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Where an ear, an eye socket or a nose cannot be rebuilt from the patient's own tissue, a silicone prosthesis is made and held by adhesive or by titanium implants in bone. Implant failure differs sharply by site: across 3,630 implants, 3.5 per cent failed at the ear, 8.8 per cent at the nose and 18.7 per cent at the orbit.
Some facial defects after cancer surgery cannot be closed with tissue. An eye socket after orbital exenteration, an external ear after resection of the pinna or temporal bone, and a nose after rhinectomy are the three commonest. For these, a maxillofacial prosthodontist or anaplastologist makes a painted silicone prosthesis matched to the patient's remaining features, held on with skin adhesive or clipped to abutments on titanium implants placed in the bone.
How well the implants hold. A systematic review and meta-analysis of 16 studies covering 3,630 implants in 1,127 patients gives the figures by site: pooled implant failure of 3.5 per cent in the auricular region, 18.7 per cent in the orbital region and 8.8 per cent in the nasal region. Compared with the ear, the risk of failure was 4.54 times higher at the orbit and 3.00 times higher at the nose. Irradiated bone raised the risk 2.17 times for ear implants and 2.07 times for orbital implants. The review also looked at timing, which had not been examined before: 79.8 per cent of nasal implant failures happened in the first year, against 21.4 per cent of ear failures and 35.4 per cent of orbital failures. The authors are explicit that the included studies were of low methodological quality and the results should be read with caution.
What the prosthesis does not do. A facial prosthesis is a static object. It does not move with expression, it does not sweat, and its colour is matched to the skin on the day it was made. A five-year clinical report following one patient through successive prostheses describes the practical consequence: the prosthesis has to be remade as the surrounding tissue changes, and colour can mismatch seasonally as the surrounding skin tans and fades. A laboratory study of the two silicones commonly used found measurable colour change, roughness change and hardening after three months of artificial sweat exposure and routine cleaning, although it judged the changes clinically acceptable.
What the evidence does not cover. There is no randomised evidence here and there is unlikely to be any. The outcomes that matter most, whether a person goes out of the house, returns to work and is comfortable being seen, are reported in single-centre case series and small satisfaction surveys. A reader should treat confident statements about psychosocial outcomes of facial prosthetics with the same scepticism they would apply to any uncontrolled series.
What comes back, and when: appearance in photographs and at conversational distance, within the weeks it takes to fabricate the prosthesis once the site has healed. What does not come back is expression on the prosthetic side, and vision when an eye has been removed. Osseointegration takes months and, in irradiated bone, may not happen at all.
Osseointegration is the direct structural bond between living bone and a titanium surface. It requires living, perfused bone, which is why the same implant behaves differently in thick mastoid bone than in the thin, often irradiated bone around the orbit and nose, and why radiotherapy roughly doubles the failure rate at both.
Query for this technology: (TITLE:"Facial reconstruction and facial prostheses: ears, orbits and noses" OR ABSTRACT:"Facial reconstruction and facial prostheses: ears, orbits and noses") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Facial reconstruction and facial prostheses: ears, orbits and noses, not a curated reading list.
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Shares Head and neck reconstruction: the free flap, and what it gives back, Cancer rehabilitation: the discipline that puts function back, Quality of life, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, rehabilitation.
Shares The devices that do the restoring, and who pays for them, Cancer rehabilitation: the discipline that puts function back, Patients lack understanding, navigation and agency, Quality of life and the tags rejuvenation, survivorship, rehabilitation.
Shares The devices that do the restoring, and who pays for them, Cancer rehabilitation: the discipline that puts function back, Quality of life, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, rehabilitation.
Shares Cancer rehabilitation: the discipline that puts function back, Patients lack understanding, navigation and agency, Quality of life, Survivorship and late effects are neglected and the tags rejuvenation, survivorship, rehabilitation.
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