Interviewees agreed that a critical component for success is a correctly prepared foundation for a facial prosthesis. A prosthetic device won’t work if the area of the defect is not prepared to accept the prosthesis. For example, we need a socket that will accept a prosthetic eye. The surgeon creates the environment that will accept an orbital prosthesis, Dr. Davis explained.
Explore This IssueFebruary 2009
The foundation for the prosthesis may be inadequate due to radiation, or it may be too voluminous and require more debulking. This is where the plastic surgeon comes in, Dr. Skoracki said.
Extraoral prosthetics requires close collaboration. A team approach is best. At our university, we collaborate to plan resection, reconstruction, and rehabilitation, Dr. Davis commented.
You need a team approach involving interested parties. Each specialist brings something more to the table. We learn from each other, and we learn from every patient. These procedures should be done at a center with sufficient volume, an appropriate infrastructure, and a dedication to the restoration of the patient as a whole, Dr. Skoracki added.
First, consider both surgical and prosthetic options with the patient, Dr. Davis advised. Patients should be shown a visual catalog of the types of prostheses available and the options for retention, and given an idea of how they will look with and without a facial prosthesis. Certain types of defects are better approached by surgical reconstruction-for example, the nose- while the ear is usually more amenable to a prosthesis, she said.
If the patient is able to discuss the procedure beforehand, it is important to explain what the amputation of an eye, nose, or ear will mean. Help the patient understand how a prosthesis will aid in their recovery, but tell them that the prosthesis will never be the same as normal tissue, Dr. Skoracki said.
Patients need to have realistic expectations of a prosthetic device. These are not live tissues, and they are not capable of functioning as such. A new eye won’t blink. No matter what the extraoral prosthesis looks like, it will not be functional, Dr. Huryn said.
Facial prosthetics is not a well-known specialty. Patients will need to be educated about prosthetic choices and attachment options. They will need an anaplastologist who concentrates only on the face so they can be satisfied with the results. An excellent result is not automatic, Mr. Gion stated. Even ear reconstructive surgeons such as R. L. Walton agree that ‘the weak link in this technology [prosthetic rehabilitation] lies in the quality of the prosthesis itself, the life-like appearance of which is wholly dependent on the artistry and skill of the anaplastologist.’