Silicone Prosthesis Research Articles

Antimicrobial effects of nano titanium dioxide and disinfectants on maxillofacial silicones

Statement of problemDeficient hygiene of maxillofacial prostheses can be a source of infection, and various disinfectants, including nano-oxides, have been suggested for the disinfection of silicone prostheses. While maxillofacial silicones involving nano-oxides at different sizes and concentrations have been evaluated in terms of their mechanical and physical properties, reports are lacking on the antimicrobial effect of nano titanium dioxide (TiO2) incorporated into maxillofacial silicones contaminated by different biofilms. PurposeThe purpose of this in vitro study was to evaluate the antimicrobial effects of 6 different disinfectants and nano TiO2 incorporation into maxillofacial silicone contaminated with Staphylococcus aureus, Escherichia coli, and Candida albicans biofilms. Material and methodsA total of 258 silicone specimens (129 pure silicones and 129 nano TiO2-incorporated silicones) were fabricated. Specimens in each silicone group (with or without nano TiO2) were divided into 7 disinfectant groups (control, 0.2% chlorhexidine gluconate, 4% chlorhexidine gluconate, 1% sodium hypochlorite, neutral soap, 100% white vinegar, and effervescent) in each biofilm group. Contaminated specimens were disinfected, and the suspension of each specimen was incubated at 37 °C for 24 hours. Proliferated colonies were recorded in colony-forming units per mL (CFU/mL). The differences in microbial levels among specimens were evaluated to test the effect of the type of silicone and the disinfectant (α=.05). ResultsSignificant difference was found among disinfectants regardless of the silicone type (P<.05). Nano TiO2 incorporation showed an antimicrobial effect on S aureus, E coli, and C albicans biofilms. Nano TiO2 incorporated silicone cleaned with 4% chlorhexidine gluconate had statistically less C albicans than pure silicone. Using white vinegar or 4% chlorhexidine gluconate led to no E coli on either silicone. Nano TiO2 incorporated silicone cleaned with effervescent had fewer S aureus or C albicans biofilms. ConclusionsThe tested disinfectants and nano TiO2 incorporation into silicone were effective against most of the microorganisms used in this study.

Treatment of tracheoesophageal fistulas following laryngectomy by customized prostheses-A bicentric case series.

Tracheoesophageal fistulas (TEF) following laryngectomy cause immense restrictions due to the inability of oral feeding, loss of voice rehabilitation, penetration of saliva, and permanent need of inflatable tracheal cannulas. Patients are consistently in threat of fatal aspiration pneumonias. The failure rate of surgical approaches to close the fistulas is high and an ultima ratio option by customized silicone prostheses can be considered. A retrospective analysis of 26 patients with a TEF was performed. The fistulas occurred in average 40 months after laryngectomy caused by an enlargement of the voice fistula in 17 patients and problems in wound healing in 6 patients. The mean diameter of the fistula was 32 × 18 mm. Eight patients were treated by a button-shaped and 18 by a tube-shaped prosthesis. Complete oral feeding was possible in 8 and additional feeding by percutaneous endoscopic gastrostomy tube in 16 patients. Voice rehabilitation by voice prostheses was possible in 18 cases. Fifteen patients died in the course of the treatment either due to oncological progression or other reasons. The median follow-up time of the patients alive was 36 months (max 88 months) with 2.2 protheses replacements in mean (max 11). The treatment of TEF by customized prostheses can be considered as an ultima ration option if other approaches had failed. At least, partial oral nutrition and voice rehabilitation as well as protection from aspiration can be achieved in the majority of the patients. 4-Case series.

Laparogastroscopy-A Transgastric Laparoscopic Approach for Malignant Esophageal Stenosis.

