|Year : 2022 | Volume
| Issue : 1 | Page : 24-26
Nasal Reconstruction due to Basal-Cell Carcinoma using Dental Implants: A Case Report
Abbas Haghighat1, Hasan Momeni2, Farzad Yeganeh3, Yamin Haghani4, Arezoo Mazaheri Nazarifar3
1 Dental Implant Research Center, Department of Oral and Maxillofacial Surgery, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
2 Dental Implant Research Center, Department of Oral and Maxillofacial Surgery, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan; Department of Oral and Maxillofacial Surgery, Islamic Azad University of Khorasgan Branch, Isfahan, Iran
3 Department of Prosthodontics, School of Dentistry, Isfahan University of Medical sciences, Isfahan, Iran
4 Department of Oral and Maxillofacial Surgery, Islamic Azad University of Khorasgan Branch, Isfahan, Iran
|Date of Submission||02-Nov-2021|
|Date of Decision||28-Nov-2021|
|Date of Acceptance||03-Dec-2021|
|Date of Web Publication||29-Apr-2022|
Dental Implant Research Center, Department of Oral and Maxillofacial Surgery, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Postal Code: 71461-81746
Source of Support: None, Conflict of Interest: None
Facial defects affect a patient’s quality of life in different aspects of psychologic health, social contacts, and functional abilities. Our report describes a 65-year-old patient who was undergone rhinectomy surgery due to nasal basal-cell carcinoma. We considered to rehabilitate the nose using two dental implants and a reversed triangle abutment to gain the best retention results for the final nasal prosthetic. The implant-supported prosthetics does not need surgery on the patient for graft, tissue transfer, or such procedures. It can effectively restore the nose in a satisfactory esthetic manner.
Keywords: Carcinoma, dental implant, external nose
|How to cite this article:|
Haghighat A, Momeni H, Yeganeh F, Haghani Y, Nazarifar AM. Nasal Reconstruction due to Basal-Cell Carcinoma using Dental Implants: A Case Report. Dent Hypotheses 2022;13:24-6
|How to cite this URL:|
Haghighat A, Momeni H, Yeganeh F, Haghani Y, Nazarifar AM. Nasal Reconstruction due to Basal-Cell Carcinoma using Dental Implants: A Case Report. Dent Hypotheses [serial online] 2022 [cited 2022 Nov 30];13:24-6. Available from: http://www.dentalhypotheses.com/text.asp?2022/13/1/24/344454
| Introduction|| |
Facial defects affect a patient’s quality of life in different aspects of psychologic health, social contacts, and functional abilities.,
Three things are important for nasal reconstruction: surgical skill, patient motivation, and medical condition. Some patients benefit from just a simple solution, such as a prosthetic device, rather than a very complex multistage reconstruction.
Due to the limitation and inadequacy of adhesives and anatomic undercuts in providing retention, the use of long-life implants enhances the retention of facial prostheses.
The present clinical report describes the patient who underwent total nose excision due to basal-cell carcinoma (BCC). An implant-retained nasal prosthesis was designed for her 6 months after the surgery due to existing no sign of recurrence.
| Case report|| |
A 65-year-old woman with BCC was referred to the Department of Maxillofacial Surgery, Dental School of Isfahan University of Medical Sciences.
The patient data were retrieved from medical files. The following criteria were scored: age, sex, type of surgical excision (conventional or Mohs’), defect location according to the subunit principle, defect size, type of tissue involved (skin, cartilage, mucosa), number of operations, and the type of nasal reconstruction. All histologic reports from nasal skin malignancies were evaluated as well. After preliminary screening, we developed an algorithm for treatment based on the defect size, subunits involved, and complexity.
We planned to wait for the defect for secondary healing to have a safe margin after the excision of the lesion. Following the healing of the lesion, we reconstructed the defect using implants and nasal prostheses.
Six months after excision, the patient was undergone surgery for implant placement. Two 4.1 × 10 mm BLT implants (Roxolid, Institut Straumann AG, Basel, Switzerland) were placed through the nasal floor to the maxilla. The insertion torque was 45 N/Cm, and satisfactory primary stability was achieved [Figure 1]. As the patient was edentulous, she also desired full mouth rehabilitation. Hence, we planned to place four implants in the sites of maxillary canines and second premolars and two implants in the sites of mandibular canines to make maxillary and mandibular overdentures [Figure 2].
|Figure 1 Placement of two straumann BLT implants through the nasal floor to the maxilla.|
Click here to view
In this case, especial prosthetic components and intraoral implants have been designed and introduced for the retention of the craniofacial prosthesis (Tooth-gam ideal tak pars, Isfahan, Iran).
Transcutaneous abutment level impression was made by additional silicone. After placement of printed prosthetic coping, a round plastic connecting bar was fabricated between the copings and cast. Then, an acrylic base was formed over the casted triangular bar with attachments, and the wax-up adapted to the underlying base. After the investment of wax-up to the flask and lost wax step, retentive holes and primer were used to improve silicone to acrylic bond. Silicone (Technovent Ltd, Bridgend, UK) was colored with intrinsic pigments and flakes (Cosmesil Master color and FLOCKING, PRINCIPALITY, Newport, Wales, UK) and adapted into the flask based on the skin color. After deflasking and external painting (Cosmesil Dry Pigment; PRINCIPALITY) of the prosthesis, sunglasses help wipe out the borders of the prosthesis and improve the retention.
Along with extraoral prosthesis, the intraoral implant-supported prosthesis was also made with the application of low-height transcutaneous abutments for the mandible and ball abutment for the maxilla.
Six months after the implant placement due to the osseointegration, the final prosthetics were granted to the patient [Figure 3].
The patient completely agreed and signed the consent letter to join and publication of her pictures in this study.
| Discussion|| |
Nasal reconstruction is one of the most complicated procedures and using conventional surgical reconstructions or implant-supported prosthetics depends on many factors.
The implant site is such an important factor to get the best results for nasal rehabilitation.
The best site for implant placement for nasal prosthetics has been reported in the anterior nasal floor.
Nasal reconstruction by surgical procedures needs many surgical appointments and causes the patient pain and discomfort, also the results are unpredictable.
On the other hand, using implant-supported prosthetics is such a viable way, especially when it comes to total rhinectomy.
Many factors affect the success rate of implants used in maxillofacial surgery.
Achieving esthetic and function is the main goal of nasal reconstruction in patients with nasal excision due to BCC. Reconstruction of the defect using free vascularized tissue transfer and cartilage grafts causes a high level of morbidity, and the results are unpredictable.
Using implant-supported prosthetics does not need surgery on the patient for graft, tissue transfer, or such procedures. It can effectively restore the nose in a satisfactory esthetic manner.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]