Page 114 - Craniomaxillofacial Implant Surgery - Jeroen P.J. Dings

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Chapter 6
score: 4) or ‘excellent’ (Likert score: 5), although the overall patient satisfaction with the prosthesis was disappointing. The authors attributed this poor overall satisfaction to a high rate of skin complications. Although this was not assessed in our study, recent developments in implant and abutment design as well as surgical technique have resulted in a decrease in the rate of skin complications7.
Satisfaction with facial aesthetics after treatment has also been studied in cleft lip and palate patients. Similar to our findings, patients and professionals in these studies were found to be more satisfied with the treatment outcome than the laymen22-24. Gkantidis et al.22 hypothesised that these differences could be attributed to the greater familiarity of medical specialists with the aesthetic consequences of treatment. Other studies report contradictory results however25,26; for example, Eliason et al.26 found that professionals respond more negatively to the facial appearance of cleft lip and palate patients following treatment than the laymen. The authors suggest this difference could be due to professionals being more critical and focusing on isolated features, such as nasal alar asymmetries and lip scarring.
Two types of medical professionals were included in the present study, namely OMF and ENT surgeons. Both are involved in the reconstructive treatment of nasal and auricular defects. The OMF surgeons rated the prosthetic rehabilitations higher overall than did their ENT counterparts. The different experiences of individual OMF and ENT surgeons in reconstructive treatment modalities and associated technical difficulties may have influenced their perspectives on aesthetic outcome27,28.
Normal facial appearance is an important factor in decreasing the negative perceptions of patients following reconstructive surgery during social interactions, and is important for the psychological wellbeing of patients10,17,29,30. Smolarz et al.31 suggested that satisfaction following reconstruction depends on the localisation of the defect. Auricular appearance and symmetry contribute to facial aesthetics and auricular defects, and abnormalities can be easily noticeable32. The nose arguably plays an even more essential role in facial aesthetics due to its central localisation, prominent and protruding aspect, and the fact that it cannot easily be concealed33,34. This means that reconstructions of the nose (and their camouflaged defects) are more conspicuous in facial appearance, and may therefore be rated lower than auricular reconstructions. Here, we found that satisfaction with auricular reconstructions was rated more highly than the nasal reconstructions, in particular when comparing auricular prostheses to nasal prostheses.