CLINICAL RESEARCH

Maxillofacial prosthetic rehabilitation: A survey on

the quality of life
Jeroen P. J. Dings, MD, DMD,a Matthias A. W. Merkx, MD, DMD, PhD,b
Manon T. P. de Clonie Maclennan-Naphausen, MD, DMD,c Pascal van de Pol, MFP,d
Thomas J. J. Maal, PhD, MSc,e and Gert J. Meijer, DMD, PhDf

The face has a unique role in ABSTRACT

social and emotional expres- Statement of problem. Maxillofacial prostheses, especially those supported by endosseous
sion and communication.1,2 implants, are regarded as a viable, secure treatment for the reconstruction of facial defects to
Maxillofacial defects and their restore quality of life. The long-term quality of life of patients treated with facial prostheses with
eventual reconstruction may different retentive systems is unclear.
have important psychosocial Purpose. The purpose of this clinical study was to assess the long-term quality of life of patients
implications in affected patients treated with facial prostheses with different retentive systems over a 14-year period at a Dutch
because social interactions and oral and maxillofacial surgery unit.
emotional expression depend
Material and methods. A total of 66 patients with facial prostheses were inventoried and categorized
mainly on the structural and based on anatomic location and type of retention. A 62-item questionnaire was designed to survey the
functional integrity of the head daily prosthetic use, care, quality, durability, longevity, and reliability of retention. Furthermore, issues
and neck region.1,3-8 Maxillo- relating to general satisfaction, self-image, and socialization frequency were addressed.
facial prosthetic rehabilitation Results. Completed validated questionnaires were returned by 52 patients. Of the prosthetic
poses a valid alternative when replacements, 23% (n=12) were orbital, 33% (n=17) nasal, and 44% (n=23) auricular prostheses. The survey
surgical reconstruction is not showed that a prosthetic reconstruction led to high satisfaction scores with regard to wearing comfort,
feasible or desirable.5,9-17 Tradi- anatomic fit, color, and anatomic form. A significant difference was shown for implant-retained facial
tionally, the retention of maxil- prostheses, which provided enhanced retention and increased ease of placement and removal (Fisher
lofacial prostheses involved skin exact test P=.01 and P=.04). Patients with nasal prostheses were less satisfied with the junction of their
prostheses to the surrounding soft tissue and more aware of others noticing their prosthetic
adhesives, anatomic undercuts,
rehabilitation. Patients with auricular defects were less embarrassed (P=.01) by their prostheses.
and connection to spectacles or Although auricular prostheses were less frequently cleaned (P=.01), no significant difference was found
intraoral prostheses.14,18 The in minor soft tissue complications between different anatomic locations and the various retentive systems.
use of adhesives, however, has
Conclusions. Implant-retained prostheses have advantages over adhesive-retained prostheses
several disadvantages, including
in terms of ease of handling. However, improvements in prosthetic material properties, including
discoloration of the prosthesis, color stability and durability, are needed to increase the longevity of facial prostheses. (J Prosthet
dermatologic reactions, and Dent 2018;120:780-6)
poor performance during ac-
tivity or perspiration.9,12,19 The introduction of craniofa- postsurgical complications.15,18,20,21 A successful pros-
cial endosseous implants has improved the retention and thetic rehabilitation is one in which patients do not
stability of prostheses with low surgical risks and few experience the prosthesis as an extraneous object and

a
Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
b
Professor, Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
c
Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Elkerliek Hospital, Helmond, The Netherlands.
d
Maxillofacial Prosthodontist, Department of Dentistry, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
e
Coordinator 3D Laboratory, Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
f
Professor, Department of Implantology and Periodontology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.

