TANOUE, MORI, AND MATSUMURAINT CHIN J DENT

A nasal prosthesis magnetically connected with a maxillary complete
denture: A clinical report
Naomi Tanoue, DDS, PhD,a Shuichi Mori, DT,b and Hideo Matsumura, DDS, PhDc
aProsthodontics, General Dentsitry Department, bDental Laboratory Center,Nagasaki University Hospital of Dentistry, and cDivision of Fixed Prosthodontics
and Oral Rehabilitation, Nagasaki University Graduate School of BiomedicalSciences, Nagasaki, JapanA sectional denture/prosthesis was fabricated for an edentulous patient with a nasal defect for the purposeof recovery of orofacial functions. The denture and the prosthesis were connected by a cobalt-samarium
magnetic retainer (Hicorex Super) and an acrylic joint rod through an access hole under the nose. Although
the hard plastic prosthesis component and the inflexible joint slightly affected the patient’s orofacial
movement, color stability, fitting, and retention were satisfactory. The patient recovered the anatomic formof the nose wing, as well as mastication, respiration, and speech through use of the sectional
denture/prosthesis. (Int Chin J Dent 2002; 2: 86-91.)
Key words: magnet, nasal prosthesis, sectional denture.

INTRODUCTION
A facial defect caused by either traumatic injury or extirpation of neoplasm induces esthetic andfunctional problems for the patient.

Prosthetic treatment of a nasal defect is typically performed inconjunction with a prosthodontic procedure when the defect includes the maxilla or passes through thepalate. A number of techniques and materials for recovering nasal defects1-13 as well as methods anddevices for removal/insertion or orientation of prostheses14,15 have been reported. Fabrication of a facial
prosthesis connected with a maxillary denture contributes both to recovery of anatomic form and toimprovement in the oral functions of the patients who underwent orofacial surgery. Due to complicatedmarginal and internal forms of the defects, special attention should be taken with respect to the impression
procedure, mode of retention, sealing at the prosthesis border, home care, etc.16-20
A number of magnetic retainer systems have been developed for retaining removable dentures andmaxillofacial prosthesis. Application to sectional prostheses of magnetic retainers is quite useful forachieving an appropriate path for insertion/removal of complicated dentures.21-23 Materials and techniques
used for orofacial prostheses, however, vary considerably according to the cause of the defect, the healing
condition, and the post-operative anatomic structure of individual cases. This clinical report describes a86

TANOUE, MORI, AND MATSUMURAINT CHIN J DENT

case of a nasal prosthesis connected with a maxillary complete denture in which a magnetic retainer isbonded to a joint rod.

CLINICAL REPORT
A 74-year-old male patient was referred to the Prosthodontics Department of the University Hospital forrecovery of his lateral nasal defect and dentition (Fig. 1). Examination revealed that the patient wasedentulous in both the maxilla and the mandible. In addition, his right maxilla, eyeball, and nose wing had
been resected due to squamous cell carcinoma originating from maxilla. Post operative radiation therapy
using a linear accelerator (60 Gy) had been completed by the time of the prosthodontic consultation.
According to the report from the Plastic and Reconstructive Surgery Division, the facial defect wasreconstructed several times after resection of carcinoma with auto-grafted rib and flaps. Considering theconnection of a nasal prosthesis and a maxillary denture, the surgeon prepared an access hole 6 mm indiameter under the original right nasal cavity, lined with the cutaneous tissue of the patient.

Fig. 1. Appearance of the patient with nasal defect before prosthetic treatment.
Fig. 2. Lateral view of the patient before impression for nasal prosthesis. The maxillary complete
denture with an acrylic rod and a keeper component of a magnetic retainer is seated.

Fig. 3. A custom tray used for facial impression. An air-way made of a piece of straw was placedat the orifice of the left nasal cavity.
Fig. 4. Combined impression was made with two types of silicone elastomeric materials.

87

TANOUE, MORI, AND MATSUMURAINT CHIN J DENT

Fig. 5. A wax pattern for the nasal prosthesis on the working die.
Fig. 6. A nasal prosthesis connected to the maxillary denture with a magnetic retainer (Hicorex).

Fig. 7. Separated prosthesis/denture.

The magnetic retainer is embedded into the nasal

prosthesis, whereas the keeper component is bonded to the acrylic rod built in the denture.
Fig. 8. Seated complete denture and nasal prosthesis.
Prior to fabrication of the nasal prosthesis, the patient underwent seating of maxillary and mandibularcomplete dentures. Both dentures were made of a heat-cured acrylic denture base resin (Acrell, Nissin
Dental Products Inc., Kyoto, Japan) and composite artificial teeth (Endura, Shofu Inc., Kyoto, Japan). A
hole was sunk into the maxillary denture base, which was located to near the right central incisor andcorresponded to the access hole of the patient, using a rotary cutting instrument. A transparent acrylic rod
6 mm in diameter by 15 mm in length was built up using a self-curing acrylic resin (Repairsin, GC Corp.,Tokyo, Japan). After confirmation of the proper position of the rod passing through the access hole, akeeper component of a magnetic attachment system (Hicorex Super, Hitachi Metals Ltd., Tokyo Japan) wasbonded to the end of the rod. The bonding procedure is as follows; 1) the surface to be bonded of thekeeper was air-abraded with 50 µm grain sized alumina (Hi-Aluminas, Shofu Inc.) followed by air-spraying,2) a phosphate metal conditioner (Cesead II Opaque Primer, Kuraray Co., Ltd., Osaka, Japan) was applied
to the alumina-blasted surface, and 3) the keeper was bonded to the rod with a self-curing adhesive resin(Super-Bond C&B, Sun Medical Co., Ltd., Moriyama, Japan). Fig. 2 shows the lateral view of the patient
before impression for nasal prosthesis. The keeper component was located at the bottom of the nasal defect88

