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*The material in this program of instruction is protected by copyright ©. No
part of this program of instruction may be reproduced, recorded, or
transmitted by any means, electronic,digital, photographic, mechanical, etc.
or by any information storage or retrieval system, without prior permission.
This should be considered for most patients. Implant retention improves
patient acceptance and frequency of use (Chang et al, 2005)
Chang et al, 2005
Chang et al, 2005
This speeds the rehabilitation process, saves the patient a
surgical procedure and provides excellent retention for the
future nasal prosthesis.
With favorable total rhinectomy defects excellent
cosmetic results such as these can be obtained and
the prosthesis will be stable well retained
Problems created
a)  Nasal bones affect position of the nasal
    tip
b)  Lip will always appear too short even if
    nasal tip of the prosthesis is shortened
c)  Nasal tip will always appear too low in
    relation to the lip
d)  Nasal prosthesis will always appear too
    large and project anteriorly excessively
    because of the lip retraction and
    presence of the nasal bones
Prostheses fabricated for the previous patients. The
nostrils can be properly blended with the nasolabial
folds and the inferior margin is extended onto the lip.
If the defect is favorable the size and shape of the original nose
should be carefully reproduced, the nasolabial folds engaged
bilaterally, and the prosthesis should be relatively symmetrical.
After recontouring the columella and tucking the
margin beneath the tip of nose the appearance of the
prosthesis is improved
The fabrication of an esthetic prosthesis is
  dependent upon the position and contours
  of the residual nasal structures.

A good result is dependent upon the residual nasal
structures being in normal position and of normal contour
This partial rhinectomy defect is unusual because the residual
portions of the nose have not been displaced and present with
normal contours. Bilateral symmetrical contours can therefore
be restored with a prosthesis.
a   b
Wax sculpture is luted to the cast
Hole is placed   externally and also from the back to
through the      insure the engagement of the usable
cast as shown.   undercuts and proper extension onto
                 the floor of the nose.
Polymerized silicone
                              casting is thin, flexible
                              and light weight




Stone is vibrated through
opening in back of the cast
The patient must be warned that lip margin will open upon
movement of the upper lip. Slight positive pressure in this
region will minimize the opening somewhat.
a   b   c
Beware of the roots of the anterior teeth.
Craniofacial implants placed in the glabella have a
lower success rate. If implants are planned for this
site oral lengths (7-10mm) are recommended.
Implants should not exit through the mobile
tissues of the lip. Otherwise chronic tissue
irritation will lead to formation of granulation
tissues around the implants.
These implants are positioned too far posteriorly
making hygiene difficult for the patient.
 mpression copings are attached to the implant fixtures
  I
  ight body rubber base is applied with a syringe and
  L
       thinned with a cement spatula taking care to
avoid displacing tissues of the lip and cheek.
  thin layer of adhesive is applied to the polymerizing
  A
       polysulfide an gauze strips are adhered to the adhesive.
Before the tissue bar is designed and fabricated
a trial wax sculpting of the prosthesis must be
completed and verified on the patient.
Clip retained prostheses are preferred
a)  Better retention
b)  Magnetic attachments tend to corrode

    Magnetic attachments deliver less stress to the
    anchoring bone and are recommended when used
    when only a solitary implant is available.
Best results achieved when vertical and horizontal
components are incorporated within the tissue bar
(arrows)
a   b   c   d
a   b   c
Followup period: 5 – 13 years
*Conventional implants (7mm and 10mm in length) had the same
success rates as craniofacial implants (4mm and 5mm in length).

#The two conventional length implants used have survived
5 years and 7 years respectively
a   b   c   d   e
This facial prosthesis engages the maxillary obturator via
magnets in a manner shown on previous patients. The
prosthesis covers the tip of the nose and is extended laterally
on the right side of the nose.
a   b
23.restoration of nasal defects
23.restoration of nasal defects
23.restoration of nasal defects
23.restoration of nasal defects

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23.restoration of nasal defects

