How the war brought new challenges to anaplastologists and ocularists: facial prosthetics using a digital protocol
Author: Dmytro Filonenko
Base Hospital / Institution: Bogomolets National Medical University
Abstract ID: 25-125
Purpose
The armed aggression of the Russian Federation in Ukraine brought with it a significant number of large facial defects. Despite the wide possibilities of reconstructive and plastic surgery, some patients need ocular prosthetics. In cases of total defects of the nose, ear, with damage to the orbit and the middle facial zone , accompanied by defects of the content of the orbit, eyelids, circular eye muscle, rehabilitation of patients is achieved by methods of maxillofacial prosthetics with the participation of a multidisciplinary team consisting of an anaplastologist, maxillofacial and plastic surgeon.
Methods
the study included 72 patients (currently in work, as of the beginning of the summer I expect +5060) with defects of the bones of the facial skull and soft tissues of the face. Of these, 58 patients required orbital reconstruction and ocular prosthetics, while in 14 cases epiprostheses were made (5 noses, 3 ears, and 6 orbital). The rehabilitation protocol for patients with anophthalmos included face scanning, virtual simulation of the position of the eye prosthesis, orbital reconstruction using a patient-specific implant, orbital prosthetics, and eye prostheses made of acrylic based on the impression.
For the manufacture of epiprostheses, facial scanning, modeling in the software environment Mimics, RealGyde, Exocad, navigational surgical templates for the installation of fixation implants, production of milled beams from PEEK for prosthetically oriented placement of the magnet and additional anti-rotational retention of the epiprosthesis were performed. To optimize the production of the exoprosthesis, 3D printing of the missing part of the face was used. The epiprosthesis was made of silicone.
Results
Mean orbital volume difference between intact and injured orbits was 4.6±2.4 sm3 before treatment. After treatment this difference decreased to 1.4±2.5 cm3 (p more than 0.001). Mean difference in a sagittal position between intact eyeball and eye prosthesis was 2.8±2.6 mm. Mean time for epiprosthesis manufacturing was 3 weeks with mean number of 4 visits
Conclusion
the digital protocol makes it possible to optimize labor resources, reduce the number of visits for the patient, make the rehabilitation process more predictable, and eye prosthetics more accurate, which significantly improves the results of rehabilitation of patients with the consequences of a mine explosion injury.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Yurii | Chepurnyi | Bogomolets National Medical University |
| Oksana | Petrenko | Bogomolets National Medical University |
