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SHORT COMMUNICATION  
Year : 2011  |  Volume : 22  |  Issue : 4  |  Page : 597-599
Definitive magnetic nasal prosthesis for partial nasal defect


1 Department of Prosthodontics, PMNM Dental College and Hospital, Bagalkot, India
2 Department of Prosthodontics, AB Shetty Dental College, Mangalore, India

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Date of Submission21-Jul-2010
Date of Decision06-Oct-2010
Date of Acceptance15-Nov-2010
Date of Web Publication26-Nov-2011
 

   Abstract 

Maxillofacial trauma refers to any injury to the face or jaw caused by physical force, trauma, the presence of foreign objects, animal or human bites, and burns. Facial defects can be devastating in their impact on physical structure and function of the affected individual, leading to potential compromises in quality of life. Restoration of facial defects, especially nasal defects, is a difficult challenge for both the surgeon and the prosthodontist. Here is a case report of partial nasal defect caused by trauma, rehabilitated with a magnetic nasal prosthesis made with silicone elastomers using mechanical and anatomical retentive aids.

Keywords: Magnetic nasal prosthesis, maxillofacial trauma, silicone nasal prosthesis

How to cite this article:
Nagaraj E, Shetty M, Krishna PD. Definitive magnetic nasal prosthesis for partial nasal defect. Indian J Dent Res 2011;22:597-9

How to cite this URL:
Nagaraj E, Shetty M, Krishna PD. Definitive magnetic nasal prosthesis for partial nasal defect. Indian J Dent Res [serial online] 2011 [cited 2019 Sep 19];22:597-9. Available from: http://www.ijdr.in/text.asp?2011/22/4/597/90309
The nose is the most prominent feature of the human face. The importance of the nose to facial harmony has been well recognized throughout history. Nasal defects can result from trauma, treatment of neoplasm, or congenital malformation. [1] Recent advances in treatment and rehabilitation, particularly maxillofacial prosthetics, may alleviate the sequelae of many disfiguring surgeries and helps in maintaining good function.

Patient acceptance and use of facial prosthesis is not universal, primarily due to unrealistic patient expectations. It is in the clinical impression that nasal prostheses have the highest level of acceptance; orbital and maxillofacial prostheses have the limited acceptance. [1]

Full consideration must be given to the retention of maxillofacial prostheses on the face. Methods available for retention include mechanical, anatomic, and adhesives with or without the use of other methods. [2] In this case report, a definitive magnetic nasal prosthesis with nasal conformer has been used for rehabilitation of a partial nasal defect using mechanical and anatomic retentive aids.


   Case Report Top


A 67-year-old male patient with partial nasal defect [Figure 1] reported to the Department of Prosthodontics, A B Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India, for rehabilitation of nose. Patient's history revealed that injury was caused in childhood due to chemical burn (patient does not know nature and type of chemical used). On examination of the defect, it was noticed that ala on both sides and part of the nasal septum were destructed. Rehabilitation can be accomplished either surgically or prosthetically. [3]
Figure 1: Pre-operative view of the patient

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The method of rehabilitation depends upon the site, size, etiology, age, and patient's wishes. However, age, general medical condition, complexity of surgical procedure, and the patient's refusal to undergo surgery may contraindicate surgical reconstruction. [4] Complications of surgical reconstruction include constriction of the tissues inward and collapse of the tissues, leading to an unfavorable esthetic results. [5] For patient not willing for surgery, prosthetic treatment was chosen.

Procedure

The boundary for the impression was outlined on the face. Primary impression of nose was made using an irreversible hydrocolloid material (Algitex; Dental products of India, Mumbai). The irreversible hydrocolloid was reinforced with gauze and dental plaster. The impression was poured in dental stone/hydrocal (Kala stone; Kala bhai Pvt Ltd, Mumbai, India). Acrylic resin special tray was prepared using wax spacer to the confined areas of the defect site. Secondary impression was made using light body polyvinyl siloxane impression material (Aquasil; Dentsply, Dentray, Germany). Multiple casts were obtained for the procedure. Heat-cured acrylic resin nasal conformer/stent (DPI-Heat cure; Dental products of India Ltd) was fabricated. This engages the soft tissue undercuts of the defect site and helps in retaining magnets. Two magnets were embedded at the corners of the conformer using self-cure acrylic resin (DPI-cold cure; Dental products of India Ltd). This conformer provides channel for the air to pass through it and helps in breathing [Figure 2].
Figure 2: Nasal conformer

