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Prostheses for nasal cavity and paranasal sinus cancer
Prostheses are artificial replacements for body parts. If you are treated for cancer in the nasal cavity or a paranasal sinus, you may have one of the following types of prostheses.
Sometimes doctors have to remove large amounts of bone and tissue during surgery to treat cancer in the nasal cavity or paranasal sinuses. Today’s surgical techniques and reconstructive surgery methods help lessen the changes to how the face looks after surgery. Advances in plastic and reconstructive surgery allow skin and bone grafts or tissue flaps to repair most surgical defects.
If reconstructive surgery can’t provide good functional and cosmetic results, or if reconstruction isn’t an option, you may need a facial prosthesis.
Prostheses are fitted by a maxillofacial prosthodontist. This healthcare professional is specially trained to make replacements for structures of the head and neck, including the oral cavity. Each prosthetic device is designed and custom fit for the person who will be using it. A new facial prosthesis needs to be remade about every 2 years.
An artificial eye, or ocular prosthesis, is used to replace an eye that has been removed by surgery. After the eye is removed, a plastic disc (called a conformer) is placed in the socket to keep the shape of the orbit, or eye socket. Some people may have the feeling that the eye is still there or have visual hallucinations. This is normal and temporary.
About 3 to 6 months after surgery, you will be fitted for an artificial eye. A mould will be made of the eye socket. The artificial eye will be made to fit the socket and painted to match the colour of the other eye. Until the permanent prosthesis is made, a temporary artificial eye may be used. An artificial eye may be held in place with an orbital implant (a device surgically attached to the orbit that helps keep the artificial eye in place).
It takes time to adjust when cancer or its treatments affect your eyes and vision. Some people find it helps to talk to others about changes to their sight or appearance. You may also be coping with new sensations, such as feeling like the eye is still there when it has been removed. Talk to your healthcare team about the support groups available to help you cope with your emotions and daily life with an artificial eye.
Once the eye socket is healed and your artificial eye is in place, you can return to most of your daily activities. You can leave the prosthesis in place when you are sleeping. You can also wear eye makeup, if you want to.
Your healthcare team may recommend that you wear protective eyewear to help protect your functional eye. Examples of protective eyewear include safety glasses, goggles and face guards, visors or face shields on helmets. It is especially important to protect your eye when you play sports. Wear goggles when you go swimming. Remove your artificial eye or wear protective goggles when you dive or go skiing.
Talk to your doctor about how having an artificial eye may affect driving and other daily activities. When you have an artificial eye, your range of vision is affected. This means that you will need to turn your head more to check from side to side when driving or crossing a road.
You will need to tell your provincial or territorial driver-licensing authority and your motor vehicle insurance company that you have an artificial eye. They will likely want to test your vision. They may also place restrictions on your driving, such as only allowing you to drive for short periods of time to allow your functioning eye to rest.
Sometimes surgeons need to remove part or all of the nose to completely remove an advanced tumour in the nasal vestibule or nasal cavity. If the nose can’t be repaired with reconstructive surgery, a removable nasal prosthesis, or artificial nose, may be made for you.
The nasal prosthesis will be made to look as much like your nose as possible. It will be made to match your skin tone. The edges of the prosthesis will be made to blend in with the contours of the face. Sometimes you may need several appointments to match the prosthesis to your face.
A nasal prosthesis may be held in place with special adhesives, tape, glasses or an extraoral implant (a device surgically attached to the bones of the face that the prosthesis clips to).
An obturator prosthesis is a removable denture that fills the area that has been removed by surgery. It creates a barrier between the nasal cavity and the mouth. It makes it possible for a person to speak and swallow when the hard palate is removed during surgery for cancer in the nasal cavity or paranasal sinuses.
Immediately after surgery, you will likely get a surgical obturator. A surgical obturator is a prosthesis that is wired or screwed into place. It helps you speak and swallow almost immediately after surgery. It also helps keep the surgical packing in place. The surgical obturator prosthesis is removed 5–8 days after surgery and made into a removable, temporary (interim) obturator prosthesis.
A maxillofacial prosthodontist makes and fits the temporary obturator prosthesis before surgery. A temporary obturator prosthesis is used up to 6 months until the area heals. It may take several fittings to get the best fit for the obturator prosthesis. At about 6 months, you will be fitted for a permanent (definitive) obturator prosthesis.
A permanent obturator prosthesis can help improve how the face looks. Some permanent obturator prostheses are made with artificial teeth to replace those removed by surgery. Close follow-up is needed to make sure that the permanent obturator prosthesis fits well. A new obturator is needed every 3–5 years.
If you have an obturator prosthesis, a speech language pathologist can help you if you have difficulty speaking or swallowing.
Not all people who have surgery for cancer in the nasal cavity or paranasal sinuses want an obturator prosthesis. Sometimes a flap of tissue can be used to repair the surgical wound so the prosthesis isn’t needed. Flaps may be a good alternative in older people or those who have trouble using their hands to remove a prosthesis. It’s important to know that it may be harder to speak and swallow with a flap compared to an obturator prosthesis.
Dental implants are artificial teeth attached to special screws placed in the upper jaw (called the maxilla) or lower jaw (called the mandible). These implants are different from dentures as they can’t be removed.
People who have radiation therapy after surgery or have very little bone left in their jaw after surgery can’t have dental implants. A dentist who specializes in this type of prosthetic rehabilitation will help decide if a dental implant is a good option for you.