Complex Craniofacial Reconstruction With Prostheses as an Alternative Method to Autogenous Reconstruction

Abstract

Reconstruction of facial organ and tissue losses using autogenous tissue is a permanent and effective method in plastic surgery. However, in cases where the patient's general condition does not allow for surgical reconstruction or where the patient is in need of reconstruction of complex organs such as the eye, nose, or ear, an epithesis can be considered as an alternative to treatment with autogenous tissue. The purpose of this study was to investigate the factors affecting the success rate of facial reconstructions with an externally retained prosthesis in relation to the defect location and radiotherapy treatment. Between September 2004 and October 2008, 11 patients with facial tissue defects who had been treated with an osseointegrated implant system were evaluated. Because 1 patient with a midfacial defect died 3 months after the surgery, this case was excluded, leaving a total of 10 patients for evaluation. Five patients' facial defects were located in the ear, 2 patients had nasal defects, and 3 patients had defects in the midfacial region. The total numbers of implants applied to these regions were 13, 6, and 25, respectively. A total of 44 implants applied were followed for an average period of 52.4 months (between 6 and 77 months). In cases where the reconstruction was considered satisfactory, no infections were observed, and there were no implant losses in the mastoid region. Implant losses were observed in a total of 14 implants (31.8%), 2 of which were in the glabellar region (4.5%), and 12 were in the midfacial region (27.2%). The implant losses were observed between the first and 18th postsurgical months (with an average of 6 months). The remaining implants were sufficient to retain the prostheses. Because of these results, the use of implant-assisted epitheses can be considered a viable alternative in patients whose facial defects cannot be corrected through reconstructive surgery performed with autogenous tissue.