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The use of zygomatic implants for the retention of nasal prosthesis following total rhinectomy
e108
P21 / British Journal of Oral and Maxillofacial Surgery 52 (2014) e75–e127
Results: Initial results from the UK wide survey have shown that couplers are not being used routinely in all units. Times for anastomoses by coupler was 8-13 minutes compared to 35-45 minutes for sutured anastomoses. There were no flap failures or take backs. The couplers cost £150 each. A suture costs £9. The approximate cost of theatre time is £15 per minute. The approximate saving is £300 per case. Conclusion: The coupler is an effective time saving tool, which is under-utilised. Couplers with an integrated Doppler probe, can also be used for flap monitoring.
P96 Poster withdrawn
http://dx.doi.org/10.1016/j.bjoms.2014.07.198 P97 The use of zygomatic implants for the retention of nasal prosthesis following total rhinectomy Neil Scott ∗ , M.A. Kittur, P. Evans
http://dx.doi.org/10.1016/j.bjoms.2014.07.196 P95 An evaluation of the survival rates of extra-oral implants used to retain over 200 facial prostheses over a 10 year period Thomas Kiwanuka ∗ , Daanesh Zakai, Peter Jeynes, Keith Webster University Hospital Birmingham NHS Trust Introduction: Osseo-integrated implants have been used for craniofacial prostheses since 1977 by Branemark, who used implants for the retention of bone anchored hearing aids. The first implant borne auricular prosthesis was placed in 1979. Since then the use of implants for the retention of prosthetic devices has been used widely at various anatomical sites in the craniofacial region with varying success. The success rate of implants used to retain prostheses is variable, studies have shown that the survival rates for auricular, nasal and orbital implants differ. This study uses data from the largest series in Europe to evaluate how significant anatomical sites and adjunctive treatments affect the overall survival. Aims: 1. Assess the survival rates of osseo-integrated implants placed at 3 different anatomical sites (auricular, nasal, orbital) over a 10 year period. 2. Evaluate the effect of radiotherapy on the success rates. 3. Assess other factors that may have had an effect on the survival rates. Methods & Materials: A retrospective analysis of the survival rates of extra-oral implants from over 200 patients over a 10 year period. Results: Overall survival was greatest for auricular prostheses, then orbital & nasal prostheses. Radiation had a significant outcome on survival. Conclusions: Overall implant survival for implant borne facial prostheses is high. Radiotherapy, especially prior to implant placement has a negative effect on implant survival. http://dx.doi.org/10.1016/j.bjoms.2014.07.197
Morriston Hospital, Swansea Introduction: Reconstruction and rehabilitation following rhinectomy remains controversial and presents a complex problem. Although reconstruction with local and microvascular flaps is a valid option, the aesthetic results may not always be satisfactory. The aesthetic results achieved by a nasal prosthesis are far superior but patient acceptance relies on a secure method of retention. The advent of osseo-integrated implants has greatly improved anchorage, however, placement of fixtures in the nasal region still provides challenges due to the quantity and quality of the bone available. We present our technique and experience of zygomatic implants for the retention of nasal prostheses post rhinectomy. Methods: 25 patients underwent rhinectomy with prosthetic rehabilitation using zygomatic implant retained nasal prostheses. 0.5 mm slice 3D CT scans were imported into 3D imaging software (MIMICS) to allow the pre-operative planning and design of the surgical guide which is used for the placement of the zygomatic implants. Results: All patients were reviewed at 1, 6 and 12 months post-operatively. At each review, stability of fixtures, condition, fit, retention of the prosthesis and patient satisfaction were checked. Complications both intra-operative, delayed and post radiotherapy were noted. 50 implants have now been placed and our detailed results from this cohort will be presented. Conclusion: This method allows accurate placement of zygomatic implants avoiding vital structures and minimises the incidence of complications and implant loss. It offers great retention and durability thus improving patient satisfaction in a cohort of patients often with reduced implant survival rates and limited bone available for fixture placement. http://dx.doi.org/10.1016/j.bjoms.2014.07.199
P21 / British Journal of Oral and Maxillofacial Surgery 52 (2014) e75–e127
Results: Initial results from the UK wide survey have shown that couplers are not being used routinely in all units. Times for anastomoses by coupler was 8-13 minutes compared to 35-45 minutes for sutured anastomoses. There were no flap failures or take backs. The couplers cost £150 each. A suture costs £9. The approximate cost of theatre time is £15 per minute. The approximate saving is £300 per case. Conclusion: The coupler is an effective time saving tool, which is under-utilised. Couplers with an integrated Doppler probe, can also be used for flap monitoring.