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excluded based on demographic data, defect etiology, or

Clinical implications type of retention, except those deceased, lost to follow-
Patients were highly satisfied with the prosthetic up, or having combined prostheses or local recurrence
of the malignant process. None of the authors were
reconstruction of facial defects. However, adequate
involved in fabricating the facial prostheses for the pa-
retention of maxillofacial prostheses is regarded as
tients. All patients had been surgically and prosthetically
the primary factor affecting patient satisfaction and
treated between 1997 and 2013 at the Departments of
acceptance. Ease of handling and retention by means
Oral and Maxillofacial Surgery and Special Dental Care of
of osseointegrated implants proved advantageous
the Radboud University Nijmegen Medical Center
over adhesive-retained facial prostheses.
(RUMC), the Netherlands. The study protocol was
approved by the medical ethical committee of the faculty.
No separate analysis was performed to determine the
which improves function and esthetics from both a number of specimens required in each separate test
psychological and social point of view.3,12,22 Another group because this study aimed to maximize the group of
advantage of a prosthesis is the possibility of tumor respondents out of a limited number of patients with
surveillance compared with surgical reconstruction, maxillofacial prostheses.
which covers up the surgical defect.17 Despite well- The cohort of patients was stratified according to the
documented psychological benefits, maxillofacial pros- anatomic location of the defect and adhesive-retained
theses are also subject to limitations, including material versus implant-retained prostheses. The group with
durability and color stability. These limitations necessi- implant-retained prostheses was further divided into
tate frequent reprocessing of the prosthesis, which is patients with magnetic or bar-clip retentive systems and
time-consuming for both patient and maxillofacial pros- those with or without previous experience of adhesive-
thodontist and costly for the patient.15,18,23,24 retained prostheses. Patient data were confirmed with
Patient satisfaction and the assessment of quality of medical and dental charts (age, sex, prosthetic type,
life (QOL) are becoming increasingly important in the smoking, duration of time since cancer surgery, and
quality of care.3,25 Treatment success and the level of prosthetic rehabilitation).
reintegration is mainly determined by a subjective anal- A comprehensive questionnaire to assess satisfaction
ysis of the patient.23,25 Studies primarily focused on the with maxillofacial prosthetic rehabilitation was constructed
subjective analysis of patients with facial prostheses in in consultation with prosthodontists and psychologists and
perceived QOL and using validated questionnaires are was reviewed by a statistician. The questionnaire contained
sparse, and their relevance is often limited by small 62 questions with multiple-choice answers or on a 5-point
numbers.3,10,14,22,23,26 However, these studies have Likert rating scale. This scale varied from “fully disagree” to
shown improvement in QOL after maxillofacial pros- “fully agree.” Items evaluated with a score of 1 were
thetic treatment and the need for site- and treatment- considered negative, whereas 5 represented a positive
specific questionnaires.14,15,27 appreciation. The questions were evaluated by laypeople
The purpose of this clinical study was to assess pa- who identified no confusing or unclear questions and
tients’ opinions and satisfaction regarding facial pros- indicated no apparent need for reduction in items. Overall
thetic rehabilitation considering different parameters satisfaction was based on 12 questions on the 5-point
such as localization, chosen treatment modality, and Likert rating scale which inquired about the feel of the
specific type of retention. Furthermore, the research eli- prosthetic material; junction of the prostheses to sur-
cited patient satisfaction as to differences with adhesive- rounding soft tissue, whether making facial expressions or
retained prostheses to determine the best treatment not; similarity in color of skin and tendency to discolor-
option. The null hypothesis was that patient overall ation; shape of the prostheses; and obtained facial
satisfaction with maxillofacial prostheses would be symmetry.
similar for all locations of facial defects. In addition, pa- Daily prosthetic use was evaluated by 23 multiple-
tients with adhesive-retained prostheses would report choice questions inventorying how many hours and on
similar responses as those with implant-retained pros- which occasions the prosthesis was worn and identifying
theses with regard to daily prosthetic use, retention, and potential wear and durability by obtaining information
socialization. on personal experiences, reasons for replacement,
decrease in retention, and loss of superstructures or im-
plants. User-friendliness with regard to placing and
MATERIAL AND METHODS
removing of the prostheses was determined by 3 ques-
A total of 66 patients with a prosthesis of the ear, nose, or tions on the 5-point Likert rating scale and anchor terms.
orbit were included. Patients had at least 12 months of Twelve multiple-choice questions focused on socialization
experience wearing a facial prosthesis. No patients were by determining the level of functioning, self-esteem, body