TANOUE, MORI, AND MATSUMURAINT CHIN J DENT

at this stage.
A custom tray for facial impression (Fig. 3) was made with an acrylic resin (Ostron II, GC Corp.), andthe border of the tray was partially molded with a putty type silicone material (Exafine putty, GC Corp.).
After blocking out the undercut of the nasal defect with pieces of gauze and cotton, the impression of theface including the defect and the keeper component surface was made with two types of silicone
elastomeric materials (Exafine regular and injection, GC Corp.). An air-way during the impression wassecured through the left nasal cavity by using a piece of straw embedded in the custom tray (Fig. 4). Diestone (New Plastone, GC Corp.) was poured into the boxed impression, and the undercut of the defect wasreformed with the same stone material. An outline form of the nasal prosthesis was made with paraffinwax (Fig. 5), invested into a flask, and the pattern was replaced with a heat-cured transparent acrylic
denture base material (Acron, GC Corp.).

Coloring of the nasal prosthesis was performed using alight-curing color fluid system (Creactive, Heraeus Kulzer GmbH & Co., Wehrheim, Germany). The
surface of the prosthesis was roughened with methylene chloride, and the blended color liquid was appliedwith a brush. Painting and light exposure with a laboratory light-curing unit (Dentacolor XS, Heraeus
Kulzer GmbH & Co.) were repeated until skin color of the patient was reproduced. Color slides andprinted photographs were used as the reference color indicator in the laboratory process.
The prosthesis was tried in, at the next visit of the patient, and a small hole was sunk into the inner partof the prosthesis for the placement of a magnetic retainer. The cobalt-samarium magnetic component(Hicorex Super, Hitachi Metals Ltd.) was then bonded to the nasal prosthesis with the same procedure as
the keeper metal. Fig. 6 shows the extraorally connected prosthesis/denture, whereas Fig. 7 represents theseparated parts. The completed prosthesis was seated, and the direction of insertion/removal was explained(Fig. 8). Due to the hard plastic structure of the prosthesis and the inflexible joint, movement of the face
was limited. The daily life of the patient, however, was not particularly affected. The patient recovered theanatomic form of the nose wing, as well as mastication, respiration, and speech. Color stability, fitting, andretention were also judged as satisfactory.

Adjustment and relining of the prosthesis/denture wereperformed several times in accordance with the change in anatomical post-operatively. In addition, thepatient wore dark spectacles to hide the flattened surface around the resected right orbita.

Regularcheck-ups were continued both by the plastic and reconstructive surgery division and by the prosthodontics
division, and the prosthesis/denture functioned for more than six months.

DISCUSSION
This clinical report presented a sectional prosthesis/denture connected with a magnetic retainer forrecovering the anatomic form of the nose and the maxillary dentition. Prior to visiting the prosthodontics
division, the surgeon in the plastic and reconstructive division prepared an access hole lined with cutaneous
tissue between the lip and nasal defect for connecting the prosthesis and the denture with a rod. The 6-mm
rod diameter was determined considering the size of the defect, diameter of the magnetic retainer (4 mm),and the strength of the connector.

89

TANOUE, MORI, AND MATSUMURAINT CHIN J DENT

A combined impression with silicone elastomers was made in fabrication of the current nasal prosthesis.
For further improvement in sealing at the prosthesis border, especially the movable area, the use of afunctional impression technique should be considered.24 By use of the magnetic connector, both the nasal
prosthesis and the denture of this report appeared to be stabilized at the centric occlusion. Respiration,speech, and mastication have also been considerably improved through the use of the sectionalprosthesis/denture. The patient, however, sometimes felt discomfort due to slight vertical movement of thenasal prosthesis during mastication, probably due to rigid connection between the two sections. The use ofa more flexible or movable connector9 should be taken into consideration if stability of the nasal part isconsiderably affected by daily oral functioning.
The current nasal prosthesis was fabricated with a heat-cured acrylic resin, and stabilized using a magnet
system. When a facial prosthesis cannot be connected with a removable denture, another retention systemshould be employed. If sufficient undercut for retaining the prosthesis were available, a prosthesis made ofelastomeric material combined or not combined with other materials would be beneficial, althoughelastomers are inferior in color stability to plastic materials. The use of medical adhesive, surgical tape,7,12
or Velcro17 is an alternative for retaining a facial prosthesis with insufficient undercut. An adhesively
retained nasal prosthesis made of a light-cured resin overlaid with a silicone elastomer has been reported.8It should be noted, however, that medical adhesives are generally more compatible to acrylic polymers thanto silicone elastomers.8 Although the hard plastic segments of a facial prosthesis restrict movement of
orofacial tissues and organs, repair/relining as well as coloring can be quickly performed. The use ofacrylic resins is therefore profitable for patients with small facial defects, and reform of the prosthesis is tobe scheduled in future.

