Page 88 - Craniomaxillofacial Implant Surgery - Jeroen P.J. Dings

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Chapter 5
Mean satisfaction scores were high on the anatomic form of the prosthesis and achieved symmetry of the face for all prostheses (Fig. 1). In comparison with the orbital and auricular region, nasal prostheses scored statistically significantly lower while holding the face in a neutral expression (P=.04). Figure 1 shows the results on satisfaction with the characteristics of the color of the prostheses. Undesirable color change was noted at 11 months for orbital (range 1-36) and 10 months for nasal (6-16 months) and auricular prostheses (0-24 months). No statistically significant difference was found (P=.09). No clear relation with smoking could be established.
Orbital, nasal, and auricular prostheses were worn for 18, 14, and 14 hours per day. Only 1 patient stated that he did not wear his adhesive-retained nasal prosthesis because of allergic reactions. Seventy-six percent of the respondents reported wearing their prostheses during the day. The remaining respondents also wore their prostheses while sleeping (36% of orbital prostheses, 7% of nasal prostheses, and 19% of auricular prostheses). One patient with a magnet-retained nasal prosthesis responded that he wore his prosthesis solely during social outings. None of the patients used devices to help place or remove their prostheses. However, 3 patients needed others to help apply the adhesives; one patient with an orbital prosthesis and 2 patients with an auricular prosthesis. With regard to anatomic location of the prosthesis, no statistically significant difference was found in ‘ease of placement’ (P=.59) and ‘ease of removal’ (P=.92). However, both activities proved more difficult with adhesive-retained prostheses (P=.01 and P=.04).
The longevity of maxillofacial prostheses was mainly determined by the fading of color (43.8% of auricular prostheses and 55.6% of nasal prostheses), independent of the type of attachment. The other main factor with nasal prostheses was the suboptimal junction (25%). With auricular prostheses, the wear of the silicone material (19%) and the suboptimal junction (22%) were prominent complaints. Magnets and adhesive attachments were equally divided with respect to the ‘fading of color’ of the silicone material, the suboptimal fit of the prosthesis, or the suboptimal junction of the silicone at the skin. Orbital prostheses with a bar-clip attachment (n=2) only needed replacement because of color fading.
Seven patients reported the loss of an implant (2 orbital, 4 nasal, and 1 auricular prosthesis) with an equal distribution of type of attachment. Only 1 patient with a nasal prosthesis and 2 patients with an auricular prosthesis reported breakage of the bar-