-resistant tracheoesophageal fistula.

[Epithetic replacement in otorhinolaryngology]

The past century saw rapid development of craniofacial prostheses. Particularly the challenging issue of surgical fixation was the subject of intensive research and development. During the past three decades, the principle of osseointegration has proven to provide a reliable method for epithesis fixation. The continuous technical development of implant systems has led to almost minimally invasive surgical techniques, with ever increasing stability of the implants. Osseointegrated implants are a proven and durable solution in the rehabilitation of the patient with a defect in the craniofacial region. Overall complication rates are low. The design and mechanics of the implants, as well as the artificial body of the epithesis itself, are topics of current medical-technical research by anaplastologists and surgeons. Finally, functional prostheses, such as the tracheostomy epithesis, deserve particular attention.

[Satisfaction of patients with tracheostomal epithesis]

BACKGROUND

The utilization of craniofacial prosthesis has proven to be very successful for craniofacial defects. However, there is a lack of knowledge about the value of an epithesis for voice rehabilitation in patients with tracheostomy. The aim of this study was to describe application of the tracheostomy epithesis and to present a systematic analysis of the functional results of this prosthetic technique.

MATERIALS AND METHODS

This retrospective analysis included 48 patients on follow-up being treated in three different centers after laryngectomy and/or tracheostomy between 2008 and 2014. Subjects were given a questionnaire with items such as speech quality, quality of life, free hand speech ability, respiratory quality and sufficient tracheostomal sealing comparing values before and after application of an individually custom-made tracheostomy epithesis. Twenty-eight answered the questionnaire and could be reported.

RESULTS

Twenty-eight of 48 patients were consistently being included in follow-up. The statistical analysis revealed a significant improvement of tracheostoma occlusion (p < 0.05) and improvement in free hand speech ability (p < 0.05). A leakage of air during voice production could be prevented in 59.3% after application of an epithesis. Quality of life correlated directly with successful utilization of an epithesis.

CONCLUSION

In the literature, different industrialized products are described to realize occlusion of the tracheostoma for sufficient speech production without using the hands. In numerous cases commercial solutions fail and the patients need individual modifications. Our study first describes the evaluation of custom-made tracheostomal epithesis. From our observed results we advocate the individual tracheostomal epithesis as a durable solution for voice rehabilitation.