Partial Rhinectomy Research Articles

Silicone cure inhibition with material jetting additive manufacturing utilized for facial prosthesis fabrication - A clinical report.

This clinical report outlines the prosthetic restoration of a 92-year-old Caucasian patient who underwent a partial rhinectomy. Utilizing CAD-CAM technology, scanning and design were accomplished digitally, and material jetting additive manufacturing was used to create a two-piece mold for a partial nasal silicone prosthesis. An unprecedented challenge was observed involving cure inhibition when the silicone came into contact with the additively manufactured (AM) material, and multiple attempted strategies to remedy this situation were discussed. The report emphasizes the critical need for further research to optimize digital workflows in prosthetic facial rehabilitation.

CRTC1::TRIM11-fusion tumor with rare sinonasal presentation and locally aggressive disease course

Abstract Introduction/Objective Cutaneous melanocytic tumor with CRTC1::TRIM11 fusion (CMTCT) is a rare dermatological neoplasm that has not yet been formally recognized by the World Health Organization. At present, our knowledge of this disease is limited to single reports and a series 41 cases with limited follow-up information. It is typically described as a skin lesion expressing melanocytic makers, often leading to its misdiagnosis as melanoma or clear cell sarcoma. CMTCT is regarded as an indolent tumor with infrequent recurrence after complete surgical excision. However, we present a case with uncommon sinonasal presentation and metastasis after multiple resections. Methods/Case Report A 23-year-old woman presented with a right nasal vestibule mass, requiring partial rhinectomy in a foreign country, where she subsequently received chemoradiation. Her tumor at the time was diagnosed as a mucosal melanoma. Eleven years following initial presentation, she demonstrated a recurrent right nasal tumor, as well as neck mass, cervical lymphadenopathy, and lung nodules. The patient then underwent a nasal endoscopic resection and modified neck dissection, which demonstrated a high-grade neoplasm with intersecting fascicles of medium-to-large monomorphic cells; whole exome and whole transcriptome sequencing performed on the resected neck mass identified a pathogenic TERT c.-146C>T alteration and CRTC1 exon 1::TRIM11 exon 2 fusion. The patient is currently alive and undergoing post-surgical chemoradiation. Results (if a Case Study enter NA) NA Conclusion This case expands our understanding of CMTCT and emphasizes its potentially aggressive behavior. The sinonasal presentation contrasts the tumor’s typical appearance on the skin and could mimic mucosal melanoma. Of note, our patient developed recurrent disease and distant metastases, thereby emphasizing the possible role of systemic therapy and suggesting that simple surgical excision may not be curative in all cases. Our case illustrates that CMTCT is an uncommon and potentially misidentified neoplasm, but that its proper diagnosis is essential for treatment selection and follow up.

Definitive treatment with PD-1 blockade and radiation therapy of unresected primary desmoplastic melanoma of the nose.

Two patients with primary desmoplastic melanoma of the nose were treated with definitive anti-PD-1 checkpoint inhibitor (anti-PD1) and radiation therapy. Both patients were technically resectable with partial rhinectomy but both declined for cosmetic reasons. The melanoma multidisciplinary team recommended that the patients receive PD1 blockade. The initial response to PD-1 blockade was temporary in the first case and partial in the second one. With the addition of high-dose radiotherapy, complete responses were obtained in both patients, with recurrence-free and good functional and cosmetic outcomes at a six-year and 22-month follow-up. Despite surgery being the gold standard, both cases illustrated that PD-1 blockade and radiation therapy can be a safe alternative option for desmoplastic melanoma where surgery is morbidly disfiguring.

SILICONE NOSE PROSTHESIS - A CASE REPORT

The quality of life after the rhinectomy is severely compromised if an efficient surgical reconstruction or a prosthetic device is not provided. Sometimes the results of the plastic surgery are not sufficient to restore the entire volume of the nose .In these patients, a facial prosthesis is aesthetic and provides the respiratory function. Introduction of new material which gives life-like appearance to such prosthetic restorations e.g. silicone and poly ether rubbers have given a new dimension to rehabilitation of such patients. This report presents a case of prosthetic rehabilitation of the nasal component of the face secondary to partial rhinectomy for squamous cell carcinoma. Rehabilitation of patient was done by mechanically supported prosthesis using spectacles. Patient’s aesthetics and respiratory function has been significantly improved following prosthetic rehabilitation.

Prosthetic Rehabilitation of Nose After Partial Rhinectomy in a Patient Affected with Mucormycosis: A Case Report.