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Table 1. Distribution of population and prosthetic characteristics

Variable Orbital n=12 Nasal n=17 Auricular n=23
Age in years, mean (range) 66.8 (39-82) 74.5 (59-93) 58.7 (21-88)
Sex 5 male/7 female 10 male/7 female 14 male/9 female
Follow-up period in months, mean (range) 102 (21-291) 45 (17-109) 77 (24-197)
Retention type 3 bar-clips 8 bar-clips 12 bar-clips
7 magnet 6 magnet 2 magnet
2 adhesive 3 adhesive 9 adhesive
Defect etiology 12 oncology 17 oncology 1 trauma
8 congenital
7 oncology
7 unknown
Number of implant-retained prostheses (range) 4.9 (2-16) 2.9 (1-10) 4.3 (1-10)
Years of functioning, mean (range) 2.2 (0.25-6) 1.4 (0.5-2) 2.6 (0-10)

image, sexual role, and interference in social and job (P=.06) and means of retention (P=.11) were identified
activities. (Fig. 1).
Patients could complement their responses with spe- Mean satisfaction scores were high on the anatomic
cific time spans and numbers, possible reasons for pros- form of the prosthesis and achieved symmetry of the face
thetic replacement, and their general opinions and for all prostheses (Fig. 1). In comparison with the orbital
recommendations. Furthermore, 2 multiple-choice and 2 and auricular region, nasal prostheses scored statistically
open-ended questions were asked to patients who had significantly lower while holding the face in a neutral
previously worn adhesive-retained prostheses about dif- expression (P=.04). Figure 1 shows the results on satis-
ferences between implant- and adhesive-retained pros- faction with the characteristics of the color of the pros-
theses with regard to the quality of retention, ease of (daily) theses. Undesirable color change was noted at 11 months
use, cleaning regimen, and varying time lengths till wear for orbital (range, 1-36) and 10 months for nasal (6-16
occurred. months) and auricular prostheses (0-24 months). No
All questionnaires were sent with an accompanying letter statistically significant difference was found (P=.09). No
explaining the objectives and confidentiality of the study, clear relation with smoking could be established.
asking patients to participate, and obtaining informed con- Orbital, nasal, and auricular prostheses were worn for
sent. A stamped, self-addressed envelope for return of the 18, 14, and 14 hours per day, respectively. Only 1 patient
questionnaire was included. stated that he did not wear his adhesive-retained nasal
Fisher exact tests were used to assess the difference in prosthesis because of allergic reactions. Seventy-six per-
proportions between groups. Patient satisfaction scores centage of the respondents reported wearing their
for each question were statistically analyzed by 2-way prostheses during the day. The remaining respondents
analysis of variance with the type of defect and type of wore their prostheses while sleeping also (36% of orbital
retention as factors (no interaction) (a=.05). prostheses, 7% of nasal prostheses, and 19% of auricular
prostheses). One patient with a magnet-retained nasal
prosthesis responded that he wore his prosthesis solely
RESULTS
during social outings. None of the patients used devices
A total of 66 patients with orbital, nasal, or auricular to help place or remove their prostheses. However, 3
prostheses were mailed a questionnaire. Completed patients needed others to help apply the adhesives, one
questionnaires were returned by 52 patients (79%). Their patient with an orbital prosthesis and 2 patients with an
medical characteristics are given in Table 1. Internal auricular prosthesis. With regard to anatomic location of
consistency of the questions against the 5-point Likert the prosthesis, no statistically significant difference was
rating scale showed a Cronbach a coefficient value of found in “ease of placement” (P=.59) and “ease of
0.82. None of the respondents mentioned having diffi- removal” (P=.92). However, both activities proved to be
culties in understanding the questions. Fourteen patients more difficult with adhesive-retained prostheses (P=.01
(27%) wore adhesive-retained prostheses (9 auricular, 3 and P=.04).
nasal, and 2 orbital), and 38 patients wore implant- The longevity of maxillofacial prostheses was mainly
retained prostheses (73%), of whom 14 stated having determined by the fading of color (43.8% of auricular
previously worn adhesive-retained prostheses (7 nasal, 5 prostheses and 55.6% of nasal prostheses), independent
orbital, and 2 auricular). No statistically significant dif- of the type of attachment. The other main factor with
ferences based on age or sex were observed. With respect nasal prostheses was the suboptimal junction (25%).
to “wearing comfort,” no statistical differences in With auricular prostheses, the wear of the silicone ma-
perception of materials with regard to anatomic location terial (19%) and the suboptimal junction (22%) were

