ASSESSMENT OF PATIENT NEEDS

Patients vary in suitability for treatment involving implantation. Most implants are used to manage bony or soft-tissue defects caused by trauma, tumor excision, or birth defects. Most patients with a history of irradiation of the proposed recipient sites are not good candidates for implants unless distant, nonirradiated tissues can be brought into the area. This often necessitates procedures with several stages and perioperative hyperbaric oxygen therapy for best results.

Before an implant is used, the patient's wound-healing potential and immunologic status are assessed. Patients with diabetes or hypertension, those who smoke heavily, or patients undergoing chemotherapy or taking immunosuppressive drugs are at risk of wound infection and implant extrusion. A history of sensitivity to any component of the implant must be sought. With metallic implants, difficulty in dosimetry is expected if further radiation therapy is planned.

When a young adult applies for a facial, head, or neck implant, the physician must ask about the person's usual physical activity level and sports participation. A common cause of implant loss is trauma, which causes hematoma formation, loosening of the implant, and extrusion. The patients must agree not to participate in contact sports or to delay implantation until the questionable activity is no longer a consideration. In the management of deformities due to ablative cancer surgery, it often is prudent to delay prosthetic implantation as long as 1 year after surgery. The patient is observed for an extended period after implantation for the development of residual or recurrent disease and for rejection of the implant.

There is a difference between implants for functional needs and for cosmetic indications. A functional implant is chosen to provide the best restoration and the lowest risk of complications. In cosmetic applications, emotional and psychologic development is considered as well. The condition of the recipient tissues is likely to be the limiting factor in functional cases, and psychologic factors count heavily in cosmetic implantation.

For osseous replacement or augmentation implants, radiologic assessment of the recipient area often is advisable. Conventional facial and skull radiographs are not sufficient for assessing the extent of osseous abnormality, and computed tomography (CT) is needed. Three-dimensional computed tomography can be linked to a computer-aided design and fabrication system for precise manufacturing of the prosthesis (3). Magnetic resonance imaging is not as helpful for evaluation of osseous deformities as it is for soft-tissue assessment.

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  • Category: Surgical treatment