This document discusses the fabrication of nasal prostheses for patients who have undergone rhinectomy or partial rhinectomy. It notes that the position and contours of residual nasal structures are important for creating an esthetic prosthesis. Problems can arise if the nasal bones are still present, affecting the appearance of the nasal tip and lip. With favorable defects, normal nasal contours and symmetry can be restored. The document provides details on wax sculpting, casting, finishing, and retention methods like implants or magnets. Patient education is important to manage expectations.

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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.

14. With favorable total rhinectomy defects excellent
cosmetic results such as these can be obtained and
the prosthesis will be stable well retained

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

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.

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.

31. After recontouring the columella and tucking the
margin beneath the tip of nose the appearance of the
prosthesis is improved

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.

62. a b

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.

67. Polymerized silicone
casting is thin, flexible
and light weight
Stone is vibrated through
opening in back of the cast

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.

76. a b c

78. Beware of the roots of the anterior teeth.

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.

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.

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.

91. Best results achieved when vertical and horizontal
components are incorporated within the tissue bar
(arrows)

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

99. a b c d e

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.

111. a b