Page 15 - Craniomaxillofacial Implant Surgery - Jeroen P.J. Dings

1. GENERAL INTRODUCTION
Acquired- or congenital defects in the craniomaxillofacial (CMF) region result in multiple functional-, esthetic- and psycho-social difficulties and, therefore, are a major challenge in reconstructive surgery1,2.
As most CMF defects are unique in size and shape, the challenge is to find the optimal treatment for each individual patient. Addressing these defects can be accomplished by surgical reconstruction or prosthetic rehabilitation, or a combination of both methods3. As such, CMF prostheses, or epitheses, are artificial substitutes for facial defects4.
It was not until the discovery of osseointegration by Brånemark that osseointegrated implants became a viable treatment option in CMF reconstruction, offering optimal retention and stability of CMF prostheses5,6. On the same basis, Tjellström et al. pioneered the use of percutaneous titanium fixtures for anchorage of a hearing aid in 19797.
Ultimately, the choice of surgical-, prosthetic- or combined treatment depends upon the characteristics of the defect (size, location and etiology), motivation and condition of the patient, and interdisciplinary cooperation8,9.
2. RECONSTRUCTION OF CRANIOMAXILLOFACIAL DEFECTS
2.1 Surgical reconstruction
Surgically reconstructive approaches using autogenous tissue can be used as a permanent and effective method10,11. Literature abundantly presents modern techniques in plastic facial surgery that provide a wide array of reconstructive possibilities12-14. However, complex nasal-, auricular- and orbital defects pose esthetic- and functional demands that are frequently beyond the capacity of local reconstructive efforts necessitating multiple surgical steps that increase the total treatment time and can lead to unpredictable aesthetic outcomes4,15,16. Surgical reconstruction is challenged by increased size of the defect, insufficient residual hard- or soft tissue, constraints related to radiation therapy, the need for direct visual inspection of the defect for tumor recurrence, esthetic importance, and the medical- or physical condition of the patient10,17,18.
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General introduction and outline of this thesis
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