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Wearing comfort
5
4
Likert-Scale
3
2
1
0
Comfort Natural feeling Hardness material Softness material

Prosthesis fit and form

5
4
Likert-Scale

3
2
1
0
Adequate fit while Adequate fit in Natural form Symmetry
moving neutral expression

Color
5
4
Likert-Scale

3
2
1
0
General satisfaction Similarity Tendency for Overflow color
autogenous skin deterioration in prosthesis to
color color surrounding tissue

User friendliness
5
4
Likert-Scale

3
2
1
0
Ease of placement Uniformity in placement Ease of removal

Orbital prostheses Nasal prostheses Auricular prostheses

Figure 1. Outcome Likert scales on wearing comfort, prosthesis fit and form, color, and user friendliness for different anatomic locations.

prominent complaints. Magnets and adhesive attach- prosthesis reported breakage of the bar-clip system. Pa-
ments were equally divided with respect to the “fading of tients noted the loss of retentive force for bar-clip sys-
color” of the silicone material, the suboptimal fit of the tems after a mean period of 14.4 months for nasal (n=5)
prosthesis, or the suboptimal junction of the silicone at and 10.5 months for auricular prostheses (n=6). None of
the skin. Orbital prostheses with a bar-clip attachment the patients with orbital prostheses with bar-clip at-
(n=2) only needed replacement because of color fading. tachments reported loss of retention.
Seven patients reported the loss of an implant The results reveal that 46.1% of respondents reported
(2 orbital, 4 nasal, and 1 auricular prosthesis) with an minor soft tissue complications, such as slight redness of
equal distribution of type of attachment. Only 1 patient the peri-implant tissue. Seventy-three percent cleaned
with a nasal prosthesis and 2 patients with an auricular their prostheses and surrounding soft tissues daily. The

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Table 2. Influence of retentive mechanisms and anatomic location on psychological and social aspect
Total
Prostheses
Orbital Prostheses (12 Patients) Nasal Prostheses (17 Patients) Auricular Prostheses (23 Patients) (n=52)
Bar-clip Magnet Adhesive Total Bar-clip Magnet Adhesive Total Bar-clip Magnet Adhesive Total
(3 pt.) (7 pt.) (2 pt.) (12 pt.) (8 pt.) (6 pt.) (3 pt.) (17 pt) (12 pt.) (2 pt.) (9 pt.) (23 pt.)
Variable N N n n (%) n N n n (%) n n n n (%) n (%)
I do not regard my prosthesis as d 1 d 1 (8) 3 d 1 4 (23) d 1 2 3 (13) 8 (15)
part of myself (no. of patients)
Negative influence on mood 1 1 1 3 (25) 2 1 1 4 (24) 3 1 2 6 (26) 13 (25)
Negative influence on leisure d d 2 2 (17) 3 d d 3 (18) 3 d 2 5 (22) 10 (19)
Negative influence on school/work d d d 0 (0) d d 1 1 (6) - d 1 1 (4) 2 (4)
Negative influence 1 d d 1 (8) 2 d d 2 (12) 2 d 2 4 (17) 7 (14)
on social activities
Negative influence d d d 0 (0) 1 d 1 2 (12) d d d 0 (0) 2 (4)
on sexual activity
Others notice my prosthesis 2 4 1 7 (58) 7 4 1 12 (71) 2 d 4 6 (26) 25 (48)
I am embarrassed by d d d 0 (0) 1 d 1 2 (12) d 1 d 1 (4) 3 (6)
my prosthesis
My self-esteem is 2 3 1 6 (50) 3 2 1 6 (35) 8 d 3 11 (48) 23 (44)
improved by my prosthesis

