Page 146 - Craniomaxillofacial Implant Surgery - Jeroen P.J. Dings

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Chapter 8
Nasal- and auricular defects may be reconstructed using implant retained prostheses or by means of autologous reconstruction. The aim of the study in Chapter 6 was to assess opinions of different observer panels on the aesthetic outcome of both reconstructive methods. Subjective assessments of the different types of reconstruction were conducted by patients, professionals (oral and maxillofacial (OMF) surgeons and ear, nose and throat (ENT) surgeons) as also laymen. Overall appreciation, aesthetic outcome of anatomical subunits and possible interaction between both, were scored. A total of 77 patients, treated between 1997 and 2016, were included. The cohort comprised 48 patients with nasal defects (24 autologous and 24 prosthetic reconstructions) and 29 with auricular defects (12 autologous and 17 prosthetic reconstructions). The control group included 31 non-affected patients (20 ears and 11 noses). Observer panels encompassed 10 laymen, 10 professionals (5 OMF surgeons, 5 ENT surgeons) and 5 patients with reconstructed auricular- or nasal defect.
Prosthetic reconstructions were frequently found to be associated with significantly higher scores. The only exception was the assessment of laymen and ENT surgeons with regard to the color of reconstructions of the nasal defects (p=0.02 and p=0.02, respectively). Patient observers only showed a significant preference for prosthetic reconstruction with regard to the natural shape of the auricular reconstructions (p=0.01). Laymen showed a preference for the prosthetic reconstructions in the domains ‘matches the patient’s face’, ‘natural shape’ and ‘length’ (p=0.00, p=0.00, p=0.05). The OMF-surgeons judged the prosthetic ear favorably in all domains. In contrast, ENT surgeons only significantly favored prosthetic reconstruction in the domain ‘natural shape’ (p=0.04).
Nearly all anatomical subunits of prosthetically reconstructed auricular defects showed significantly higher appreciation scores. The only exception included ENT surgeons not significantly favoring prosthetic reconstructions of the triangular fossa.
With regard to nasal reconstructions, only prosthetic reconstruction of the nasal dorsum showed lower appreciation scores by laymen, OMF and ENT surgeons, although not at a significant level. No significant influence of anatomical subunits on overall appreciation of reconstruction type was found. Furthermore, no interaction with age or gender of observed patients or observers could be determined.