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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 5  |  Issue : 2  |  Page : 95-98

Fabrication of a silicone partial nasal prosthesis


Department of Prosthodontics, College of Dentistry, King Khalid University, Abha, Saudi Arabia

Date of Submission21-Dec-2020
Date of Decision27-Dec-2020
Date of Acceptance28-Dec-2020
Date of Web Publication25-Feb-2021

Correspondence Address:
Dr. Nasser Mohammad Alqahtani
Gregair St, Abha City, 61413
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/KKUJHS.KKUJHS_33_20

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  Abstract 

Fabricating a partial extraoral prosthesis is challenging, especially partial nasal prosthesis. An extraoral prosthesis can be successful when patients can socialize without fear of being noticed with an abnormal facial defect. Homogeneity, subtle textures, and color match are essential to fabricate successful extraoral prosthesis. In this case report, a 69-year-old Caucasian female patient presented with a partial nasal defect. A silicone partial nasal prosthesis was fabricated to replicate the missing structures.

Keywords: Maxillofacial defect, nasal prosthesis, partial rhinectomy


How to cite this article:
Alqahtani NM. Fabrication of a silicone partial nasal prosthesis. King Khalid Univ J Health Sci 2020;5:95-8

How to cite this URL:
Alqahtani NM. Fabrication of a silicone partial nasal prosthesis. King Khalid Univ J Health Sci [serial online] 2020 [cited 2021 Apr 10];5:95-8. Available from: https://www.kkujhs.org/text.asp?2020/5/2/95/309609


  Introduction Top


Nasal defects can be caused by congenital malformations, trauma, or removal of malignant lesions. Basal cell carcinoma (BCC) is the most common malignant lesion in the head and neck extraorally, and it can demonstrate an aggressive behavior.[1],[2] Several treatment modalities are considered for BCC based on the size, location, and penetration of the lesion.[2],[3] Chemotherapy is a rare treatment because BCC can usually be detected early. Conservative surgical treatment as partial rhinectomy is a treatment modality for such lesions. This type of surgical excision might result in a surgical site contraction due to scarring, and this might cause deviation of the tip of the nose toward the defective site. Therefore, when a nasal orientation is indicated for correction, nasal prosthesis usually becomes bulky.[2],[3],[4],[5]

Surgical reconstruction of any nasal defect still represents the gold approach. However, nasal surgical reconstruction could be challenging to be conducted due to the size and the location of the defective site and the surgeon's skill. Nasal prosthesis after rhinectomy, on the other hand, might improve the patient's quality of life. The patient's desire is to appear in public without fear or concern of being noticed with unusual figures.[3],[5],[6]

Silicone elastomers are the most common materials to be used for an extraoral maxillofacial prosthesis. The ability to mimic the texture of normal skin and the color match increases the popularity and the use of such material. Furthermore, it is cost-effective, easy to fabricate, and has acceptable weight.[3],[5],[7]

This clinical report describes the prosthetic rehabilitation of a patient diagnosed with nasal BCC, and a partial rhinectomy was performed, resulting in a defect in the lateral part of the nose with a slight deviation of the tip of the nose.


  Case Report Top


A 69-year-old Caucasian female patient presented in the maxillofacial prosthetic clinic at Indiana University School of Dentistry with a partial nasal defect. The patient was diagnosed with BCC in the right alar, and a partial rhinectomy was performed. After 5 months, the scare contraction had occurred, which resulted in slight nasal tip deviation toward the defective site, upward upper lip contraction, and downward contraction of the medial canthus of the right eye [Figure 1]. The patient refused to undergo any surgical reconstruction. Fabrication of a partial nasal prosthesis out of silicone was offered and accepted. The outcome of this plan was explained to the patient, the detailed procedure was clarified, and the consent was obtained.
Figure 1: Frontal view of the partial nasal defect