Table 3. Rating of general satisfaction of prostheses on different anatomical locations having different retentive mechanisms
Orbital Prostheses Nasal Prostheses Auricular Prostheses
Different Retentive Mechanisms Bar-clip Magnet Adhesive Bar-clip Magnet Adhesive Bar-clip Magnet Adhesive
Score (0-10) (n=3) (n=7) (n=2) (n=8) (n=6) (n=3) (n=12) (n=2) (n=9)
Score implant-retained prostheses 9.7 (SD, 0.6) 8.0 (SD, 1.2) 7.0 (SD, 1.4) 7.7 (SD, 2.3) 7.8 (SD, 1.2) 6.5 (SD, 2.1) 8.9 (SD, 0.8) 8.5 (SD, 0.7) 8.3 (SD, 1.4)
Score previous prostheses with n=1 n=4 n=0 n=4 n=3 n=0 n=2 n=1 n=0
adhesive attachment 0.0 3.0 (SD, 1.8) d 5.5 (SD, 0.6) 4.7 (SD, 1.5) d 8.0 (SD, 0.0) 1.0 d

remaining patients, of whom 73% wore auricular pros- earlier findings of the questionnaire, with patients sug-
theses, cleaned their prosthesis only 2 or 3 times weekly. gesting improvement of color stability, longevity, and a
This difference was statistically significant (P=.01). Pros- more pleasant feeling of the prosthetic material. Two
theses and skin were mainly cleaned with soap and water. patients who previously wore adhesive-retained pros-
However, 6 patients used disinfectant alcohol or stain- theses noted hygiene as an advantage over bar-clip
removing powder. No relation with earlier deterioration systems. Two other patients regarded adhesive-retained
in color or material properties could be established. In prostheses as more user-friendly (1 nasal and 1 auric-
addition, 12 patients described protecting their prostheses ular prosthesis).
from environmental influences by using sunblock hats
(n=4), eyeglasses (n=3), or an eye patch (n=1) or by
DISCUSSION
covering the auricular prostheses with hair (n=4).
Statistically significantly more patients with nasal The data from this study led to the rejection of the null
prostheses felt noticed by others in their environment hypothesis that no differences would be found in overall
(P=.01). Fewer patients with auricular prostheses felt satisfaction between the locations of facial defects and
embarrassed to show their defect in different social en- the types of retention for maxillofacial prostheses. Only
vironments (P=.01). However, questions concerning the placement and removal of the prostheses were
psychological and social aspects revealed no further sta- shown to be statistically significantly more difficult with
tistically significant differences for anatomic location or adhesive-retained prostheses. No differences could be
type of attachment. For type of prosthesis, an equal established between different retention systems and
distribution was found for patients who gained self- psychological or social aspects. In addressing all impor-
confidence (44%) (Table 2). tant details, the questionnaire was lengthy, containing
Finally, patients were asked to score their prostheses more than 62 items. However, no remarks about the
using the traditional Dutch grading scale that is based on number of questions were received from any of the
a numeric scale from 0 to 10, in which 10 represents the respondents.
highest general satisfaction rate. In addition, patients Although the number of respondents was greater
were asked for suggestions on improvement (Table 3). than that in previous research and representative of the
Responses to open-ended questions corresponded with whole group, one limitation of the present study was the