This paper presents the laparogastroscopy procedure, a mini-invasive, palliative method as an alternative to gastrostomy to be recommended by gastroenterologists. Laparogastroscopic stenting with endoluminal transtumoral drilling solves the problem of oral nutrition in patients with unresectable esophageal cancer, avoiding percutaneous feeding. The results of this technique are presented in a retrospective analysis of a study group of 63 patients with advanced esophageal carcinoma admitted between January 2015 and December 2020 at Department of General Surgery of Emergency County Hospital Sibiu, Romania, in terms of post-operative morbidity and mortality. The type of stents used were Pezzer prostheses (48.6%), silicone prostheses (31.9%), and self-expanding metal stents (6.9%). Eight patients (12.7%) had fistulas (at admission to the clinic), which were successfully sealed. Post-operative dysphagia was absent in most patients and minimal in 16.6% of patients, so all patients could initiate oral feeding, improving their nutritional status. The average length of hospitalization for all patients was 9.22 ± 5.05 days. The most frequent local complications were restenosis (9.5%), stent displacement (7.9%), and bleeding (4.8%). The mean survival time was 10.75 ± 15.72 months. Laparogastroscopic stenting could be a valuable alternative in palliative esophageal cancer surgery, improving the quality of life and nutritional status in patients unsuitable for endoscopic stenting.

The interaction of ionizing radiation and silicone medical implants: Evaluation of the effects on radiotherapy dose distribution and alteration in the physical properties of the silicone

Silicone prostheses are implanted inside the human body for medical aesthetics and reconstructive reasons. The presence of a silicone prosthesis around the radiotherapy volume may alter radiotherapy dose distribution and cause overdose and underdose areas in the target volumes and organs at risk. The interaction of silicone with radiation may be two-sided since high dose radiation may cause alteration of the physical and chemical properties of silicone which further contributes to changes in the dose distribution. The aim of this study was to evaluate the changes in radiation dose distribution caused by silicone and the effects of irradiation on silicone elastomer prostheses.A special set-up was prepared in the water phantom to obtain depth dose and profile data for non-irradiated silicone blocks prior to the irradiation schedule. Entrance and exit doses between silicone and water medium were measured using thermoluminescence dosimetry (TLD). Hardness tests on silicone blocks were performed by using Tronic Shore A Durometer device and density tests were performed by using Scaltec density determination instrument. Irradiation of the silicone was performed using a linear accelerator with 6 MV and 10 MV photon energies, 2 Gy daily fractions in 5 weeks were delivered to a total dose of 50 Gy. After the completion of 5 weeks schedule depth doses, profile measurements, entrance-exit doses and density-hardness tests were repeated.The non-irradiated silicone blocks affected the depth dose distribution in the water phantom to a maximum dose reduction of 1.5% for 6 MV and 1.6% for 10 MV. After the 5 weeks of irradiation, depth dose reduction increased to 2.5% for 6 MV and 2.0% for 10 MV. Silicone blocks affected the dose profile as well: maximum dose difference was 2.7% for 6 MV and 2.4% for 10 MV for non-irradiated silicone, 2.6% for 6 MV, and 2% for 10 MV after 50 Gy. However, these changes in depth dose and profile data in non-irradiated and irradiated silicone were not significant. There was up to an 8% dose decrease in exit doses beyond the silicone with the use of a single direct irradiation field, which is expected to be reduced with multi-field radiotherapy. The physical properties of the non-irradiated and irradiated silicone measured by hardness and density tests were similar. The only physical difference we noted was the discoloration of silicone to a yellowish color. According to our results silicone elastomer prostheses did not have significant effects on dose distribution after 50 Gy irradiation, and radiation doses used for radiotherapy did not alter the physical properties of silicone blocks except for discoloration.

Silicone radial head prostheses revisited: do they have a role in today's practice? A systematic review of literature on clinical outcomes.

Silicone radial head prostheses (SRHP) are considered obsolete due to reports of frequent failure and destructive silicone-induced synovitis. Considering the good outcomes of modern non-radial silicone joint implants, the extent of scientific evidence for this negative view is unclear. The aim of this research was to systematically analyze the clinical evidence on complications and outcomes of SRHP and how SRHP compare to both non-SRHP and silicone prostheses of other joints. A systematic literature review was conducted through the Cochrane, PubMed, and Embase databases. Eight cohort studies were included, consisting of 142 patients and follow-up periods ranging from 23 months to 8 years. Average patient satisfaction was 86%, range of 71%-100%, and 58 complications were seen, but no cases of synovitis. These outcomes were in line with non-SRHP. Four case series with 11 cases of synovitis were found, all due to implant fractures years to decades after implantation. Six systematic reviews of currently used non-radial silicone joint implants showed excellent outcomes with low complication rates. Since SRHP have satisfactory clinical results and an acceptable complication rate when selecting a patient group in suitable condition for surgical indications, it is considered that SRHP can still be chosen as a potential surgical treatment method in current clinical practice. Level of evidence: 2A.