Mucormycosis is a fungal infection commonly seen in Indian population, in which aggressive surgical intervention to cut away the infected tissue becomes necessary. This may cause disfigurement and leave open wounds which requires prosthetic replacement for psychological benefit and also protect the inner soft tissues of the patient which are exposed to the foreign bodies. Mucormycosis has shown a sudden surge in recent times associated with patients affected by Covid-19. It is a rare but serious complication which can cause loss of eye, nose and associated structures leaving the patient disfigured. The aim of this case report is to describe an economic but effective nonsurgical treatment option to restore the facial defect using acrylic resin baseplate to enhance retention by using the available undercuts and was packed using silicone material. The prosthesis was retained mechanically and omitted the use of any retentive aids such as the use of spectacles or implants.

A single centre's experience of 23 cases of total rhinectomy for the treatment of squamous cell carcinoma involving the nasal vestibule.

This study aims to analyse the oncological outcomes of total rhinectomy (TR) for squamous cell carcinomas (SCCs) involving the nasal vestibule, and to identify prognostic factors for disease recurrence. A retrospective single-centre study was conducted between September 2003 and February 2021 including all patients who underwent a TR for a SCC involving the nasal vestibule. 23 patients were included in the study. Tumours originated from the anterior septum (n = 12), vestibule (n = 8) or skin (n = 3). Six TRs (26.1%) were salvage procedures, after primary radiotherapy or partial rhinectomy. Seven patients had a concurrent neck dissection and 17 patients (73.9%) received adjuvant treatment (14 patients had radiotherapy and 3 had chemoradiotherapy). After a median follow-up of 32months, six patients (26.1%) presented with tumour recurrence. Three patients (13%) had nodal-only recurrence. The estimated 5-year overall survival, disease-free survival and disease-specific survival were 67.5%, 66.3% and 80.7%, respectively. Positive excision margins were a predictive factor for tumour recurrence (p = 0.0401). For SCCs involving the nasal vestibule that are not amenable to limited surgical resection, TR along with adjuvant radiotherapy provide good oncological outcomes and should be considered the main treatment option.

Elevated APOBEC mutational signatures implicate chronic injury in etiology of an aggressive head-and-neck squamous cell carcinoma: a case report

BackgroundAggressive squamous cell carcinomas (SCCs) present frequently in the context of chronic skin injury occurring in patients with the congenital blistering disease recessive dystrophic epidermolysis bullosa. Recently, these cancers were shown to harbor mutation signatures associated with endogenous deaminases of the active polynucleotide cytosine deaminase family, collectively termed APOBEC, and clock-like COSMIC [Catalogue of Somatic Mutations in Cancer] signatures, which are associated with normal aging and might result from cumulative DNA replication errors. We present a case of a nasal septal SCC arising in the context of recurrent injury, but also modest past tobacco use. Our genetic analysis of this tumor reveals unusually high APOBEC and clock-like but low tobacco-related COSMIC signatures, suggesting that chronic injury may have played a primary role in somatic mutation. This case report demonstrates how signature-based analyses may implicate key roles for certain mutagenic forces in individual malignancies such as head-and-neck SCC, with multiple etiological origins.Case presentationWe report the case of a 43-year-old male former smoker who presented with congestion and swelling following a traumatic nasal fracture. During surgery, the mucosa surrounding the right nasal valve appeared abnormal, and biopsies revealed invasive keratinizing SCC. Frozen section biopsies revealed multiple areas to be positive for SCC. Gene sequencing showed loss of PTEN (exons 2–8), CDKN2A/B and TP53 (exons 8–9), MYC amplification, and BLM S338*. Exome sequencing data also revealed that 36% of mutations matched an APOBEC mutational signature (COSMIC signatures 2 and 13) and 53% of mutations matched the clock-like mutation signature (COSMIC signature 5). These proportions place this tumor in the 90th percentile bearing each signature, independently, in a reference data set combining cutaneous and The Cancer Genome Atlas (TCGA) head and neck SCC data. In contrast, few mutations harbored a tobacco-related COSMIC signature 4, representing about the 10th percentile in our reference SCC data set. The patient was treated with partial rhinectomy with local flap reconstruction, bilateral neck dissection, and adjuvant radiation therapy; the patient remains disease-free to date.ConclusionBased on comparative mutational signature analysis, we propose that the history of tobacco use and traumatic injury may have collaborated in activating APOBEC enzymes and the clock-like mutational process, ultimately leading to cancer formation. Clinical awareness of the relationship between epithelial injury and tumorigenesis should enhance earlier detection of this particularly aggressive type of cancer.

Facial rehabilitation with implant-retained nasal prosthesis of acrylic resin: a case report

ABSTRACT The objective of this study was to report a clinical case of facial rehabilitation with an acrylic implant-retained nasal prosthesis after partial rhinectomy resulting from the resection of a basal cell carcinoma in the patient, a 53-year-old Caucasian, normosystemic, professional cowboy. After clinical examination and in possession of computed tomography images, surgery was performed for the placement of conventional dental implants in the premaxillary region (left side). After the surgery, a three-month period of waiting was observed to allow osseointegration of the implants. Later, the nasal prosthesis was prepared, and at the end of treatment, this presented satisfactory peripheral adaptation, retention and esthetics. The patient has returned for follow-up every 6 months, regarding analysis of the prosthesis color, peri-implant health, hygiene, and exchange of the magnets and relays when necessary. The authors concluded that this therapy may be well indicated in patients with partial and total nasal defects, provided that there is correct planning and execution of the surgical, clinical and laboratory phases.