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total number of patients included. Maxillofacial pros- proved to be statistically significantly better than the
theses are sparse, and as with most studies, our research adhesive-retained methods (ease of placement [P=.01]
was based on a heterogeneous and reduced cohort with and ease of removal [P=.04]).
different follow-up periods necessitating greater longi- The choice of retentive mechanisms depends on the
tudinal comparison.4 The difference in longevity may number of implants, flexibility of the prosthesis, and local
allow patients with longer survival to develop coping anatomic aspects. Bar-clips are the most indicated system
strategies. for retention of auricular prostheses.13 Three patients with
The distribution by patient sex (56% male and 44% bar-cliperetained prostheses reported on mechanical
female) demonstrated similar proportions of the sexes as failures of the acrylic resin substructure or the retentive
reported in previous studies.23 In contrast to other studies, structures. This is in accordance with previous studies in
in which women have been shown to be more susceptible which requirements for clip revision and repair are
to depressive symptoms, no statistical differences for age described as disadvantageous compared with the use of
or sex were observed.2 Although the influence of social magnets.12,15 Magnets are mostly used for orbital
support on the psychosocial functioning of the individual defects13and can compensate for nonparallelism of the
patient was not evaluated, available support can suppress installed implants. Moreover, magnets induce relatively
depressive symptomatology.2 low lateral forces and minimize the amount of stress
Atay et al3 stressed that patients with nasal prostheses delivered to the implants.21 Current magnetic systems in-
scored worse in all domains of QOL because the nose crease ease of use, are easy to clean, and have adequate
plays a key role in facial appearance and social in- retention.12,13 In the present study, only one patient
teractions. In contrast, no such difference was shown in wearing an implant-retained orbital prosthesis with a
the present study, with only a few patients with auricular magnet system reported troublesome dislodgment of his
prostheses being embarrassed to show their defect in prosthesis at inopportune times, such as during exercise.
different social environments (P=.01). No statistically significant differences were shown in the
The longevity of maxillofacial prostheses in the pre- prevalence of minor soft tissue complications with regard to
sent study varied from 0.5 to 10 years with a mean of 26, different retentive mechanisms, although some respondents
17, and 31 months for orbital, nasal, and auricular reported the limiting aspect of bar-clips on local hygiene.
prostheses, respectively. Whether this difference is This is in accordance with reports describing limited access
caused by material properties or behavioral factors such for cleaning in the presence of bar-clip systems.8,21 Nemli
as “frequency of removing,” “cleaning,” or “maintaining et al19 reported a higher frequency of dermatologic problems
of the prosthesis” is unclear. Karakoca et al20 and Hooper for auricular prostheses than for nasal and orbital prostheses.
et al2 reported a mean life span of maxillofacial pros- No such difference was found in the present study, although
theses of 1 to 1.5 years. Visser et al24 demonstrated a auricular prostheses were statistically significantly cleaned
survival time of 1.5 to 2 years with some prostheses less frequently (P=.01) than other maxillofacial prostheses.
having a life span of more than 5 years. Seven respondents reported the loss of 1 or more implants, 4
Ideal prosthetic material properties include durability, of whom had received radiation therapy. Bone irradiation is
biocompatibility, flexibility, ease of cleaning, and light- the best-known cause of implant failure, and implants in the
ness.11 The maxillofacial prostheses in this study were temporal region tend to have the highest rate of
made of heat-polymerized and autopolymerizing sili- success.8,17,18,20
cone. Autopolymerizing silicone is the material of Results in this study revealed negative influences of
choice.15,24 The majority of patients (86%) responded that prostheses on mood (25.0%), leisure (19.2%), and social
they were comfortable wearing their prostheses; a few activities (13.5%). The extent to which this negative in-
remarked on the hardness of the material (5%). Satisfac- fluence hampered social life was not specified. Negative
tion is directly related to appropriate retention delivered influence on educational or working activities and
by craniofacial implants. Several studies showed signifi- diminished feelings of sexuality were only mentioned by
cant improvements with implant-retained facial prosthe- 2 patients, 79 and 91 years old, indicating that the ma-
ses in all domains of QOL in comparison with adhesive- jority of (younger) patients were unaltered in their atti-
retained groups.5,10 In the present study, the distribution tudes and habits. Respondents with nasal prostheses,
of prosthetic retention type was consistent with that of more than others, felt that their prostheses were
other studies.17 In contrast with the findings of Nemli noticeable (P=.01). This was corroborated by Atay et al,3
et al19 and Goiato et al,4 overall patient satisfaction scores who showed the nasal region to be one of the most
were similar for the various retentive mechanisms. important features determining total facial appearance.
However, although not statistically significant, patients Larger and multicenter studies are needed to draw
did tend to give higher scores for bar-clip systems. As in generalized conclusions on the impact of maxillofacial
the studies of Chang et al6 and Smolarz-Wojnowska prosthetic rehabilitation on overall treatment satisfaction
et al,14 the handling of implant-retained prostheses and patient QOL. Future research should also focus on

