Page 103 - Craniomaxillofacial Implant Surgery - Jeroen P.J. Dings

Autologous versus prosthetic nasal and auricular reconstruction
INTRODUCTION
Craniomaxillofacial (CMF) defects resulting from congenital malformation, cancer or trauma are generally considered severe impairments and can be functionally and emotionally devastating1. The recovery of a natural appearance and function through reconstructive surgery is important for patients to achieve social integration and enhance their quality of life2. The rehabilitation of CMF defects as complex as an absent nose or ear can be challenging for the surgeon however, as the final result is difficult to predict3-5.
In 1977, the first introduction of osseointegrated implants to regions outside the oral cavity marked an important step in the reconstruction of CMF defects6, making prosthetic reconstruction a viable and effective alternative to autologous reconstruction5,7. The drawbacks of prosthetic rehabilitation include the need for daily care, implant-related problems and the short lifespan of the prosthesis4,57.
Because most CMF defects are unique in size and shape, it can be challenging to find the
optimal treatment plan for each individual patient. The choice of treatment modality
depends on multiple factors, including the characteristics of the defect (size, location
and aetiology), the motivation and physical condition of the patient, and the need 6 for multidisciplinary medical care. Treatment success is predominantly measured by
patient satisfaction with their postoperative facial appearance, social integration and overall quality of life8,9. However, few studies have reported on patient satisfaction with the aesthetics of nasal and auricular reconstructions10-15. Measuring the normalcy of appearance is difficult and different methods have been described for the evaluation of facial appearance1,16-18.
The current study evaluates subjective aesthetic outcome as perceived by patients, medical professionals and laymen after the autologous or prosthetic reconstruction of nasal and auricular defects. Additionally, we address the influence of anatomical subunits on the aesthetic value of nasal and auricular reconstructions.
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