Abstract
Maxillofacial prostheses are constructed by maxillofacial prosthetists and technologists (MPTs), as an alternative treatment when maxillofacial defects cannot be surgically fulfilled. A questionnaire was conducted surveying 220 MPTs working in all UK maxillofacial units about their opinions, attitudes, and experience regarding several aspects related to maxillofacial silicone prostheses. Numbers and percentages of maxillofacial prostheses, their retention method, serviceability, reduced serviceability causes, and digital technologies (DT) used in constructing prostheses were analysed. Thousand hundred and ninety-three prostheses were constructed (42% ocular, 31% auricular, 13% orbital, 12% nasal, 1% composite, more than one facial prosthesis). Adhesives commonly retained orbital (48%) and nasal (45%) prostheses. Implant-retained bars commonly retained auricular prostheses (70%). Ocular prostheses were entirely retained by undercuts. Implant-retained prostheses remained serviceable for twice as long (19–24 months) as adhesive-retained prostheses (7–12 months). Causes for prosthesis replacement included colour changes (71%), poor maintenance (41%), and silicone tear (37%). Thirty-one percent of MPTs used DT computer software and programs for designing and constructing maxillofacial prostheses. In conclusion, adhesives, implant-retained bars and magnets are commonly used retentive methods. Prosthesis failure is caused mainly by colour change, poor maintenance, silicone tear and delamination. Different DTs are used by one-third of MPTs.
Maxillofacial defects are facial disfigurements resulting from congenital abnormalities, surgical resection of tumours, trauma, or a combination of these . A facial prosthesis is the efficient alternative, when aesthetic and functional demands cannot be surgically fulfilled .
The serviceability of maxillofacial prostheses depends on the materials used in their fabrication and the patient’s attitude toward the prosthesis , and it can be directly associated with the effectiveness of the prosthesis in achieving its objectives . Many studies report improvements in silicone properties and bonding to underlying substrates , and suggest new fabrication techniques . The objective is to enhance the patient’s quality of life and re-socialisation as the patient’s level of reintegration in society is related to the degree of satisfaction with rehabilitation .
Complete rehabilitation of patients with facial disfigurements is achieved using a multidisciplinary team approach, involving surgical and prosthetic personnel. Treatment requires cooperation between those treating the disease and those responsible for the emotional wellbeing of the patient . Maxillofacial prosthetists are a small healthcare profession. In 2002, there were only 147 maxillofacial prosthetists and technologists (MPTs) registered in the UK . By 2007, the number had increased to more than 220 (Institute of Maxillofacial Prosthetists and Technologists Newsletter, 2007). MPTs provide prosthetic rehabilitation for disfigured patients, but the provision of prostheses forms only part of their work . The construction of maxillofacial prostheses is labour intensive, time consuming, and costly . A literature review reveals several studies that explored patients’ opinions and attitudes towards their prostheses . MPTs’ perception about various aspects of maxillofacial prostheses is unknown.
The aim of this study was to investigate the opinions, attitudes, and experience of MPTs in the UK regarding extra-oral maxillofacial silicone prostheses.
Materials and methods
A pilot, self-administrated questionnaire was carried out on 8 experienced MPTs in different maxillofacial units in the UK to improve the layout and format of the questions, and to ensure that they were easily understood ( Appendix A ). The National Research Ethics Service (NRES) of the regional ethics committee was supplied with a copy of the questionnaire along with its aims. As all personal information sought from participants was deemed not to be sensitive, Ethics Committee Approval was not required.
The questionnaire included close-ended and partially close-ended questions in 3 categories ( Appendix A : questions 1, 2, 3, 4, 5, 13, 14 and 15): demographics (gender and pattern of work); professional experience (years of experience; numbers and types of maxillofacial prostheses fabricated in 2007; methods of prosthesis retention; durability of adhesive-retained and implant-retained maxillofacial prostheses, and causes of reduced facial prostheses longevity); digital technologies (DTs) used in fabricating facial prostheses.
The questionnaire was distributed via the Institute of Maxillofacial Prosthetists and Technologists (IMPT) to all MPTs and maxillofacial units in the UK. It was sent via the IMPT newsletter, and the sample size comprised 220 MPTs. It was accompanied by a covering letter explaining the aims and objectives of the study and affirming that all information would remain confidential and anonymous. A prepaid envelope was included with the academic address of the main investigator. MPTs were asked to complete the questionnaire, especially sections about numbers and figures in accordance with their individual work in the unit, to ensure accuracy and consistency within the results.
Follow up reminders were not sent because they were not approved by the IMPT council. The authors were not given the list of IMPT members and their addresses as this would contravene their privacy rights. After collecting the responses, the data were imported into SPSS software (release 16, SPSS Inc., Chicago, USA), and analysed using frequencies and the χ 2 test ( P = 0.05).
Results
The responses were divided into two groups: usable responses in which respondents had completed the questionnaire; non-usable responses, including blank copies of the questionnaire, only the cover letters, and undelivered returned mail. There were 96 responses; a 44% response rate. Of the original sample size (220), 32 questionnaires were non-usable (10 returned cover letters only, 22 returned blank questionnaires, and 15 were undelivered), 47 were not considered when the data were analysed, giving a usable response rate of 22% .