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786 Volume 120 Issue 5

enhancing material durability and color stability to 13. Katz MR, Irish JC, Devins GM, Rodin GM, Gullane PJ. Reliability and validity
of an observer-rated disfigurement scale for head and neck cancer patients.
improve the service life of prostheses. Head Neck 2000;22:132-41.
14. Smolarz-Wojnowska A, Raithel F, Gellrich NC, Klein C. Quality of implant
anchored craniofacial and intraoral prostheses: patient’s evaluation.
CONCLUSIONS J Craniofac Surg 2014;25:e202-7.
15. Arcuri MR, LaVelle WE, Fyler A, Funk G. Effects of implant anchorage on
Based on the findings of this survey, the following conclu- midface prostheses. J Prosthet Dent 1997;78:496-500.
16. dos Santos DM, Goiato MC, Sinhoreti MA, Fernandes AU, Ribeiro Pdo P,
sions were drawn: Dekon SF. Color stability of polymers for facial prosthesis. J Craniofac Surg
2010;21:54-8.
1. The overall acceptance of maxillofacial prostheses 17. dos Santos DM, Goiato MC, Pesqueira AA, Bannwart LC, Rezende MC,
Magro-Filho O, et al. Prosthesis auricular with osseointegrated implants and
was good, showing high satisfaction with anatomic quality of life. J Craniofac Surg 2010;21:94-6.
form, color, and wearing comfort. 18. Goiato MC, Delben JA, Monteiro DR, dos Santos DM. Retention systems to
implant-supported craniofacial prostheses. J Craniofac Surg 2009;20:
2. Implant-retained prostheses provided more ease of 889-91.
19. Nemli SK, Aydin C, Yilmaz H, Bal BT, Arici YK. Quality of life of patients with
placement and removal than traditional adhesive implant-retained maxillofacial prostheses: a prospective and retrospective
techniques. study. J Prosthet Dent 2013;109:44-52.
20. Karakoca S, Aydin C, Yilmaz H, Bal BT. Retrospective study of treatment
outcomes with implant-retained extraoral prostheses: survival rates and
prosthetic complications. J Prosthet Dent 2010;103:118-26.
REFERENCES 21. Leonardi A, Buonaccorsi S, Pellacchia V, Moricca LM, Indrizzi E, Fini G.
Maxillofacial prosthetic rehabilitation using extraoral implants. J Craniofac
1. Millsopp L, Brandom L, Humphris G, Lowe D, Stat C, Rogers S. Facial Surg 2008;19:398-405.
appearance after operations for oral and oropharyngeal cancer: a comparison 22. Schoen PJ, Raghoebar GM, van Oort RP, Reintsema H, van der Laan BF,
of casenotes and patient-completed questionnaire. Br J Oral Maxillofac Surg Burlage FR, et al. Treatment outcome of bone-anchored craniofacial pros-
2006;44:358-63. theses after tumor surgery. Cancer 2001;92:3045-50.
2. Hooper SM, Westcott T, Evans PL, Bocca AP, Jagger DC. Implant-supported 23. Curi MM, Oliveira MF, Molina G, Cardoso CL, Oliveira Lde G, Branemark PI,
facial prostheses provided by a maxillofacial unit in a U.K. regional hospital: et al. Extraoral implants in the rehabilitation of craniofacial defects: implant
longevity and patient opinions. J Prosthodont 2005;14:32-8. and prosthesis survival rates and peri-implant soft tissue evaluation. J Oral