  • 1. *The material in this program of instruction is protected by copyright ©. No part of this program of instruction may be reproduced, recorded, or transmitted by any means, electronic,digital, photographic, mechanical, etc. or by any information storage or retrieval system, without prior permission.
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9. This should be considered for most patients. Implant retention improves patient acceptance and frequency of use (Chang et al, 2005)
  • 10. Chang et al, 2005
  • 11. Chang et al, 2005
  • 12. This speeds the rehabilitation process, saves the patient a surgical procedure and provides excellent retention for the future nasal prosthesis.
  • 13.
  • 14. With favorable total rhinectomy defects excellent cosmetic results such as these can be obtained and the prosthesis will be stable well retained
  • 15.
  • 16.
  • 17.
  • 18.
  • 19. Problems created a)  Nasal bones affect position of the nasal tip b)  Lip will always appear too short even if nasal tip of the prosthesis is shortened c)  Nasal tip will always appear too low in relation to the lip d)  Nasal prosthesis will always appear too large and project anteriorly excessively because of the lip retraction and presence of the nasal bones
  • 20.
  • 21.
  • 22.
  • 23. Prostheses fabricated for the previous patients. The nostrils can be properly blended with the nasolabial folds and the inferior margin is extended onto the lip.
  • 24.
  • 25.
  • 26. If the defect is favorable the size and shape of the original nose should be carefully reproduced, the nasolabial folds engaged bilaterally, and the prosthesis should be relatively symmetrical.
  • 27.
  • 28.
  • 29.
  • 30.
  • 31. After recontouring the columella and tucking the margin beneath the tip of nose the appearance of the prosthesis is improved
  • 32.
  • 33.
  • 34.
  • 35.
  • 36.
  • 37.
  • 38.
  • 39.
  • 40.
  • 41.
  • 42.
  • 43.
  • 44.
  • 45.
  • 46.
  • 47.
  • 48. The fabrication of an esthetic prosthesis is dependent upon the position and contours of the residual nasal structures. A good result is dependent upon the residual nasal structures being in normal position and of normal contour
  • 49. This partial rhinectomy defect is unusual because the residual portions of the nose have not been displaced and present with normal contours. Bilateral symmetrical contours can therefore be restored with a prosthesis.
  • 50.
  • 51.
  • 52.
  • 53.
  • 54.
  • 55.
  • 56.
  • 57.
  • 58.
  • 59.
  • 60.
  • 61.
  • 62. a b
  • 63.
  • 64. Wax sculpture is luted to the cast Hole is placed externally and also from the back to through the insure the engagement of the usable cast as shown. undercuts and proper extension onto the floor of the nose.
  • 65.
  • 66.
  • 67. Polymerized silicone casting is thin, flexible and light weight Stone is vibrated through opening in back of the cast
  • 68.
  • 69.
  • 70.
  • 71.
  • 72.
  • 73.
  • 74. The patient must be warned that lip margin will open upon movement of the upper lip. Slight positive pressure in this region will minimize the opening somewhat.
  • 75.
  • 76. a b c
  • 77.
  • 78. Beware of the roots of the anterior teeth.
  • 79.
  • 80.
  • 81.
  • 82. Craniofacial implants placed in the glabella have a lower success rate. If implants are planned for this site oral lengths (7-10mm) are recommended.
  • 83.
  • 84. Implants should not exit through the mobile tissues of the lip. Otherwise chronic tissue irritation will lead to formation of granulation tissues around the implants.
  • 85. These implants are positioned too far posteriorly making hygiene difficult for the patient.
  • 86.  mpression copings are attached to the implant fixtures I   ight body rubber base is applied with a syringe and L thinned with a cement spatula taking care to avoid displacing tissues of the lip and cheek.   thin layer of adhesive is applied to the polymerizing A polysulfide an gauze strips are adhered to the adhesive.
  • 87.
  • 88. Before the tissue bar is designed and fabricated a trial wax sculpting of the prosthesis must be completed and verified on the patient.
  • 89. Clip retained prostheses are preferred a)  Better retention b)  Magnetic attachments tend to corrode Magnetic attachments deliver less stress to the anchoring bone and are recommended when used when only a solitary implant is available.
  • 90.
  • 91. Best results achieved when vertical and horizontal components are incorporated within the tissue bar (arrows)
  • 92.
  • 93.
  • 94. a b c d
  • 95. a b c
  • 96. Followup period: 5 – 13 years *Conventional implants (7mm and 10mm in length) had the same success rates as craniofacial implants (4mm and 5mm in length). #The two conventional length implants used have survived 5 years and 7 years respectively
  • 97.
  • 98.
  • 99. a b c d e
  • 100.
  • 101.
  • 102.
  • 103. This facial prosthesis engages the maxillary obturator via magnets in a manner shown on previous patients. The prosthesis covers the tip of the nose and is extended laterally on the right side of the nose.
  • 104.
  • 105.
  • 106.
  • 107.
  • 108.
  • 109.
  • 110.
  • 111. a b