Epitheses

Introduction:

Epithetics deals with the restoration of missing body parts.

Missing parts of the face, such as the nose, eye, ear and other areas, are often the cause of tumor diseases and associated surgeries, traumas, burns or congenital malformations.

The parts to be replaced, so-called epitheses, are artificially made facial parts, mostly made of medical-grade silicone and individually manufactured for each patient.

In this process, the anatomy and color of the missing area are replicated, so that the restored facial part looks deceptively real.

Skin textures, freckles, age spots, hair, eyelashes, eyebrows and other characteristics can be realistically recreated.

Attachment:

Epitheses are removable and nowadays are predominantly attached to the skull bone by means of surgically inserted implants.

These implants usually have magnets screwed onto them, which allow the artificial facial part to be easily attached and removed.

Magnets ensure a firm and secure fixation and easy handling of epitheses.

Alternatively, epitheses can be anchored with medical skin adhesive, to glasses, or anatomically in the defect.

Interdisciplinary collaboration:

Surgeons and prosthetists work closely together in the care and treatment of patients with facial deformities.

This close cooperation between epithetics and surgery is the basic requirement for the care and treatment of patients who receive epithetic fittings.

The doctor and the prosthetist are in close contact and provide care for patients and relatives before, during and after surgery and prosthesis fitting.

For a high-quality functional and aesthetic result, the positioning, number, and choice of implant system are crucial.

Ideally, the prosthetist should be present during the implantation (surgical support).

Material and durability:

The silicones used for the prostheses change due to sun exposure, becoming lighter, the material ages and the thin edges can tear.

Daily use will inevitably lead to signs of wear and tear over time. Therefore, a replacement is urgently needed after a maximum of two years.

Due to very high and rapid bacterial colonization and/or defect changes, premature remanufacturing is necessary from a medical point of view.

Changes in prosthetic defects can occur due to impaired wound healing, scar contracture, tissue swelling, and changes in skin color caused by radiation. Especially during childhood and adolescence, regular replacement of prostheses is necessary due to growth.

Procedure and production:

The fabrication and individual fitting of an epithesis requires approximately 3-5 appointments. Prior to this, an interdisciplinary treatment plan is developed to determine the appropriate anchoring methods and the size of the epithesis.

The treatment must be prescribed by a doctor, submitted in writing to the insurance company, and the cost coverage declaration must be available.

Only now can an impression be taken of the patient, from which a model is made.

On this model, the missing facial part is pre-modeled in wax and then tried on the patient.

It is advantageous for the fitting to take place in the presence of family members, as they can assist the patient in the decision-making process regarding the shape, color, and aesthetics. The color selection of the prosthesis is also made individually for the patient in several areas of the face.

Especially in the case of nasal prostheses, patients should bring pictures from recent years, if available, in order to recreate the “nose” as faithfully as possible to the original based on these specifications.

Complex facial defects usually require several fittings.

Once the shape and colors have been determined, the epithesis can now be manufactured in the laboratory.

Once the epithesis is fully modeled, it is transferred to silicone. The individually colored silicone is applied layer by layer into a mold.

The detailed design and individual finishing, including features such as eyebrows and eyelashes, take a lot of time.

Once completed, the prosthesis is fitted to the patient. Together with the patient and their family, the handling of the new “facial part” is demonstrated and practiced (insertion, removal, and daily care of the prosthesis).

Further support:

Follow-up appointments are scheduled with the patient as needed to detect changes in the defect area and on the prosthesis, pressure sores, or other problems early on. If necessary, an unscheduled appointment will be made at the treating clinic. The recall and follow-up intervals remain separate from these appointments.

MRI scans in patients with magnetically fixed prostheses present a special challenge. Before the MRI scan, the patient-side magnets must be removed and then screwed back in afterwards.