**Biomaterials and Epithesis, Our Experience in Maxillo Facial Surgery**

G. Fini, L.M. Moricca, A. Leonardi, S. Buonaccorsi and V. Pellacchia *La Sapienza/ Roma Italy* 

#### **1. Introduction**

28 Biomaterials – Physics and Chemistry

Tanzer, M. L., Chandrasekaran, S., Dean, J. W., 3rd & Giniger, M. S. (1993). Role of laminin carbohydrates on cellular interactions. *Kidney International*, 43, pp. 66-72. Tinari, N., Kuwabara, I., Huflejt, M. E., Shen, P. F., Iacobelli, S. & Liu, F.-T. (2001).

induced cell aggregation. *International Journal of Cancer*, 91, pp. 167-172. Tomizawa, T., Koshiba, S., Inoue, M., Kigawa, T., Yokoyama, S. & Initiative, R. S. G. P.

critical review. *Glycoconjugate Journal*, 19, pp. 537-542.

van den Brule, F., Califice, S. & Castronovo, V. (2004). Expression of galectins in cancer: A

Vasta, G. R. (2009). Roles of galectins in infection. *Nature Reviews Microbiology* 7, pp. 424-438. Wen, Y. F., Makagiansar, I. T., Fukushi, J., Liu, F. T., Fukuda, M. N. & Stallcup, W. B. (2006).

Yamamoto, H., Nishi, N., Shoji, H., Itoh, A., Lu, L. H., Hirashima, M. & Nakamura, T. (2008).

Yamaoka, A., Kuwabara, I., Frigeri, L. G. & Liu, F. T. (1995). A Human Lectin, Galectin-3

Yoshii, T., Fukumori, T., Honjo, Y., Inohara, H., Kim, H.-R. C. & Raz, A. (2002). Galectin-3

Zhou, Q. & Cummings, R. D. (1993). L-14 lectin recognition of laminin and its promotion of

Zhuo, Y. & Bellis, S. L. (2011). Emerging Role of alpha 2,6-Sialic Acid as a Negative

Zick, Y., Eisenstein, M., Goren, R. A., Hadari, Y. R., Levy, Y. & Ronen, D. (2004). Role of

(2008). pdb database 2YRO.

*Cellular Biochemistry*, 98, pp. 115-127.

*Journal of Biochemistry*, 143, pp. 311-324.

*Journal of Biological Chemistry*, 277, pp. 6852-6857.

in vitro cell adhesion. *Arch Biochem Biophys*, 300, pp. 6-17.

*Immunology*, 154, pp. 3479-3487.

pp. 5935-5941.

19, pp. 517-526.

Glycoprotein 90K/Mac-2BP interacts with galectin-1 and mediates galectin-1-

Molecular basis of interaction between NG2 proteoglycan and galectin-3. *Journal of* 

Induction of cell adhesion by galectin-8 and its target molecules in Jurkat T-cells.

(Epsilon-Bp/Mac-2), Stimulates Superoxide Production by Neutrophils. *Journal of* 

phosphorylation is required for its anti-apoptotic function and cell cycle arrest. *The* 

Regulator of Galectin Binding and Function. *The Journal of Biological Chemistry*, 286,

galectin-8 as a modulator of cell adhesion and cell growth. *Glycoconjugate Journal*,

Maxillofacial prosthetics is considered in literature as ''... the art and science of anatomic, functional and cosmetic reconstruction, by the use of non-living substitutes, of those regions in the maxillae, mandible and face that are missing or defective..." 1. In the maxillofacial surgery where malformative, oncologic traumatologic pathology and the plastic surgery are treated, the maxillofacial prostheses, in selected cases, can reach a satisfactory therapeutic result from functional, aesthetic, psychologic, and social point of views. In a delicate district, such as the face, where a heavy deficit can determine huge psychologic and social problems, the conventional reconstructive surgery intervenes with reconstructive techniques and with the biomaterials insertion, often insufficient to guarantee the restoration of the harmony of the face. When these conditions are verified, the solution resides in the osteointegration concept and in the application of the epithesis. There are certainly some limits of application of these prostheses, first, the ethics limits: the epithesis constitute in fact an alternative only when the conventional reconstructive surgery cannot be applied, but inside these limits, it is really possible to find an excellent therapeutic resource in patients who cannot undergo surgical interventions. In literature, it is possible to find different kinds of reconstruction of missing body parts by the application of prothesis2.The osteointegration concept was introduced at first time by Professor Branemark in 1960 to describe the ''direct structural and functional connection between living bone and the surface of a plant exposed to load, understood as a not static but dynamic process3. According to his school of thought, the technique of positioning of the implant is fundamental, to take place in the most complete precision and to allow the initial stability of one's self. Other elements conditioning the success of the osteointegration are the material of the implant, the form, the areas of the application, and the patient's clinical conditions. The first titanium osteointegration implant was positioned in 1965 in the jaw without dental elements 4;in 1977, implants were positioned in mastoid areas for the application of an acoustic translator. In 1979,implants for the fixation of epithesis of ears, noses, and eyes were positioned. At present, the indication to the position of epithesis as the first choice of treatment is when the conventional reconstructive interventions turn out to be inapplicable or ineffective. The epithesis is a good resolution for the patient because it is not traumatic and has short-time result, removing every psychologic physique obstacle for the inclusion in a normal social life.

