Page 133 - Craniomaxillofacial Implant Surgery - Jeroen P.J. Dings

General discussion and future perspectives
Prosthetic rehabilitation has considerable advantages specifically in restoring large defects, such as the ability to evaluate recurrence of illnesses. In addition, little or no morbidity is involved, and aesthetical advantages are introduced, especially in complex anatomical sites, such as noses and ears18,36,47. However, implant-retained prosthetic reconstruction relies on sufficient bone stock at the implant site, an intact manual dexterity for handling of the prostheses and continued care by a CMF prosthodontist18.
Nowadays, quality of life and patient satisfaction are becoming increasingly important in clinical decision-making. Therefore, subjective outcomes of treatment are also becoming more imperative. Although surgical- and implant-retained reconstruction of nasal- and auricular defects are widely described, literature on comparison of different reconstructive methods for CMF defects is sparse54,55. Various instruments evaluating patient satisfaction have been developed within facial plastic surgery, but none of them has achieved widespread use.
The goal of the study presented in Chapter 6 was to compare the subjective evaluation of different observer panels on prosthetic rehabilitation and autologous reconstruction of CMF defects.
Orbital defects were not included in this study, as autogenous reconstruction of
orbital defects is merely indicated for coverage of anatomical structures and does not
meet the goal of esthetic rehabilitation32. Autologous repair and implant-retained
prostheses are both good options for reconstruction of nasal- and auricular defects45,53. Traditionally, nasal- and auricular defects were reconstructed using autologous tissue 7 in several laborious surgical stages. Reinisch et al. have introduced porous polyethylene
as an alternative for the autologous costal graft for the reconstruction of the ear51-53.
The results of the study in Chapter 6 showed patients with reconstructed nasal- and auricular defects being perceived significantly less attractive in comparison to controls. This is in accordance to the findings of Moolenburgh et al. (2008), although their study only incorporated autologous reconstructions of nasal defects56.
In contrast to patients, laymen, ENT-surgeons and OMF surgeons expressed a preference for prosthetic reconstruction. An explanation could be that OMF-surgeons in the Netherlands both require a dental- and medical degree and, therefore, are more familiar with prosthetic rehabilitations. In contrast, our cohort of ENT-surgeons had more clinical experience with surgical correction of auricular- and nasal defects.
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