Prosthetic Rehabilitaion of an Exenterated Defect with a Magnet Retained, Customised Stock Eye Two-piece Hollow Orbital Prosthesis: A Case Report

Loss of the eye results in a functional impairment, disfigurement of the face and long-term psychological effects on the patient. Coronavirus Disease-2019 (COVID-19) pandemic was accompanied by an increase in the number of patients reporting with mucormycosis. The treatment often involves widespread excision of the involved area, leading to gross facial deformity. Rehabilitation of the orbital defect is a complex task and requires a thorough treatment planning. It has always been challenging for a prosthodontist to create an orbital prosthesis for an exenterated defect brought on by post-COVID mucormycosis because it is difficult to meet the patient’s expectations. It is a time-consuming process requiring multiple appointments with every appointment being an important one. The advent of Computer-Aided Design/Computer-Aided Manufacturing (CAD-CAM) technology has made the fabrication simple, but not all have access to the required infrastructure. The conventional and economical silicone prosthesis still is a popular choice among clinicians. A 52-year-old male patient reported to the Department of Prosthodontics for an artificial substitute of his missing left eye, which was exenterated in the surgical treatment of mucormycosis. The present case report describes the fabrication of a two-piece magnet retained hollow orbital prosthesis with a “customised stock eye”. The prosthesis is designed in such way that, it utilises the natural undercut in the defect and a magnet between the conformer and the prosthesis. This yields in better maintenance and limiting the contact of silicon with the body fluids, thereby, enhancing the long-term use.

Fabrication of Silicon Prosthesis For a Partial-Auricular Defect in an Eight- Year-Old Patient: A Case Report

Loss of the external ear can be congenital or acquired due to accidental trauma or malignant disease. Patients usually seek the prosthetic treatment for defects in head and face area when they feel that their function or esthetics are compromised. Literatures show that most of the prosthesis are fabricated in adult patients. Most of the time, dependence of the children on the parents for decision making and finances overshadows the psychological needs and perspectives of children. Present care report highlights the fabrication of silicone prosthesis for partial auricular defect in an eight-year-old child patient, who was conscious about his appearance due to the external defect in his pinna.

A Case Report on Prosthetic Rehabilitation of Post-Mucormycosis-Clinical Cases

Mucormycosis is an opportunistic fungal infection, which mainly affects immunocompromised patients. Once the maxilla and orbit are involved, surgical resection and debridement of the necrosed areas can result in extensive defects .in prosthetic rehabilitation of such cases the major challenge is the replacement of misssing soft and hard tissues following surgical resection. Hence an acceptable replacement of such defects becomes a challenge to maxillofacial prosthodontists. This case series describes two cases of post mucormyosis rehabilitation. The first case describes the fabrication of an orbital silicone prosthesis retained with medical grade adhesive and the second case describes fabrication of a hollow bulb obturator for hemimaxillectomy. The final prosthesis in both the cases were esthetically pleasing, functionally efficient and boosted the patient’s morale, encouraging them to lead a normal life.

