Rehabilitation of Facial Defects with Prosthesis as a Salvage Option After Flap Failure-A Study of 13 Cases

Surgical removal of cancerous lesion may sometimes lead to large defects that connect the oral cavity with the exterior. The loss of a microvascular flap used to reconstruct the defect sometimes complicates the matter. A second surgery is at times refused or not amenable due to unavoidable reasons. In these situations, a facial prosthesis serves as a salvage treatment option, thus improving the quality of life (QOL) of the patients. The purpose of this clinical study is to document the non-invasive retentive aids used for the facial prosthesis and assess the improvement in QOL after rehabilitation with facial prosthesis for participants with facial defects. Data of 13 head and neck cancer patients rehabilitated with facial prosthesis was collected retrospectively. The relevant sociodemographic, clinical, surgical, histopathological, TNM staging, reconstructive flap, prosthesis, material used for prosthesis, and retentive aids related data was collected. The psychosocial perception scale (PSP) questionnaire was administered to the patient at baseline and 6 months of follow-up to evaluate the quality of life. QOL data pre and post prosthesis was subjected to statistical analysis. Wilcoxon signed rank test and paired t-test was used to analyze pre and post assessment of QOL. A total of 13 patients (10 males and 3 females) who underwent surgical resection for oral cavity cancer received facial prosthesis. Majority of the lesions occurred in the buccal mucosa followed by the maxilla. All participants had T4 lesions and had received adjuvant radiation (60 Gy, 30 fractions). Reconstruction by pectoralis major myocutaneous flap in 6 participants, free anterolateral thigh flap in 4, free fibular flap in 1, vascularized iliac crest in 1 and split thickness skin graft in 1 participant was done. Twelve prosthesis were retained with magnetic attachments and favorable undercut was used to retain 1 prosthesis. The pre and post-prosthesis scores showed statistical significant values in the domains of functions (p = 0.05) and positive emotions (p = 0.04). Given the psychosocial impact a facial defect has on a head and neck cancer patient, considerable improvement was noted in the QOL. The PSP scale is a very specific questionnaire aimed at addressing patients with extraoral prosthesis, and this study drives that point succinctly. Retaining extraoral prosthesis is challenging; careful selection of retentive undercuts or choice of retentive aids is necessary to make the prosthesis a success.