To ensure that the figures reported were accurate and not duplicated by other MPTs working in the same unit, MPTs were asked to complete the questionnaire, in accordance with the work that they personally have done within the unit. Four completed questionnaires indicated that the figures and workload were conducted by the whole maxillofacial unit.
Sixty-nine percent of participants were male and 31% female. Most respondents worked in the NHS (96%), 4% worked in other disciplines such as charities or academia. Four percent worked in both the NHS and the private sector. Forty-eight percent had over 15 years of experience and 6% had up to 3 years’ experience ( Table 1 ).
| Experience | Percentage (%) |
|---|---|
| Up to 3 years | 6.3% |
| 4–7 years | 14.6% |
| 8–11 years | 18.8% |
| 12–15 years | 12.5% |
| Over 15 years | 47.9% |
A key question in the survey asked about the numbers and types of maxillofacial prostheses fabricated during from January to December 2007. Respondents were asked to specify the number and types of retention methods used to retain these prostheses. Of maxillofacial prostheses, the highest and lowest proportions of prostheses fabricated were ocular (42%) and composite (1%) prostheses, respectively ( Table 2 ). Composite prostheses restore more than one facial part in one prosthesis (e.g. orbital, cheeks and part of the nose). Methods of retention varied among each type of prosthesis fabricated ( Table 2 ).
| Prostheses | § Method of retention | ¥ Number (percentage) | ||||
|---|---|---|---|---|---|---|
| 1st | 2nd | 3rd | 4th | 5th | ||
| Nasal | Adhesives 65 (44.52%) | Magnets 44 (30.14%) | Bars 25 (17.12%) | Devices 11 (7.53%) | Undercuts 1 (0.68%) | 146 (12.24%) |
| Orbital | Adhesives 76 (48.10%) | Magnets 50 (31.65%) | Devices 26 (16.46%) | Bars 6 (3.8%) | – | 158 (13.24%) |
| Ocular | Undercuts 506 (100%) | – | – | – | – | 506 (42.41%) |
| Auricular | Bars 258 (70.11%) | Adhesives 69 (18.75%) | Magnets 36 (9.78%) | Devices 5 (1.36%) | – | 368 (30.85%) |
| * Composite | Adhesives 7 (46.67%) | Magnets 5 (33.33%) | Undercuts 2 (13.33%) | Bars 1 (6.67%) | – | 15 (1.26%) |
| Total | 1193 | |||||
§ Percentages in regard to total numbers of prostheses fabricated within each type.
¥ Percentage in regard to all prostheses fabricated.
* Restoring more than one facial part in one prosthesis (i.e. orbital, cheeks and part of the nose).
Participants were asked about the average service duration of adhesive-retained and implant-retained prostheses, until they require replacement. Thirty-two percent of MPTs reported 7–12 months for adhesive-retained prostheses, and 44% reported 18–24 months for implant-retained prostheses ( Table 3 ).
| Prostheses | 1–6 months | 7–12 months | 13–18 months | 19–24 months |
|---|---|---|---|---|
| Adhesive-retained | 24% | 31.7% | 22% | 22% |
| Implant-retained | 0 | 13.9% | 41.7% | 44.4% |
MPTs were asked to indicate the most common factors causing reduced serviceability in maxillofacial prostheses (this was a close-end question and 8 factors were mentioned) ( Table 4 ). Prosthesis colour change was the most common cause (71%), and patient dissatisfaction with the prosthesis was the least common cause (6%).
| Factor | Percentage (%) |
|---|---|
| Colour change of the prosthesis | 71.4% |
| Poor maintenance of prosthesis | 40.8% |
| Tear in silicone body | 36.7% |
| Poorly fitted prosthesis | 26.5% |
| Deterioration in adhesive | 16.3% |
| Separation of silicone from acrylic base | 12.2% |
| Patient dissatisfaction with the prosthesis | 6.1% |
| Others | 6.1% |
A key question in the survey asked whether MPTs used DT in fabricating maxillofacial prostheses. In the case of an affirmative answer, respondents were asked to specify the types of DT employed (multiple responses were available), and their reflections on using them (open-ended question). Only 31% of MPTs ( n = 15) used DT of different types ( Table 5 ). The MPTs positive reflection on using DT were mainly accuracy (23%) and better planning (23%), while their negative reflections were mainly the greater skill required (14%) and the additional procedures needed (9%) ( Table 6 ).
| Digital technologies categories | Number of MPTs (%) |
|---|---|
| Computer software only | 1 (6.67%) |
| Computer manufacturing programs only | 4 (26.67%) |
| Colour matching systems only | 1 (6.67%) |
| Other digital procedures | 1 (6.67%) |
| Computer software and manufacturing programs | 5 (33.33%) |
| Computer programs and colour matching systems | 1 (6.67%) |
| Computer software, computer manufacturing programs, and colour matching systems | 2 (13.33%) |
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