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Petroleum jelly was applied to both eyebrows, and wet gauze was placed into the nasal cavity to prevent any impression material from flowing inside. Room temperature vulcanizable (RTV) organopolysiloxane silicone impression (Clone Silicone FX-302, Factor II, USA) was applied gently with a small cement spatula around the defect, including both cheeks, remaining nasal structure with the nasal bridge, and the upper lip. After complete polymerization, a vinyl polysiloxane putty (VPS) impression material (Silicone Putty FX-304, Factor II, USA) was applied on top of the first layer for back and support [Figure 2]. The impression was then poured with type IV white die stone (Silky-Rock, Factor II, USA) [Figure 3]. A trial wax-up was fabricated by sculpting on a medical sculpting wax (Sculpting Wax G-120, Factor II, USA) and following the remaining contralateral side anatomy as a guide. The adaptation, appearance, and textures of the wax pattern were evaluated and modified directly on the patient's face. The airway was kept open to facilitate breathing. A slight inner extension of the wax pattern into the defect undercut was created to ensure proper prosthesis retention [Figure 4].
Figure 2: Impression of the defect

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Figure 3: Master cast

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Figure 4: Wax pattern try-on

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A chairside visual, trial and error method was performed to select a correct skin shade and color by adding several pigmentations (Functional Intrinsic Skin Color FI-SK, Factor II, USA) into silicone elastomers (RTV-40, Factor II, USA) and then holding it next to the face to confirm the color and shade match. The wax pattern was positioned back on the master cast, and the edge was sealed well and thinned to allow the silicone edge to feather with surrounding natural skin [Figure 5]. Positioning indices were created on the master cast to facilitate the mold pieces' positioning during packing [Figure 6]. Clay material was placed around the wax pattern on the master cast about 10 mm away from the wax pattern edges to reduce the contact area and the resistance force between the mold pieces during packing [Figure 7]. Thus, the prosthesis edges will be thin and would feather on the surrounding skin for maximum esthetics. The top piece mold was then poured with type IV white stone (Silky-Rock) to create a two-piece mold. After de-waxing, the stone mold was cleaned out of any wax or clay debris [Figure 8]. Flocking fibers and some pigmentation (H-Flocking, Factor II, USA) were painted on some areas of the mold's negative piece as a part of the intrinsic coloration [Figure 9].
Figure 5: Final wax pattern and sealed border

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Figure 6: Positioning indexes

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Figure 7: A clay material on the border of the master cast

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Figure 8: After de-waxing of the two-piece mold

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Figure 9: Intrinsic coloration on the mold before packing

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A silicone mixture (RTV-40) with the base skin color (FI-SK) and different color swatches (Functional Intrinsic II, Factor II, USA) was added to the mold and then packed. The silicone was allowed to cure for 24 h at room temperature, and then, the prosthesis was carefully removed from the mold [Figure 10] and [Figure 11]. Extrinsic coloration (Functional Intrinsic II, Factor II, USA) was accomplished chairside to reach the prosthesis's final shade. The final extrinsic coloration was then sealed with acetoxy silicone dispersion (Acetoxy Silicone Dispersion adhesive, TS-564, Factor II, USA). Finally, de-glossing was provided on the prosthesis using silicone matting dispersion (Matting Dispersion MD-564, Factor II, USA) [Figure 12]. The patient was instructed to use a medical skin adhesive (Daro, Adhesive Regular B-200-R, Factor II, USA), and the application of the adhesive was demonstrated to the patient. The patient was instructed about the nasal prosthesis's follow-up care and to use antimicrobial agent spray regularly. The patient was very satisfied with the appearance of the prosthesis. She completely understood the postoperative instructions and showed up in the follow-up appointments without any complaints or complications.
Figure 10: Final prosthesis after complete

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Figure 11: Final prosthesis before extrinsic coloration

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Figure 12: Final prosthesis after extrinsic coloration de-glossing

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  Discussion Top


The most common treatment modality for BCC is surgical excision. Surgical reconstruction is not always applicable for several reasons. The defect site condition and size, patient health condition, surgeon skills, and patient preference make the prosthetic option preferable.[1],[2],[3],[4],[5]

