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Table of Contents
CASE REPORT
Year : 2021  |  Volume : 11  |  Issue : 2  |  Page : 84-87

Rehabilitation of oncological nasal defect with effective maxillofacial prosthesis material


1 Department of Prosthodontics, SRM Dental College, Chennai, Tamil Nadu, India
2 Department of Prosthodontics, Tamil Nadu Government Dental College, Chennai, Tamil Nadu, India

Date of Submission01-May-2020
Date of Acceptance22-Mar-2021
Date of Web Publication31-Aug-2021

Correspondence Address:
Dr. Ahila Singaravel Chidambaranathan
Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai - 600 089, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jid.jid_29_20

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   Abstract 


Acquired maxillofacial defects usually result from surgical removal of tumors, infectious diseases, or traumatic injuries and affect the function, esthetics, and psychology of the patient. These extraoral defects can be effectively rehabilitated through surgical reconstruction and/or prosthetic rehabilitation to bring back a near-normal life. This clinical report describes a nasal defect due to squamous cell carcinoma which was successfully managed with an effective prosthesis, and for which, the retention was obtained mechanically using spectacles which is not only cost-effective but also easy to fabricate.

Keywords: Maxillofacial defect, nasal prosthesis, polymethyl methacrylate resin, rehabilitation


How to cite this article:
Chidambaranathan AS, Thulasingam C. Rehabilitation of oncological nasal defect with effective maxillofacial prosthesis material. J Interdiscip Dentistry 2021;11:84-7

How to cite this URL:
Chidambaranathan AS, Thulasingam C. Rehabilitation of oncological nasal defect with effective maxillofacial prosthesis material. J Interdiscip Dentistry [serial online] 2021 [cited 2021 Oct 28];11:84-7. Available from: https://www.jidonline.com/text.asp?2021/11/2/84/325105




   Clinical Relevance to Interdisciplinary Dentistry Top


  • This case report describes the rehabilitation of midfacial defect due to carcinoma with heat-activated polymethyl methacrylate resin prosthesis
  • Nasal prosthesis closes the defect and facilitates the appearance and engraves psychological benefits and confidence to the patient
  • Mechanical method of retention will reduce the recurrence rate and further complications.



   Introduction Top


The face is a person's identity. Any disfigurement of the facial esthetics can lead to a loss in their quality of life.[1] Maxillofacial defects resulting from neoplasms, congenital deformations, or are accidents can be rehabilitated with different prosthetic materials to bring a life-like appearance and function.[2]

Squamous cell carcinoma is the most common malignant neoplasm and comprises 66% of cancers of the nasal cavity.[3] Management of facial defects is a multidisciplinary approach which involves maxillofacial plastic surgeon, prosthodontist, and psychologist.[1]

Restoration of maxillofacial defects is a taunting task for both the plastic surgeon and the prosthodontist.[3] The most commonly used materials for extraoral prosthesis include acrylic, vinyl, and polyurethane resins and silicone elastomers.[4],[5] This clinical report describes an oncological nasal defect which was rehabilitated with custom-made sculpted polymethyl methacrylate (PMMA) resin prosthesis which was retained by spectacles.


   Case Report Top


A 30-year-old female patient reported to the Department of Prosthodontics, Tamil Nadu Government Dental College and Hospital, Chennai, with a nasal defect [Figure 1]. The clinical record showed that the midfacial defect was due to surgical excision of squamous cell carcinoma of the nose. On examination, it was observed that the defect extended superiorly to the root of the nose, inferiorly to the base of the nose, and laterally short of the nasolabial fold [Figure 2]. Hence, the treatment of rehabilitating the patient with PMMA resin prosthesis was advocated to the patient as other treatment prostheses such as silicone prosthesis were excluded because of the patient's low economic back ground and also because her work involved being exposed to sunlight. The option of implant-supported prosthesis was also not considered as the defect was due to malignancy which would affect the quality of the underlying bone and osseointegration. Hence, the treatment was started after informing about the procedures and obtaining consent forms from the patient and the family members.
Figure 1: Nasal defect

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Figure 2: Extension of nasal defect