Biomaterials and Epithesis, Our Experience in Maxillo Facial Surgery 31

performed to evaluate the bone and the soft tissues (Figs 10 and 11). After the clinical and radiologic evaluation and the patient's agreement, 4 fixtures with corresponding abutments were placed to support the anchor of the orbital epithesis. Nasal and orbital scars were

Clinical Case 4 F.M., a 61-year-old man, was referred with a nose extirpation for a squamocellular cancer on the nasal tip, involving all nasal structure, 7 years before (Fig 14).The patient and his family declined any kind of reconstructive operative interventions, so the patient underwent nasal movable prosthesis resting. Based on this situation,wehad proposed tohimnasal removable prosthesis fixed with bone paranasal implants. For this reason, the patient had undergone computed tomography scan of the head and neck to study bone density and then 2 implants (4 mm) were placed. Follow-up at 3, 6, and 12 months with clinical visits and computed tomography scan revealed correct implant bone

Clinical Case 5 P.D., a 25-year-old woman, underwent surgical exenteration orbitae because of retinoblastoma. The orbital cavity was restored by temporal muscle flap and dermal-free flap. The patient underwent many reconstructive surgical treatments through the use of fillers of biomaterials in frontal-temporal-cheek side, to reconstitute the anatomic structure. She arrived in our observation with a moving orbital prosthesis (Fig 16). Clinical and radiologic examinations with three-dimensional computed tomography were performed to evaluate the bone and the soft tissues. In accordance with the patient's desire, 3 titanium fixtures with abutments were implanted to position the orbital

Clinical Case 6 M.N., a 56-year-oldwoman,was referred with a partial auricular extirpation for a basocellular cancer on the auricular left elice. The 2/3 superiors of the auricular pavilion have been removed, with a partial deficit of the pavilion itself, which has caused psychologic problems to the patient. In agreement with the patient, a second surgical treatment was performed, modeling porous polyethylene peace with Nagata technique and covered by temporoparietal fascia and dermo-epidermic flap to fill the auricular fault. The biomaterial is not osteointegrated, so it has been removed. For such reason, in agreement with the patient justified strongly to an immediate and no invasive aesthetic rehabilitation, 2 fixtures with abutments have been positioned that support auricular epithesis (Figs 18Y20). The clinical and radiologic follow-up has shown a correct osteointegration of the implants

Clinical Case 7 G.B., a 68-year-old woman, with epatotrasplanting and hepatitis C virus has arrived in our observation with a necrotic lesion of the nasal tip resulting to immunosuppressive therapy. She was referring to have noticed the appearance of the necrosy and his progressive growth soon after the end of the therapy. The patient was presenting exposure of the cartilaginous septum with erosion and cutaneous necrosy to the nasal base (Fig 21). Because of the clinical conditions of the patient, a fixture's implant has been made for the positioning of an epithesis in order to obtain an effective reconstruction. Three fixtures with abutments have been applied. A fixture was removed approximately 2 months after the installing because it is not integrated. The other 2 implants seemed to be well supplemented to allow the positioning of the bar that supports the epithesis, but after 2months, 1 fixture has been removed because of missed osteointegration. Therefore, it was decided to position some magnets to anchorage the

corrected by little flaps (Figs 12 and 13).

integration (Fig 15).

prosthesis (Fig 17).

epithesis (Fig 22).

reaching psychologic stability of the patient.
