Page 113 - Craniomaxillofacial Implant Surgery - Jeroen P.J. Dings

Autologous versus prosthetic nasal and auricular reconstruction
DISCUSSION
The present study assessed the subjective appreciation of aesthetic outcomes following the prosthetic or autologous reconstruction of nasal and auricular defects among patients, medical professionals and laymen.
Although various instruments have been developed to evaluate patient satisfaction
following facial plastic surgery, none have achieved widespread use, and the wide
variety of questionnaires and methodological approaches in use makes the comparison
of different studies difficult18,20. In this study, VAS was used to score the overall view of
the ear and nose. In comparison with using a Likert scale to score patient satisfaction,
VAS has been shown to be less vulnerable to bias from confounding factors and to
better detect variation21. To facilitate the comparison of our results with those of
previous research, we also used a five-point Likert scale to score the general questions
and those relating to the anatomical subunits10-14. To the best of our knowledge, no
previous study has evaluated the differences between panels in perceptions of the
aesthetic outcome of prosthetic and autologous reconstruction for both nasal and
auricular defects; however, some studies have reported on subjective satisfaction
after these procedures10-15. Moolenburgh et al.10 and Mureau et al.11 found that medical
professionals and laymen offered lower estimations of ‘total nasal appearance’ 6 following autologous reconstruction than patient panels. These results (scored on
a 5-point Likert scale) are in accordance with our own, which showed that patients scored total nasal appearance higher than the OMF surgeons and laymen, although we found no significant difference in the assessment of total nasal appearance by ENT surgeons and patients. A similar result was found in another study by Moolenburgh et al.12, who showed no difference in the assessment of autologous nasal reconstruction by laymen and professionals.
Moolenburgh et al.10 also reported higher overall assessment scores for all anatomical subunits of the nose following autologous reconstruction than we reported here. Our patient satisfaction scores were also lower than those reported by Arden et al.13 and Quatela et al.14, who evaluated patient and professional satisfaction with aesthetic outcomes following autologous nasal reconstruction; however, neither of these studies described the differences between both groups. Satisfaction with aesthetic outcome following auricular reconstruction by prosthesis was reported by Younis et al.15, who found that the majority of patients (85%) rated the aesthetic result as ‘very good’ (Likert
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