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The prosthetic restoration was carried out in a short period considering the profession of the patient. The patient was seated in supine position, and the nasal passage was blocked with surgical gauze. The impression procedure was started with the marking of the outline of the defect on the patients face. Then, boxing of the defect area was done using modeling wax (Hindustan Dental Products, Hyderabad, Telangana, India), and following which, an irreversible hydrocolloid material (Zelgan Plus Alginate Impression Material, Dentsply, International, Inc., New York, USA) was manipulated and poured into the defect area. Before the hydrocolloid impression set, gauze pieces were applied over the alginate surface, which provided mechanical retention for the rigid plaster which was poured over the set alginate. Once the plaster set, the impression was carefully removed from the defect area and poured with Type III gypsum (Golden Stone, Golden Stone Ramaraju Traders, Chennai, Tamil Nadu, India).

The wax pattern of the nose was made with modeling wax (Hindustan Dental Products, Hyderabad, Telangana, India) on the model, and stippling was done on the prominent part of the nose [Figure 3]. The wax pattern was then tried on the patient's face to check for the relevant contours and the border areas of the wax prostheses [Figure 4]. After patient's approval, the wax pattern was acrylized by compression molding technique using heat-activated PMMA resin (Heat Cure, DPI, Mumbai, Maharashtra, India) with intrinsic coloring and extrinsic water-resistant coloration done to match with the skin tone of the patient. The nasal prosthesis was tried on the patient's face to evaluate the seating, extension, verifying the match, and satisfaction of the patient [Figure 5]. After the necessary corrections, the acrylic resin nasal prosthesis was attached with a pair of spectacles in the proper oriented position [Figure 6].
Figure 3: Wax pattern of the nose on the cast

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Figure 4: Wax pattern of the nose for trail

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Figure 5: Polymethyl methacrylate resin nasal prosthesis

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Figure 6: Nasal prosthesis attached to the spectacles

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   Discussion Top


Although reconstructive and plastic surgery is the treatment priority for persons with maxillofacial defects, in case of extensive defects with mass anatomical tissue loss, the most suitable treatment option is prosthetic rehabilitation.[6] The objective behind the treatment of these patients is to restore the lost tissue after surgery and improve esthetics and self-esteem of the patients.[7]

The treatment plan for maxillofacial defect depends upon the age, location, size, etiology, severity, and the patient's need.[8] If the plastic surgery outcome is not satisfactory to restore the complete shape of the nose,[9],[10] the defect can be restored using either a medical silicone or PMMA resin prosthesis. The PMMA resin prosthesis is economical and can be modified at any time after insertion into the defect area.[11]

The maxillofacial prosthesis can be made using conventional method or digital method using laser scanning and computer-aided design/computer-aided manufacturing method, thereby reducing the time and the number of appointments. Further, it eliminates the annoyance to the patients and improves the shelf-life of the maxillofacial prosthesis and appearance.[12]

The facial moulage and the impression of the defect area were made with thin consistency of irreversible hydrocolloid (alginate), which does not displace the underlying soft tissue and easily flows into the defect.[6] Anchorage of the maxillofacial prosthesis is very important for the psychological benefit of the patient. The nasal prosthesis can be retained by means of glasses, tissue undercut, medical adhesives, and implants or double-sided tape. Medical adhesives may elicit allergy and tissue irritation and may damage the fitting surface of the prosthesis during removal of the prosthesis. Osseointegrated implants are relatively expensive, require adequate bone for implant placement, and involve a longer duration. Nasal prosthesis supported by eyeglasses are cost-effective and provide sufficient retention.[12]

In this case, since the defect was extensive and close to conchae, the mechanical method of retention using spectacles was chosen for retention of the prosthesis. As the patient's occupation involves working outdoors under sunlight every day, the potential for discoloration of the prosthesis and the loss of its mechanical properties which lead to frequent change of silicone nasal prosthesis was considered. In addition, fabricating a silicone prosthesis is expensive and technically sensitive, and hence, PMMA resin prosthesis was the right option in this case [Figure 7]. Further, PMMA resin extended into the undercut of the nasal cavity and helped with the retention of the nasal prosthesis. However, the nasal mucosa can be easily damaged by repeated movements. Hence, relining of the fitting surface of the PMMA resin nasal prosthesis with soft-liner would aid in comfortable wearing and removal of the prosthesis without any injury to nasal mucosa. Spectacle frame retention was chosen for the present patient, which not only provided good retention but also completely sealed the margins of the prosthesis and improved the appearance.[13],[14]
Figure 7: Rehabilitated with nasal prosthesis