Problems associated with esthetic and function are both a concern and a challenge to the patient and clinician. The patients want to run through their everyday lives without fear of being noticed with any abnormal facial appearance. However, the clinician is worried about deriving support and enhancing retention with the available tissues present.[8],[9],[10]

Full face impression can be very unpleasant for most patients, and a partial facial impression is sufficient for partial nasal defects, especially when nose orientation with the face is not necessary. In this case, the impression covered the remaining nasal structure and part of both checks. Even though the tip of the nose deviates slightly, it was not significant to be corrected.[3],[5],[8]

Elastomer impression material can be fast with superior accuracy. In this case, the RTV silicone impression was applied gently using a mixing spatula to record detailed skin textures. A thick layer of VPS putty impression material was used for support during impression removal and pouring. Impression plaster can be used for the same purpose, but it might add more weight, which will change the skin dimension and will distort the first impression layer. This will result in an inaccurate master cast to fabricate a silicone prosthesis.[3],[5],[6]

The silicone material is the more popular material for extraoral prosthesis because it can replicate the real skin texture, and it is easy to fabricate.[3],[5],[6] However, the patient should pay special care while wearing and cleaning the prosthesis to prevent microbial growth. Further, the silicone material can be affected by sunlight and moisture and tore under careless handling. Thus, silicone prosthesis needs to be replaced whenever needed. The prosthesis retention was achieved by a slight extension of the prosthesis's fitting surface in the anatomical undercut in the defective site and by using medical adhesive in the peripheral fitting surface of the surrounding skin. Retention could be improved by utilizing implants with different attachments' system. However, in this case, the implant was not an option due to the patient preference and the limited size of the defect.[7],[8],[11]


  Conclusion Top


Nasal defect usually restricts patients' life styles and limits their social communications. In addition, silicone prosthesis can successfully solve this problem and the patients can go to public without fear and with high confidence.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Wu S, Han J, Li WQ, Li T, Qureshi AA. Basal-cell carcinoma incidence and associated risk factors in U.S. women and men. Am J Epidemiol 2013;178:890-7.  Back to cited text no. 1
    
2.
Ceilley RI, Del Rosso JQ. Current modalities and new advances in the treatment of basal cell carcinoma. Int J Dermatol 2006;45:489-98.  Back to cited text no. 2
    
3.
Negahdari R, Pournasrollah A, Bohlouli S, Sighari Deljavan A. Rehabilitation of a partial nasal defect with facial prosthesis: A case report. J Dent Res Dent Clin Dent Prospects 2014;8:256-9.  Back to cited text no. 3
    
4.
Harashina T, Nakajima H, Imai T. Reconstruction of mandibular defects with revascularized free rib grafts. Plast Reconstr Surg 1978;62:514-22.  Back to cited text no. 4
    
5.
Beumer J, Curtis T, Marunick M. Maxillofacial rehabilitation: prosthodontic and surgical considerations. St. Louis: Ishiyaku EuroAmerica; 1996. p. 377-454.  Back to cited text no. 5
    
6.
Jain S, Maru K, Shukla J, Vyas A, Pillai R, Jain P. Nasal prosthesis rehabilitation: a case report. J Indian Prosthodont Soc 2011;11:265-9.  Back to cited text no. 6
    
7.
Guttal SS, Vohra P, Pillai LK, K Nadiger R. Interim prosthetic rehabilitation of a patient following partial rhinectomy: A clinical report. Eur J Dent 2010;4:482-6.  Back to cited text no. 7
    
8.
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. 8
    
9.
Ramkumar V, Sangeetha A. Early rehabilitation of facial defects using interim removable prostheses: A clinical case report. J Pharm Bioallied Sci 2013;5:S160-2.  Back to cited text no. 9
    
10.
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. 10
    
11.
Toljanic JA, Lee J, Bedard JF. Temporary nasal prosthesis rehabilitation: A clinical report. J Prosthet Dent 1999;82:384-6.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]



 

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