Fabricating a partial nasal prosthesis with a custom nasal dilator design

Patients undergoing partial rhinectomy with limited size may have the major portion of the nasal structure preserved. However, the fibrosis or scar formation after the surgery may cause distortion of remaining tissues, followed by nasal airway obstruction. By physically expanding an affected nostril during the impression and using digital technology to design a custom flexible internal nasal dilator, embedded in the medical grade silicone during processing, a partial nasal prosthesis with airway-maintaining purpose can be fabricated to improve quality of life both esthetically and functionally.

Nasal prosthesis after partial rhinectomy. A case report.

Maxillofacial defects can result from several reasons, including neoplasia, congenital malformations, trauma, oral infections, etc. This kind of defects can be severely debilitating to the patients. To improve the quality of life of these patients, the options include surgical reconstruction and maxillofacial prosthesis. However, surgical approaches have many inherent disadvantages and limitations. This case report describes the prosthetic rehabilitation of a female patient who underwent partial rhinectomy secondary to basal cell carcinoma. The case was planned with a silicone prosthesis with anatomic and spectacle retention. A non-surgical method of rehabilitation was followed owing to the patient’s choice and financial constraints. The final prosthesis was aimed at enhancing the esthetics and function of the patient, thereby improving her quality of life.

Nasal prosthesis with magnetically secured intranasal framework for a patient with partial rhinectomy and intra-oral defects: a case report

Partial rhinectomy is a challenge for most maxillofacial prosthodontists, as retention of the prosthesis is a major issue to overcome. The scenario becomes even more difficult when there is an intraoral defect. This article describes the fabrication of a removable silicone nasal prosthesis and removable PMMA intraoral obturator prosthesis to rehabilitate a patient following partial rhinectomy with associated loss of premaxilla. The retention of removable intraoral and extraoral prosthesis was achieved partially from anatomical undercuts and further enhanced by rare earth magnets placed between both prostheses. An acrylic framework was fabricated and placed inside to provide rigidity to the nasal part of the prosthesis. A customized method of making impressions using a modified syringe tube to mold the inner surface of the nasal defect is described. The obturator function scale (OFS) questionnaire was used to measure the patient's satisfaction with the obturator. After insertion of the prosthesis, there was an overall improvement in the OFS of the patient.This case report documents the rehabilitation of a patient following partial rhinectomy and associated loss of premaxilla with customized intraoral obturator prosthesis and a removable silicone nasal prosthesis. The successful outcome of this case shows that for people with similar orofacial defects, these prostheses are a good option to achieve acceptable esthetics, speech, and function.

Prosthetic Rehabilitation via Silicone Nasal Prosthesis with Internal Alar Support Following Partial Rhinectomy: A Short Communication.

To describe prosthetic rehabilitation following partial rhinectomy with use of a novel retentive internal nasal keeper piece. The reported novel nasal keeper piece engaged the intact inferior portions of the major alar cartilages and the alar fibrofatty tissues to aid in retention of the prosthesis. The reported prosthesis utilizes a retentive mechanism not previously reported in the literature to maximize function and esthetics.

A rare localised nasal CD30+ primary cutaneous T-cell lymphoma following liver transplantation

Cutaneous T-cell post-transplant lymphoproliferative disorder (PTLD) is a rare clinical presentation that can potentially turn aggressive in solid-organ transplant recipients if not detected and intervened on early. We encountered a...

Dentistry in nasal reconstruction

Introduction: Popularity of aesthetic nasal surgery is testament to the importance patients place on the cosmetic appearance of the nose. Some nasal defects following tumour surgery require a Rhinectomy or partial Rhinectomy. Nasal defects can have significant psychological and functional morbidity. There are various surgical options for reconstruction of nasal defects. There a variety of reconstructive methods including prosthetic. Dentists are used to taking intra oral impressions. We used this expertise to reconstruct patient specific splints.

Enhancing the quality of life: Prosthetic rehabilitation of nasal defect

Face is an important part of one's personality and body image. Facial disfigurement can have extremely negative psychological impact on any individual, which may include feeling of being ugly, deformed, disfigured, and complete loss of self-confidence. A facial prosthesis is fabricated to restore any such anatomical compromise, which can be congenital, due to trauma or oral/facial malignancies. Patients who need such prosthesis usually present a wide array of rehabilitation challenges mainly associated with restoring normal appearance. The following case report illustrates the prosthetic rehabilitation of a 9-year-old boy who was diagnosed with basal cell carcinoma of the nose and underwent partial rhinectomy. Surgical reconstruction was also done for the same, which was unsuccessful due to failure of graft. This led to loss of right lateral ala of the nose and depression of the upper half of the bridge of the nose. This case was then prosthetically managed with a spectacle retained nasal prosthesis made up of acrylic.

