437Pakistan Oral & Dental Journal Vol 34, No. 3 (September 2014)

INTRODUCTION

Defects of the oral and maxillofacial region may result from trauma, tumor ablative surgeries, and congenital defects.1 These defects not only affect the fuctions and quality of life but also affect the psychology and social behavior of the patients.2 Face is the sensi-tive and presentable part of the body demanding the functional and esthetic surgical reconstruction or tissue like prosthesis which may camouflage the defect. The reconstructive options depend upon the size and site of defect, etiology, general health and medical condi-tion of the patient, and patient’s desire for surgical or prosthetic rehabilitation.6 Prosthetic rehabilitation of nasal defects with or without implant support is also helpful treatment therapy which allow the patients to participate actively in society.5 The advantages of nasal prosthesis are that it is inexpensive, easy to fabricate, esthetically good, can be given in healing phase and most importantly recurrence can be observed easily after the malignant tumor resections.1 The disadvan-tages include these prosthesis need adhesive or implant support, its removal could affect patients perception of the body image.4 Eyeglasses are easily available and inexpensive mean of retaining the nasal prosthesis.3 Different materials and techniques have been used

to fabricate nasal prosthesis, however still there is no material that resemble the natural skin. Silicones are the preferred material for maxillofacial prosthesis fabrication due to its qualities of light weight and tissue like appearance.1

CLINICAL REPORT

A 60 years old male patient came to Oral and Maxillofacial Department of King Edward Medical University, Lahore with the history of blast injury one year back. On clinical examination it was noted that he had lost his all nose resulting in large defect in nasal region. Nasal soft tissue and bone was lost and nasal chonchae were visible. Surgical and prosthetic Treatment options were discussed with patient which included Reconstruction of nose using autogenous rib graft and median forehead flap or prosthetic rehabili-tation of nose using silicone nasal prosthesis. Patient refused to undergo extensive reconstructive surgery under general anesthesia and showed the desire for prosthetic rehabilitation. Informed consent was taken after explaining all the procedure and possible results to the patient.

PROCEDURE DETAILS

1 Moist gauze pack was filled in the defect to avoid the intrusion of impression material into the nasal cavity.

2 Petroleum jelly was applied to lubricate the skin of face, eyes lashes, and eyebrows.

3 Using the irreversible hydrocolloid impression material impression of the defect was taken and poured in hard plaster.

PROSTHETIC REHABILITATION OF TRAUMATIC NASAL DEFECT: A CASE REPORT

1AHMAD LIAQUAT, BDS, FCPS Resident2NABEELA RIAZ, BDS, MCPS, FCPS (Prosthodontics), FCPS (Oral & Maxillofacial Surgery)

ABSTRACT

Trauma, tumor resection, and congenital deformities results in facial defects.1 These defects are highly unpleasing and cause a considerable psychological stress to patients. Site and size of defect, etiology of tissue loss and age of the patients are the factors which are to be considered when planning for reconstruction. Some people may not be medically fit for long reconstructive surgeries or may not wish to undergo surgery. Here is the case report of the patient who preferred prosthetic nasal rehabil-itation rather plastic reconstructive surgery.

Key Words: Nasal prosthesis, prosthetic rehabilitation of nose, nasal defect.

1 Head of the Department of Oral and Maxillofacial Surgery, King Edward Medical University, Lahore. Tel: 0092 300 4621538

E-mail: drnabeelariaz@yahoo.com Postal address: 24-C, G.O.R-II Bahawalpur House, Lahore.

2 FCPS Resident in Oral and Maxillofacial Surgery, King Edward Medical University, Lahore. Corresponding Author,

Tel: 0092 345 4155798 E-mail: ahmadliaquat@hotmail.com Postal address: 27-E PIA Colony, Lahore. Received for Publication: April 6, 2014 Revision Received: August 20, 2014 Revision Accepted: August 25, 2014

438Pakistan Oral & Dental Journal Vol 34, No. 3 (September 2014)

Nasal defect prosthetic rehabilitation

Fig 7: Final prosthesis after color matchingFig 3: Incorporation of hair to simulate originality

Fig 4: Retension and camouflage of prosthesis by eye-glases

Fig 1: Post traumatic nasal defect

Fig 2: Fabrication of silicon nasal prosthesis

Fig 5: Left lateral view Fig 6: Right lateral view

4 Patient was asked to bring pre injury photographs to evaluate the shape of his original nose. Then his relatives were called to select the donor for impression of prosthetic nose. Luckily his younger son had nose resemblance of his father. Alginate impression of the nose of his son was taken and poured in wax.

5 The wax nose was sculptured to adapt the defect on model. Holes were made through the defect area to fabricate light weight prosthesis and to allow breathing.

6 Eye glass frame was given to the patient for reten-tion and to camouflage the nasal prosthesis.

7 The wax prosthesis was verified at trial insertion with the eye glasses and then sent to the laboratory for fabrication in silicone.

8 Paints were added in silicone to simulate the skin of nose and artificial hair were applied on the external surface and nares to give originality to prosthesis

439Pakistan Oral & Dental Journal Vol 34, No. 3 (September 2014)

Nasal defect prosthetic rehabilitation

9 Finally the silicone nasal prosthesis was applied on the patient with the eye glass framework. The prosthesis provided a life like appearance and exactly matched the skin color and texture.

SUMMARY

Road traffic accidents, interpersonal violence and blast injuries results in facial defects. Various treat-ment modalities are available to treat such defects. This clinical report describes an effective, quick and non invasive method for prosthetic rehabilitation of a nasal defect with mechanical retention with glass framework. The advantages of this prosthesis are that the technique is cost effective, tissue friendly, esthet-ically good, ease to handle and use, and good option for the patients who are unfit for surgery for any other medically compromised condition or who don’t want to undergo extensive reconstructive surgeries. The patient’s esthetics, confidence and satisfaction were tremendously improved by such nasal prosthesis.

REFERENCES

1 Rodrigues. S, Shenoy KV, Shenoy K. Prosthetic rehabilitation of a patient after partial rhinectomy: a clinical report; J prosthet dent 2005; 93: 125-8.

2 Karakoca. S, Aydin C, Yilmaz H, Bal TB. Retrospective study of the treatment outcomes with implant-treated extraoral pros-thesis: survival rates and prosthetic complication. J prosthet dent 2010; 103: 118-26.

3 Karakoca S, Ersu B. Attaching a midfacial prosthesis to eyeglass frames using a precision attachment. J prosthet dent 2009; 102: 264-65.

4 Bidra SA, Montgomery CP. Maxillofacial rehabilitation of a microstomatic patient after resection of nose, lip, and maxilla. J oral maxillofac surg 2010; 68: 2513-19.

5 Goiato CM, Mancus ND, Zuccolotti RCB, Murakawa CA, Lima CD, Santos MD, Andreotti MA. Retention and processing meth-ods os nasal prosthesis. Jcpsp Pakistan 2012; 22: 716-19.

6 Thawley SE, Batsakis JG, Lindberg RD, Panje WR, Donley S, editors. Comprehensive management of head and neck tumors. 2nd ed. St. Louis: Elsevier; 1998. p. 526-7.