3. Atay A, Peker K, Gunay Y, Ebrinc S, Karayazgan B, Uysal O. Assessment of Maxillofac Surg 2012;70:1551-7.
health-related quality of life in Turkish patients with facial prostheses. Health 24. Visser A, Raghoebar GM, van Oort RP, Vissink A. Fate of implant-retained
Qual Life Outcomes 2013;11:11. craniofacial prostheses: life span and aftercare. Int J Oral Maxillofac Implants
4. Goiato MC, Pesqueira AA, Ramos da Silva C, Gennari Filho H, Micheline 2008;23:89-98.
Dos Santos D. Patient satisfaction with maxillofacial prosthesis. Literature 25. Abu-Serriah MM, McGowan DA, Moos KF, Bagg J. Outcome of extra-oral
review. J Plast Reconstr Aesthet Surg 2009;62:175-80. craniofacial endosseous implants. Br J Oral Maxillofac Surg 2001;39:
5. Bonanno A, Esmaeli B, Fingeret MC, Nelson DV, Weber RS. Social chal- 269-75.
lenges of cancer patients with orbitofacial disfigurement. Ophthal Plast 26. Lemon JC, Chambers MS, Jacobsen ML, Powers JM. Color stability of facial
Reconstr Surg 2010;26:18-22. prostheses. J Prosthet Dent 1995;74:613-8.
6. Callahan C. Facial disfigurement and sense of self in head and neck cancer. 27. Montgomery PC, Kiat-Amnuay S. Survey of currently used materials for
Soc Work Health Care 2004;40:73-87. fabrication of extraoral maxillofacial prostheses in North America, Europe,
7. Chang TL, Garrett N, Roumanas E, Beumer J 3rd. Treatment satisfaction with Asia, and Australia. J Prosthodont 2010;19:482-90.
facial prostheses. J Prosthet Dent 2005;94:275-80.
8. Katz MR, Irish JC, Devins GM, Rodin GM, Gullane PJ. Psychosocial
adjustment in head and neck cancer: the impact of disfigurement, gender and Corresponding author:
social support. Head Neck 2003;25:103-12. Dr Jeroen P.J. Dings
9. Markt JC, Lemon JC. Extraoral maxillofacial prosthetic rehabilitation at the Department of Oral and Maxillofacial Surgery
M. D. Anderson Cancer Center: a survey of patient attitudes and opinions. Radboud University Nijmegen Medical Center
J Prosthet Dent 2001;85:608-13. PO Box 9101
10. Wondergem M, Lieben G, Bouman S, van den Brekel MW, Lohuis PJ. Patients’ NL 6500 HB, Nijmegen
satisfaction with facial prostheses. Br J Oral MaxillofacSurg 2016;54:394-9. THE NETHERLANDS
11. De Leeuw JR, De Graeff A, Ros WJ, Hordijk GJ, Blijham GH, Email: [email protected]
Winnubst JA. Negative and positive influences of social support on
depression in patients with head and neck cancer: a prospective study. Acknowledgments
Psychooncology 2000;9:20-8. The authors are grateful to T. De Haan for assistance in statistical analysis of data.
12. Vickery LE, Latchford G, Hewison J, Bellew M, Feber T. The impact of head
and neck cancer and facial disfigurement on the quality of life of patients and Copyright © 2018 by the Editorial Council for The Journal of Prosthetic Dentistry.
their partners. Head Neck 2003;25:289-96. https://doi.org/10.1016/j.prosdent.2018.03.032

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