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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 13  |  Issue : 1  |  Page : 24-26

Nasal Reconstruction due to Basal-Cell Carcinoma using Dental Implants: A Case Report


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 Submission02-Nov-2021
Date of Decision28-Nov-2021
Date of Acceptance03-Dec-2021
Date of Web Publication29-Apr-2022

Correspondence Address:
Hasan Momeni
Dental Implant Research Center, Department of Oral and Maxillofacial Surgery, Dental Research Institute, Isfahan University of Medical Sciences, Isfahan, Postal Code: 71461-81746
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/denthyp.denthyp_168_21

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  Abstract 


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 May 18];13:24-6. Available from: http://www.dentalhypotheses.com/text.asp?2022/13/1/24/344454




  Introduction Top


Facial defects affect a patient’s quality of life in different aspects of psychologic health, social contacts, and functional abilities.[1],[2]

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.[3]

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.[4]

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 Top


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.

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Figure 2 The panoramic view of nasal and intraoral implants.

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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].
Figure 3 Final view of intraoral and nasal prosthetics.

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The patient completely agreed and signed the consent letter to join and publication of her pictures in this study.


  Discussion Top


Nasal reconstruction is one of the most complicated procedures and using conventional surgical reconstructions or implant-supported prosthetics depends on many factors.[5]

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.[6]

Nasal reconstruction by surgical procedures needs many surgical appointments and causes the patient pain and discomfort, also the results are unpredictable.[7]

On the other hand, using implant-supported prosthetics is such a viable way, especially when it comes to total rhinectomy.[8]

Many factors affect the success rate of implants used in maxillofacial surgery.[9]

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

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Reisberg DJ, Habakuk SW. Nasal conformer to restore facial contour. J Prosthet Dent 1990;64:699-701.  Back to cited text no. 1
    
2.
Gurbuz A, Kalkan M, Ozturk AN, Eskitascioglu G. Nasal prosthesis rehabilitation: a case report. Quintessence Int 2004;35:655-6.  Back to cited text no. 2
    
3.
Austin GK, Shockley WW. Reconstruction of nasal defects: contemporary approaches. Curr Opin Otolaryngol Head Neck Surg 2016;24:453-60.  Back to cited text no. 3
    
4.
Goiato MC, Pesqueira AA, Ramos da Silva C, Gennari Filho H, Micheline Dos Santos D. Patient satisfaction with maxillofacial prosthesis. Literature review. J Plast Reconstr Aesthet Surg 2009;62:175-80.  Back to cited text no. 4
    
5.
Abu-Serriah MM, McGowan DA, Moos KF, Bagg J. Extra-oral endosseous craniofacial implants: current status and future developments. Int J Oral Maxillofac Surg 2003;32:452-8.  Back to cited text no. 5
    
6.
Nishimura RD, Roumanas E, Moy PK, Sugai T. Nasal defects and osseointegrated implants: UCLA experience. J Prosthet Dent 1996;76:597-602.  Back to cited text no. 6
    
7.
Brooks MD, Carr AB, Eckert SE. Nasal stent fabrication involved in nasal reconstruction: clinical report of two patient treatments. J Prosthet Dent 2004;91:123-7.  Back to cited text no. 7
    
8.
Scolozzi P, Jaques B. Treatment of midfacial defects using prostheses supported by ITI dental implants. Plast Reconstr Surg 2004;114:1395-404.  Back to cited text no. 8
    
9.
Esposito M, Hirsch JM, Lekholm U, Thomsen P. Biological factors contributing to failures of osseointegrated oral implants. (II). Etiopathogenesis. Eur J Oral Sci 1998;106:721-64.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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