Analysis of breast follow-up results in patients after polyacrylamide hydrogel (PAAG) or silicone prosthesis removal

BackgroundPolyacrylamide hydrogel has been prohibited since 2006 due to numerous complications. Unsatisfactory breast contour was always observed in patients after PAAG removal. The same occurred in patients after silicone prosthesis removal. We attempt to compare and analyze the difference in postoperative breast conditions and pathology between the two groups. MethodsWe retrospectively reviewed the data of patients who underwent PAAG or silicone prosthesis removal between 2011 and 2021. The BREAST-Q was used to evaluate the follow-up results, including satisfaction with breasts, physical well-being, psychosocial well-being, sexual well-being, and the operation. ResultsA total of 63 patients were analyzed. The PAAG group complained of more lumps or indurations (p = 0.004), benefited less from operations as for symptomatic relief (p = 0.002), and had more chronic inflammation(p = 0.000) than the silicone group. No breast cancer was found. All the Breast-Q scores were lower in the PAAG group than in the silicone group, and there was a significant difference in satisfaction with physical well-being (p = 0.035). Besides, patients without symptoms tended to score higher in all aspects of Breast-Q than patients with symptoms after removal. The two groups (symptom & no symptom) differed in psychosocial well-being (p = 0.043) and satisfaction with operation (p = 0.048). ConclusionsThe breast contour of patients after PAAG or silicone prosthesis removal was worse than before. Early removal of PAAG before complications arise may result in a better surgical benefit. There is no doubt that PAAG are harmful both physically and psychologically. All patients are suggested to have PAAG injections removed.

Replacement of Missing Hallux with Glove type Silicone Prosthesis- A Case Report

Loss of hallux produces significant esthetic and functional deficiencies. The concealment of an amputated part with the help of prosthesis can shield an amputee from social stigma. Prosthesis for such patient must be comfortable to wear lightweight, durable, cosmetically pleasing easy to put on and remove. The prosthetic rehabilitation of an amputated finger/toe is considered when microvascular reconstruction is not possible, unavailable, unsuccessful, or unaffordable. Replacement by prosthesis offers psychological support and social acceptance in such cases. This clinical report describes a method to fabricate glove retained silicone toe prosthesis in a patient with greater toe loss.

EFFECT OF DISINFECTION ON THE PHYSICAL PROPERTIES OF MAXILLOFACIAL SILICONE MATERIAL : A SYSTEMATIC REVIEW

Purpose – Prosthetic results are largely dominated by physical and mechanical properties of materials used. This systematic review aims to identify and interpret results of studies that evaluated effect of disinfection on physical properties of maxillofacial silicone elastomers. Search for all articles regarding the topic, written Method – in English language only, before December 2021 was carried out using electronic search in PubMed, Google Scholar and Scopus. Also a manual search in all major Prosthodontic, Research and Biomaterial journals was carried out. A Results – fter initial search, screening and final selection, 28 studies were selected for review based on inclusion-exclusion criteria. Among the studies selected only 1 study was published before year 2000 describing the influence of disinfectant on physical properties of maxillofacial silicone elastomer. Though 27 studies have been published in the period between 2008 to 2021, depicting the change of trend in research in maxillofacial prosthodontics. Disinfectio Conclusion- n influence various physical properties of maxillofacial silicone elastomer. Currently no ideal silicone material is available for prosthetic rehabilitation. So there is a need for more search and research to develop a successful maxillofacial silicone elastomer. Also the literature describing selection of disinfectant and protocol for disinfection of silicone is highly variable. Hence the standardization organisations or scientific community must design a standard protocol for disinfection procedure to improve longevity of silicone prosthesis and health of surrounding natural tissues.

Braxon®-assisted prepectoral breast reconstruction: A decade later.

We are sitting on the cusp of the bioengineered breast era, in which implant-based breast reconstruction is seeing a growing trend and biotechnology research progressively empowers clinical practice. As never before, the choice of biomaterials has acquired great importance for achieving reconstructive outcomes, and the increase in the use of acellular dermal matrices (ADMs) in the field of senology tells us a story of profound upheaval and progress. With the advent of prepectoral breast reconstruction (PPBR), plenty of devices have been proposed to wrap the silicone prosthesis, either completely or partially. However, this has caused a great deal of confusion and dissent with regard to the adoption of feasible reconstructive strategies as well as the original scientific rationale underlying the prepectoral approach. Braxon® is the very first device that made prepectoral implant positioning possible, wrapping around the prosthesis and exerting the proven ADM regenerative potential at the implant-tissue interface, taking advantage of the body's physiological healing mechanisms. To date, the Braxon® method is among the most studied and practiced worldwide, and more than 50 publications confirm the superior performance of the device in the most varied clinical scenarios. However, a comprehensive record of the working of this pioneering device is still missing. Therefore, our aim with this review is to lay a structured knowledge of surgery with BRAXON® and to provide a decision-making tool in the field of PPBR through a complete understanding on the very first device for prepectoral, one decade after its introduction.