P96 Poster withdrawn
http://dx.doi.org/10.1016/j.bjoms.2014.07.198 P97 The use of zygomatic implants for the retention of nasal prosthesis following total rhinectomy Neil Scott ∗ , M.A. Kittur, P. Evans
http://dx.doi.org/10.1016/j.bjoms.2014.07.196 P95 An evaluation of the survival rates of extra-oral implants used to retain over 200 facial prostheses over a 10 year period Thomas Kiwanuka ∗ , Daanesh Zakai, Peter Jeynes, Keith Webster University Hospital Birmingham NHS Trust Introduction: Osseo-integrated implants have been used for craniofacial prostheses since 1977 by Branemark, who used implants for the retention of bone anchored hearing aids. The first implant borne auricular prosthesis was placed in 1979. Since then the use of implants for the retention of prosthetic devices has been used widely at various anatomical sites in the craniofacial region with varying success. The success rate of implants used to retain prostheses is variable, studies have shown that the survival rates for auricular, nasal and orbital implants differ. This study uses data from the largest series in Europe to evaluate how significant anatomical sites and adjunctive treatments affect the overall survival. Aims: 1. Assess the survival rates of osseo-integrated implants placed at 3 different anatomical sites (auricular, nasal, orbital) over a 10 year period. 2. Evaluate the effect of radiotherapy on the success rates. 3. Assess other factors that may have had an effect on the survival rates. Methods & Materials: A retrospective analysis of the survival rates of extra-oral implants from over 200 patients over a 10 year period. Results: Overall survival was greatest for auricular prostheses, then orbital & nasal prostheses. Radiation had a significant outcome on survival. Conclusions: Overall implant survival for implant borne facial prostheses is high. Radiotherapy, especially prior to implant placement has a negative effect on implant survival. http://dx.doi.org/10.1016/j.bjoms.2014.07.197
Morriston Hospital, Swansea Introduction: Reconstruction and rehabilitation following rhinectomy remains controversial and presents a complex problem. Although reconstruction with local and microvascular flaps is a valid option, the aesthetic results may not always be satisfactory. The aesthetic results achieved by a nasal prosthesis are far superior but patient acceptance relies on a secure method of retention. The advent of osseo-integrated implants has greatly improved anchorage, however, placement of fixtures in the nasal region still provides challenges due to the quantity and quality of the bone available. We present our technique and experience of zygomatic implants for the retention of nasal prostheses post rhinectomy. Methods: 25 patients underwent rhinectomy with prosthetic rehabilitation using zygomatic implant retained nasal prostheses. 0.5 mm slice 3D CT scans were imported into 3D imaging software (MIMICS) to allow the pre-operative planning and design of the surgical guide which is used for the placement of the zygomatic implants. Results: All patients were reviewed at 1, 6 and 12 months post-operatively. At each review, stability of fixtures, condition, fit, retention of the prosthesis and patient satisfaction were checked. Complications both intra-operative, delayed and post radiotherapy were noted. 50 implants have now been placed and our detailed results from this cohort will be presented. Conclusion: This method allows accurate placement of zygomatic implants avoiding vital structures and minimises the incidence of complications and implant loss. It offers great retention and durability thus improving patient satisfaction in a cohort of patients often with reduced implant survival rates and limited bone available for fixture placement. http://dx.doi.org/10.1016/j.bjoms.2014.07.199