Nasal prosthesis for a patient with xeroderma pigmentosum

Acquired facial defects caused by extirpation of neoplasms, congenital malformations or traumatic injury results in a huge functional, cosmetic and psychological handicap in those patients. These defects can be restored by facial prosthesis using different materials and retention methods to achieve a lifelike appearance and function. This clinical report describes a treatment schedule using silicone nasal prosthesis, which is mechanically retained for a patient who has undergone a partial rhinectomy due to basal cell carcinoma of the nose. The prosthesis was made to restore the esthetic appearance of patient with a mechanically retained design using a spectacle glass frame without any prosthetic adhesives so that the patient is more comfortable and confident to resume daily activities.

Rehabilitation of a case of partial rhinectomy with silicone nasal prosthesis

A considerable number of people each year acquire facial defects as a result of malignant disease, trauma and congenital deformity. Malignancies of the nasal vestibule are rare and account for only 9% of all cancers of the nasal cavity and among the malignancies, the most common is squamous cell carcinoma.1,2 These neoplasms are usually fatal and require an early intervention. Management of malignant lesions often involves surgical excision to achieve healthy residual tissue. Tumours affecting the nose may necessitate a total or near-total rhinectomy, thereby creating a prominent midfacial defect. Surgical or prosthetic reconstruction is usually required. However, due to the prominent location and complexity of the anatomical configuration, surgery is not always feasible. This situation is further complicated by the esthetic and functional demands in this site. Psychological trauma due to their primary disease and post surgical deformity make them social outcasts and also there is a risk of frequent infections. Complications of surgical reconstruction of the nose include constriction of the tissues inward, contraction of the tissues upward and collapse of the tissues leading to an unfavourable aesthetic result. Moreover, the constriction and collapse of the involved tissues may lead to a loss of internal airway space, hindering respiratory function. Prosthetic rehabilitation of such cases with skin colored silicone prostheses is a most viable mode. This clinical report describes a simple and economical method for prosthetic rehabilitation of a case of partial rhinectomy with silicone nasal prosthesis.

Single-Step Nasal Reconstruction With Osteocutaneous Forearm Flap After Total Rhinectomy

Nasal defects resulting from tumor excision can be classified according to tissues involved, such as skin, cartilage, and bone. Although in the case of "simple" defects, reconstruction with loco-regional flap eventually associated with cartilage grafts can lead to satisfactory results; in the case of total or partial rhinectomy, a minimum of 3 and a maximum of 7 operations have to be performed in the current series to achieve an acceptable end result. We present the case of a total rhinectomy reconstruction in a single-step procedure with an osteocutaneous forearm free flap (RFOFF). A 50-year-old man underwent total rhinectomy to excise a pathologically proven T4aN0 moderately differentiated squamous cell carcinoma of the nose; contemporary single-step reconstruction with an RFOFF was performed. Adjuvant radiotherapy was performed. At 18 months of follow-up, the patient is free of disease and no postirradiation flap damage has been experienced; the flap notably did not appear to be bulky. We believe that the RFOFF is morphologically and functionally better than other flaps owing to its capability to adapt to the new environments of the nasal cavity, and to avoid, when possible, a three-dimensional reconstruction of the same.

Nasal prosthesis for a patient with basal cell carcinoma: A case report

Prosthetic rehabilitation of facial defects has always been a challenge for Maxillofacial Prosthodontists. These defects not only have functional and cosmetic problems but also have crippling effect on patient's psychology. An early rehabilitation is the key to successful alleviation of these debilitating effects. This case report presents the esthetic rehabilitation of a patient of partial rhinectomy with an acrylic nasal prosthesis tintcd with a commercial facial inake-up.

Nasal Prosthesis Rehabilitation: A Case Report

Facial defects resulting from neoplasm, congenital malformation or trauma can be restored with facial prosthesis using different materials and retention methods to achieve life-like look and function. A nasal prosthesis can re-establish esthetic form and anatomic contours for mid-facial defects, often more effectively than by surgical reconstruction as the nose is relatively immobile structure. For successful results, lot of factors such as harmony, texture, color matching and blending of tissue interface with the prosthesis are important. The aim of the presented case report is to describe the non-surgical rehabilitation, with polymethyl meth-acrylate resin, nasal prosthesis for a patient who received partial rhinectomy as a result of squamous cell carcinoma of the nose. The prosthesis was made to restore the esthetic appearance of the patient with a mechanical retained design using a spectacle glass frame without inserting craniofacial implants.