Prosthetic rehabilitation of an orbital defect post-COVID, mucormycosis – A case report

Maxillofacial defects compromise appearance and function making individuals incapable of leading a relatively normal life. It is always not possible to rehabilitate all these defects using plastic surgery. Although remarkable advancements have evolved in this field, the patient’s financial constraints make the prosthodontist think about the basic concepts and techniques in the fabrication of these prostheses. Hence an acceptable replacement of such defects becomes a challenge to maxillofacial prosthodontists. Hence an acceptable replacement of such defects becomes a challenge to maxillofacial prosthodontists.This case report describes a simplified method of fabrication of an orbital silicone prosthesis retained with medical grade adhesive for the rehabilitation of the left eye using inverted anatomic tracing followed by fabrication and processing of the wax pattern. Hence it is the responsibility of the maxillofacial prosthodontist to deliver an esthetically acceptable prosthesis that improves the patient’s morale and help them to lead a normal life.

Local recurrence of mammary Paget’s disease after nipple-sparing mastectomy and implant breast reconstruction: a case report and literature review

ObjectiveTo provide a rare case of local recurrent Paget’s disease after nipple-sparing mastectomy (NSM) with immediate breast reconstruction with 10 years of disease-free survival and to analyze the clinical and pathological characteristics.BackgroundMammary Paget’s disease can be considered a rare type of local recurrence after breast cancer treatment, both in cases of conservative surgery and NSM with immediate breast reconstruction (Lohsiriwat et al, Ann Surg Oncol 19:1850-1855, 2012). Recurrent patients who present with nipple-areolar Paget’s disease usually have unfavorable primary pathological characteristics and different latency periods. However, the recurrent status in patients with favorable primary pathological characteristics and the latency periods after NSM with immediate breast reconstruction are unclear.MethodsFirst, we present a case of local recurrent Paget’s disease in a young patient diagnosed with invasive breast carcinoma at age 30 who underwent NSM with primary silicone reconstruction. Then, the keywords “Paget’s disease” and “nipple-sparing mastectomy” were selected. Articles including the local recurrence of Paget’s disease after NSM were collected from the PubMed, Springer, and OVID databases, and the acquired relevant data were analyzed. We did not restrict our search by study design or publication date.ResultsFive studies describing 31 cases of local recurrent Paget’s disease after NSM with implant breast reconstruction were included. The mean patient age reported was 45 years, and the average latency period from NSM to the local recurrence of Paget’s disease was 40.2 months. Recurrent tumor histological features were Paget’s disease with ductal carcinoma in situ (DCIS) in 16 patients (50%), Paget’s disease without DCIS in 13 patients (40.6%), and Paget’s disease with ductal intraepithelial neoplasia (DIN) in 3 patients (9.4%). The primary tumor histological feature was estrogen receptor (ER)(−)/progesterone receptor (PR)(−)/human epidermal growth factor receptor (HER-2)(+) in 21 patients (77.8%). Neither locoregional relapse nor metastatic events were found in these recurrent patients who accepted NAC excision after 4–5 years of follow-up. Our reported case showed that the patient experienced pregnancy and lactation after primary adjuvant chemotherapy and endocrine therapy. However, she developed an eczematoid lesion in the NAC 120 months after breast surgery. The histopathological examination was consistent with Paget’s disease of the breast. Complete NAC and breast silicone prosthesis removal were performed. The patient accepted no systematic or local therapy and is currently alive. It is noteworthy that the biological features of the primary tumor were ER(+), PR(+), and HER-2(−); however, the recurrent tumor changed to ER(−), PR(−), and HER-2(+).ConclusionsThe local recurrence of Paget’s disease after NSM is uncommon; it may develop at a very early age and have a very long time to recurrence, as in our patient, who presented with recurrence 10 years after primary surgery. Surgeons should be wary of local recurrence of the nipple-areola complex after NSM in patients with ER-negative and HER-2-positive primary tumors. However, patients with ER/PR-positive and HER-2-negative tumors should not be neglected; we reported a case of an ER/PR-positive and HER-2-negative primary tumor, and ER-positive recurrent cases have the longest latency period. The local recurrence rate of Paget’s disease after NSM is low, and the prognosis is good in recurrent patients who accept further extensive NAC excision. Further systematic treatment was not considered for this patient.