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The wax pattern of the nose was sculpted on the master cast. Two magnets were attached to the inner surface of the wax pattern, which comes in contact with the magnets in the nasal conformer [Figure 3]. Mutual attractive forces of magnets were used for retention of nasal prosthesis. Marginal adaptation, contour, surface texture, and the position of the wax pattern were verified during try-in [Figure 4]. The molding procedures were carried out. The silicone elastomer (Cosmesil RTV) was matched intrinsically to match different shades of the patient's skin. The intrinsic coloration increases the service life of the prosthesis and translucency. Colored silicone was layered into the mold. The molds were closed, light pressure applied to remove excess material, and the mold transferred to clamp. The silicone was processed at room temperature. When the molds were sufficiently cool, the prosthesis was carefully removed. Excess material was trimmed with scissors. Extrinsic staining for the finished prosthesis was done to make it more esthetically acceptable [Figure 5] and [Figure 6]. After delivering the prosthesis, home care instructions were given. Periodic recall check-ups were scheduled after 1 month, 3 months, 6 months, 1 year, and 2 years to make necessary adjustments. The patient was comfortable and color matching was satisfied and was kept on periodic recall.
Figure 3: Nasal conformer and wax pattern

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Figure 4: Wax try-in

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Figure 5: Post-operative view of the patient

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Figure 6: Lateral view of the patient

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   Discussion Top


When surgical reconstruction is not possible for patients with facial deformities, the choice of treatment is prosthetic rehabilitation. The problem of retention of maxillofacial prostheses should be considered at the time of prostheses designing. Retention methods include mechanical, anatomic, and adhesives. Mechanical methods include use of thread, wire loops, eyeglasses, stainless steel studs, pins, tubes, and magnets. Anatomical methods include projections/depressions of tissue and surgical constructed skin bridges. Adhesives include cements, medical adhesives, and double-coated polyethylene tape. Considering soft tissue undercuts of patient's nose, both anatomic and mechanical methods of retention are selected.

Magnets have been effectively used for the retention, maintenance, and stabilization of maxillofacial prostheses. It was first reported by Javid. [2] Advantages of using magnets are ease of placement, automatic reseating, easy replacement, small size with strong attractive forces, can be placed within the prostheses, and ease of cleaning; [6] so, magnets were considered for retention.

The silicones are the most widely used material for facial restoration. The common problems associated with silicone are as follows:

  • Rapid degradation of elastomers and color dexterity.
  • Deterioration due to environmental exposure to UV light, air pollution, and temperature.
  • Tearing of margins.
  • Microbial growth due to porous nature of silicones.
  • Short durability.


Silicone elastomers were preferred for this patient because of the following advantages:

  • Light weight.
  • Life-like appearance. [7]
  • Softness compatible to tissue.
  • Translucent.
  • Ease of intrinsic and extrinsic coloring with commercially available colorants.
  • Ease of mold fabrication, processing, and reusable molds
  • Nonallergenic and nontoxic.
  • Dimensionally stable. [2]


The purpose of the nasal stent was to maintain internal airway patency [6] and to place magnets. Adequate support, retention, and stability required extension of the stent into the nasal cavity to engage residual turbinates. [8]

In this case report, a magnetic silicone nasal prosthesis was fabricated for a patient with partial nasal defect caused due to trauma which made him psychologically more comfortable. The prosthesis was more acceptable by the patient because of its ease in use and good color matching.

 
   References Top

1.Beumer. J, Curtis TA, Marunick MT. Maxillofacial rehabilitation: Prosthodontic and surgical considerations. 2 nd ed. St. Louis: Ishiyaku euroamerica; 1996. p. 377-453.  Back to cited text no. 1
    
2.Javid N. The use of magnets in a maxillofacial prosthesis. J Prosthet Dent 1971;25:334-40.  Back to cited text no. 2
[PUBMED]    
3.Fornelli RA, Fedok FG, Wilson EP, Rodman SM. Squamous cell carcinoma of the anterior nasal cavity: A dual institution review. Otolaryngol Head Neck Surg 2000;123:207-10.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  
4.Thawley SE, Batsakis JG, Lindberg RD, Panje WR, Donley S. Comprehensive management of head and neck tumors, 2 nd ed. St. Louis: Elsevier; 1998. p. 526-7.  Back to cited text no. 4
    
5.Burget GC, Menick FJ. Nasal support and lining: The marriage of beauty and blood supply. Plast Reconstr Surg 1989;84:189-202.  Back to cited text no. 5
[PUBMED]    
6.Bhat V. A close-up on obturators using magnets: Part I - Magnets in dentistry. J Indian Prosthodont Soc 2005;5:114-8.  Back to cited text no. 6
  Medknow Journal  
7.Rodrigues S, Shenoy VK, Shenoy K. Prosthetic rehabilitation of a patient after partial rhinectomy: A clinical report. J Prosthet Dent 2005;93:125-8.  Back to cited text no. 7
[PUBMED]  [FULLTEXT]  
8.Brooks MD, Carr AB, Eckert SE. Nasal stent fabrication involved in nasal reconstruction: Clinical report of two patient's treatment. J Prosthet Dent 2004;91:123-7.  Back to cited text no. 8
[PUBMED]  [FULLTEXT]  

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Correspondence Address:
E Nagaraj
Department of Prosthodontics, PMNM Dental College and Hospital, Bagalkot
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-9290.90309

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]

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