Page 115 - Craniomaxillofacial Implant Surgery - Jeroen P.J. Dings

Autologous versus prosthetic nasal and auricular reconstruction
It is difficult to rate anatomical subunits without being influenced by surrounding structures; however, no anatomical subunits were found to have a clinically meaningful impact on the overall match of the prosthetic or autologous reconstruction with the patient’s face in this study. Many factors unrelated to nasal or auricular defects and their reconstruction can also impact the perception of the aesthetic outcome, such as makeup or hairstyle16, but the possible influence of these features was not determined in the current study.
Other limitations of this study include variability in follow-up periods and the time at which the photographs were taken. The medical photographs were taken at different intervals following reconstructive surgery or prosthetic rehabilitation. Furthermore, these twodimensional images were used to score the three-dimensional anatomy of reconstructed facial defects. Lighting, head orientation, camera and background may affect the assessment of the nasal and auricular reconstructions35. Although the majority of the photographs were standardised, the lighting and background were not always identical, and may have affected the results of this study.
Furthermore, data regarding the characteristics of the prostheses (number and age)
at time the photographs were taken could not be retrieved from the medical or dental
charts; therefore, the possible influence of prosthesis wear or discoloration on the 6 aesthetic outcome was not assessed. Another important factor is the experience of the reconstructive surgeons, as the literature shows there is a steep learning curve in the
autologous reconstruction of nasal and auricular defects3. Higher levels of experience
in reconstructive surgery may improve the aesthetic outcome of the autologous reconstructions performed by a surgeon over time, and thus influenced the outcome
of this study36.
Psychological factors, such as self-esteem and coping mechanisms, may also determine satisfaction with nasal or auricular appearance29. The psychological and social functioning of the patients (and other) respondents are therefore likely to have influenced the results, although the extent of this influence was not determined. Additionally, patient and laymen educational levels may have varied in the current study. There is a high likelihood of bias from patients in reporting satisfaction to their surgeons37. Furthermore, the digital questionnaires were extensive, comprising over 1,250 questions and consequently taking a significant amount of time to complete. It is therefore possible that answers provided at the later stages of the questionnaire were
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