Auricular prosthesis positioning using virtual planning in combination with additive manufacturing

IntroductionThis study focused on deformed or missing auricles and their replacement with silicone prostheses which are retained by craniofacial implants. Surgeons find it difficult to accurately place the implants in relation to the missing auricle in theatre. The aim of this study was to develop patient-specific devices using additive manufacturing technologies and associated software to indicate the positions of implants and to correctly orientate the prostheses relative to the positions of the implants. Material and methodsThe morphology of the patient was determined using Computed-Tomography (CT) scanning and the opposite auricle was mirrored in the virtual environment through specialized software from Materialise. A positioning guide for placing the implants was developed, together with an orientation guide that orientates the prosthesis accurately in relation to the implants. The orientation guide is a new development in the field of maxillofacial prosthetics and has not been attempted before. The guides are produced in nylon through laser sintering additive manufacturing. ResultsThe accuracy of implant placements was determined and the results showed relatively accurate positioning using the guides. DiscussionImplant placement showed some deviation which can largely be attributed to improper use of the guide by the surgeon during the marking of implant positions. The orientation guide can however somewhat compensate for this to still achieve aesthetically pleasing results. Using the guides significantly reduces risk, time and cost in placing the implants and producing auricular silicone prostheses.

Color-matching techniques for creating esthetic hand and finger prostheses.

Color matching is a critically important part of, and by far, also the most challenging aspect of producing esthetic silicone prosthesis. There is a knowledge gap in the literature and a lack of opportunities for training in the expertise, particularly regarding color-matching techniques. This article details a color-matching technique that is able to achieve life-like coloration in esthetic prosthesis. Each prosthesis is molded in an outer and inner layers of silicone tinted to different shades and opacities incorporating an intermediate touch-up layer to reproduce the detailed coloration of the hand (because of the presence of veins, finger joint/dermal pigmentations, a vascularized nail bed, and pinkish palm). This method of color-matching prosthesis combining intrinsic and extrinsic techniques simulates the layered anatomy and optical properties of the human skin to effectively replicate its esthetic and life-like coloration. Technical tips for achieving an accurate color match to the patient's skin, including pigment formulation adjustments for a tanned vs. a fair skin, and for painting the touch-up details are discussed. Methods for modifying the color tones of completed prosthesis and for minimizing metameric color differences when the prosthesis is viewed under different light sources are also presented. The technique is instrumental in achieving good outcomes for life-likeness and esthetic coloration in the prostheses fitted at our center. Studies previously published that investigated patients' evaluation of important esthetic characteristics of their prosthesis after a period of adjustment to fitting have shown a generally high level of patient satisfaction.

Impact of Silicone Finger Prosthesis in Activities of Daily Living and Passive Function in Proximal Phalanx Index Finger Amputation

The index finger plays a major role in hand function. Subjects who sustain traumatic amputation of the single index finger also suffer both psychological and functional loss. Most of previous studies primarily focused on psychological benefits with finger prosthesis; however, it is essential to identify the functional benefit of the silicone finger in respective activity spectrum. To determine the improvement in function and activities with silicone finger prosthesis in proximal phalanx index finger amputation. Sixteen subjects were evaluated for the grip strength, pinch strength, and activities with dynamometer position II, pinchometer, and DASH questionnaire, respectively. Significant improvement of grip strength revealed in dynamometer position II ( p = 0.041) when tested without and with silicone finger prosthesis. The overall abilities in activities of daily living were improved significantly ( p = 0.005) as assessed by disability of arm, shoulder and hand questionnaire. Large effect sizes were noted in some activities like writing, jar opening, and carrying heavy object. Silicone finger prosthesis provides a functional benefit to the subjects in multiple activities. Partial loss of a finger has a relationship in limitation of hand function. Generally, clinicians prescribe silicone prosthesis for rehabilitation of finger amputee to restore the cosmetic purpose; however, functionality of the finger is also required to be restored. This study describes the role of silicone finger prosthesis on function and different activities for the subjects suffering from the index finger proximal phalanx amputation. Nayak S, Lenka PK, Equebal A, et al. Impact of Silicone Finger Prosthesis in Activities of Daily Living and Passive Function in Proximal Phalanx Index Finger Amputation. Indian J Phys Med Rehab 2019;30(3):59–65.

