Subperiosteal anchorage for craniofacial epitheses: technical innovation with an illustrative nasal application.

Abstract

This note describes an innovative nasal epithesis retained by a patient-specific juxtaosseous (subperiosteal) anchorage when conventional retention is unreliable and endosseous implants are not feasible. The unique case was a 68-year-old woman with xeroderma pigmentosum and multiple nasal/upper-lip carcinomas, resulting in complete arhinia and loss of premaxillary support, precluding free-flap reconstruction and predictable endosseous implant placement. Computed tomography-based virtual planning and computer-aided design with biomechanical simulation guided fabrication of a three-dimensionally (3D) printed titanium juxtaosseous framework; fit was verified on a 3D-printed anatomical model. A retention bar was secured to the framework via three posts, providing an external interface for a bar-clip silicone epithesis. The device provided three osseous anchorage regions and was fixed subperiosteally with seven screws. Loading occurred at 1 month. At 12 months, healing was uneventful with no device-related complications or loss of retention; a satisfaction questionnaire showed high acceptance and improved self-confidence.