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Considering the extension of the nasal defect, fabrication of implant-retained nasal prosthesis would have been a better choice, but treatment in this case had its limitations. The use of PMMA resin nasal prosthesis is an economical mode of rehabilitation of the defect, which improves the self-confidence and quality of life and helps her to reintegrate back into society.[15]


   Summary Top


This case report describes a simple and effective method of prosthetic rehabilitation of the midfacial region defect using spectacles as a mechanical method of retention. The pros of the conventional method of rehabilitation are noninvasive, economical, esthetic, comfortable to use, and easy to fabricate and maintain.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Fonseca EP. The importance of form, characterization, and retention in facial prosthesis. J Prosthet Dent 1966;16:338-43.  Back to cited text no. 1
    
2.
McKinstry RE. Fundamentals of Facial Prosthesis. 1st ed. Arlington: ABL Professional Publications; 1995. p. 79-97.  Back to cited text no. 2
    
3.
Jain S, Maru K, Shukla J, Vyas A, Pillai R, Jain P. Nasal prosthesis rehabilitation: A case report. J Indian Prosthodont Soc 2011;11:265-9.  Back to cited text no. 3
    
4.
Marion LR, Rothenberger SL, Minsley GE. Judson C. Hickey Scientific Writing Award Winner. A method of fabrication of a facial prosthesis that improves retention and durability: A clinical report. J Prosthet Dent 1997;77:457-60.  Back to cited text no. 4
    
5.
Mortellaro C, Garagiola U, Lucchina AG, Grivetto F, Milone G, Pappalardo S, et al. The use of silicon elastomer in maxillofacial rehabilitation as a substitute for or in conjunction with resins. J Craniofac Surg 2006;17:152-62.  Back to cited text no. 5
    
6.
Beumer J, Curtis TA, Firtell DN. Maxillo-facial Rehabilitation: Prosthodontic and Surgical Considerations. St. Louis: C.V. Mosby Co; 1979. p. 333-40.  Back to cited text no. 6
    
7.
Ozkaya O, Turgut G, Kayali M, Urlu K, Kuran S, Bafi1 L. A retrospective study on the epidemiology and treatment of maxillofacial fractures. Turk J Trauma Emerg Surg 2009;15:262-6.  Back to cited text no. 7
    
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Rodrigues S, Shenoy VK, Shenoy K. Prosthetic rehabilitation of a patient after partial rhinectomy: A clinical report. J Prosthet Dent 2005;93:125-8.  Back to cited text no. 8
    
9.
Hatamleh MM, Watts DC. Mechanical properties and bonding of maxillofacial silicone elastomers. Dent Mater 2010;26:185-91.  Back to cited text no. 9
    
10.
Hanson MD, Shipman B, Blomfield JV, Janus CE. Commercial cosmetics and their role in the coloring of facial prostheses. J Prosthet Dent 1983;50:818-20.  Back to cited text no. 10
    
11.
Kalavathy N, Sridevi JR, Roy S, Verma N, Chhabria S. Enhancing the quality of life: Prosthetic rehabilitation of nasal defect. SRM J Res Dent Sci 2014;5:134-9.  Back to cited text no. 11
  [Full text]  
12.
Ciocca L, Bacci G, Mingucci R, Scotti R. CAD-CAM construction of a provisional nasal prosthesis after ablative tumour surgery of the nose: A pilot case report. Eur J Cancer Care (Engl) 2009;18:97-101.  Back to cited text no. 12
    
13.
Seçilmiş A, Oztürk AN. Nasal prosthesis rehabilitation after partial rhinectomy: A clinical report. Eur J Dent 2007;1:115-8.  Back to cited text no. 13
    
14.
Guttal SS, Vohra P, Pillai LK, K Nadiger R. Interim prosthetic rehabilitation of a patient following partial rhinectomy: A clinical report. Eur J Dent 2010;4:482-6.  Back to cited text no. 14
    
15.
Aggarwal V, Datta K, Kaur S. Rehabilitation of post-traumatic total nasal defect using silicone and acrylic resin. J Indian Prosthodont Soc 2016;16:87-90.  Back to cited text no. 15
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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]



 

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