Breast reconstruction with silicone prosthesis and acellular dermal matrix of porcine origin: Retrospective study of 84 cases

Breast reconstruction (BR) using a prosthesis implant (PI) associated with an acellular dermal matrix (ADM) is a known method that has been the subject of discussion in recent years. The objective of this study was to quantify the rate of PI removal after BR using prosthesis combined with ADM, and to identify the risk factors in the event of removal. This was a retrospective study conducted between 2010 and 2015. Inclusion criteria were patients who had undergone immediate (IBR) or delayed (DBR) breast reconstruction with placement of a PI associated with porcine ADM. The primary endpoint was the postoperative removal of the PI. In all, 84 reconstructions were performed. The mean age of the population was 57.5 years. 25.9% of the patients were active smokers at the time of surgery. 89.5% of patients had previously benefited from ipsilateral breast radiation therapy (IBRT) in DBR, 10.5% in IBR. The PI deposition rate, all BR combined, was 21.4%. It was 52.17% in smokers and 9.84% in non-smokers (P<0.0001), making smoking an independent risk factor for reconstruction failure (hazard ratio (HR)=7.4, 95%CI [2.64-20.9]). IBRT was also a risk factor for PI removal, especially when performed after IBR (HR=8.1, 95%CI [1.1-62.1]). Smoking and adjuvant IBRT are risk factors for failure of reconstruction by PI associated with ADM. This type of reconstruction should be selected for non-smokers who have not undergone IBRT and therefore could be a therapeutic alternative in the BR panel.

Treatment of acute intraoperative Budd-Chiari syndrome by placement of silicone prosthesis

Complete liver mobilization for major resections sometimes causes liver tilting due to the release of the suspensory elements of the liver. Rarely this may take to a liver abnormal position with acute obstruction to venous flow at the suprahepatic level (Budd-Chiari syndrome). To avoid this complication, techniques such as post-operative stent implantation have been described. The case of a patient who underwent a complete mobilization of the liver for resection of the inferior venous cava and a right renal tumor, was reported. After that, an acute Budd-Chiari Syndrome was observed caused of the liver malposition, which was solved with the placement of two silicone prostheses in the liver cell.

“A MIRAGE TO THE REAL EYE”- CUSTOM MADE ORBITAL PROSTHESIS

The art of reconstruction of the defects by non-living substitutes is the heart of maxillofacial prosthodontia1 . Reconstruction of any facial defect is a challenging task as a clinician. The prevalence of the eye defects has been reported to be about 60%, majority of which have been amongst the males.2 The loss of an eye may be due to a congenital defect,tumour,trauma. Rehabilitation of such complex defects requires a customised approach for the successful outcome of the prosthesis2. Peymen et al. has classified the surgical management of the removal of eye as: evisceration, enucleation and exenteration. Rehabilitation of the orbit with lost volume can be done either by a surgery or with the help of a prosthetic device3 . A craniofacial prosthesis that replaces the eyeball is an orbital prosthesis whereas the one which replaces the surrounding periorbital tissues is an ocular prosthesis. An accurate management for a successful rehabilitation involves a multidisciplinary approach4 This case report presents a practically convenient procedure for the construction of a customised orbital prosthesis that is aesthetically pleasant, retentive, and cost-effective. Here, the management following an enbloc removal of an eye was done using an adhesive retained silicone prosthesis.