CONCLUSION
A nasal prosthesis connected to a maxillary complete denture was fabricated for a patient with apost-operative orofacial defect. Both the prosthesis and the denture were made of heat-cured acrylic
denture base resin, and they were sectionally connected with a cobalt-samarium magnetic retainer (HicorexSuper) embedded into an acrylic rod. Although materials and techniques should be carefully considered on
the basis of the situation of each patient, application of a magnetically connected sectional prosthesis was
useful in the current case for establishing path of insertion/removal as well as stabilization of both parts.

REFERENCES
1. Brown KB. Fabrication of a nose prosthesis. J Prosthet Dent 1971; 26: 543-54.
2. McClelland RC. Facial prosthesis following radical maxillofacial surgery. J Prosthet Dent 1977; 38: 327-30.
3. Hutcheson PE, Udagama A. Surgical nasal prosthesis. J Prosthet Dent 1980; 43: 78-81.
4. Knudson RC, Saunders TR. Modified clinical and laboratory procedures for fabrication of nasal prostheses. J Prosthet
Dent 1984; 51: 660-2.
5. Shifman A. Selective-pressure impression technique for nasal prostheses. J Prosthet Dent 1987; 58: 349-51.
6. Udagama A. Urethane-lined silicone facial prostheses. J Prosthet Dent 1987; 58: 351-4.
7. Reisberg DJ, Habakuk SW. Nasal conformer to restore facial contour. J Prosthet Dent 1990; 64: 699-701.

90TANOUE, MORI, AND MATSUMURAINT CHIN J DENT

8. Marion LR, Rothenberger SL, Minsley GE. A method of fabrication of a facial prosthesis that improves retention anddurability: a clinical report. J Prosthet Dent 1997; 77: 457-60.
9. Dumbrigue HB, Fyler A. Minimizing prosthesis movement in a midfacial defect: a clinical report: J Prosthet Dent 1997;
78: 341-5.
10. Flood TR, Russell K. Reconstruction of nasal defects with implant-retained nasal prostheses. Brit J Oral MaxillofacSurg 1998; 36: 341-5.
11. Cheng AC, Morrison D, Wee AG, Maxymiw WG, Archibald D. Maxillofacial prosthodontic management of a facial defectcomplicated by a necrotic frontal bone flap: a clinical report. J Prosthet Dent 1999; 82: 3-7.
12. Toljanic JA, Lee J, Bedard JF. Temporary nasal prosthesis rehabilitation: a clinical report. J Prosthet Dent 1999; 82:384-6.
13. Cheng AC, Wee AG, Tat-Keung L. Maxillofacial prosthetic rehabilitation of a midfacial defect complicated bymicrostomia: a clinical report. J Prosthet Dent 2001; 85: 432-7.
14. Lemon JC, Chambers MS, Wesley PJ, Martin JW. Technique for magnetic placement and orientation of a facial
prosthesis. J Prosthet Dent 1996; 75: 50-2.
15. Mekayarajjananonth T, Huband ML, Guerra LR. Clear acrylic resin device for orientation and placement of a small
facial prosthesis. J Prosthet Dent 2000; 83: 656-9.
16. Hutton B, Hutton J. Living with a facial prosthesis. a guide to patient care. Am J Nursing 1984; 84: 50-2.
17. Grant GT, Taft RM, Wheeler ST. Practical application of polyurethane and Velcro in maxillofacial prosthetics. J Prosthet
Dent 2001; 85: 281-3.
18. Kiat-Amnuay S, Gettleman L, Khan Z, Goldsmith LJ. Effect of adhesive retention of maxillofacial prostheses. Part 2:Time and reapplication effects. J Prosthet Dent 2001; 85: 438-41.
19. Markt JC, Lemon JC. Extraoral maxillofacial prosthetic rehabilitation at the M.D. Anderson Cancer Center: a survey ofpatient attitudes and opinions. J Prosthet Dent 2001; 85: 608-13.
20. Pigno MA, Funk JJ. Augmentation of obturator retention by extension into the nasal aperture: a clinical report. JProsthet Dent 2001; 85: 349-51.
21. Nadeau J. Maxillofacial prosthesis with magnetic stabilizers. J Prosthet Dent 1956; 6: 114-9.
22. Masumi S, Miyake S, Kido H, Toyoda S. Use of a sectional prosthesis following partial maxillary resection. clinicalreport. J Prosthet Dent 1990; 64: 401-3.
23. Matsumura H, Kawasaki K. Magnetically connected removable sectional denture for a maxillary defect with severe
undercut: a clinical report. J Prosthet Dent 2000; 84: 22-6.
24. Pow EH, McMillan AS. Functional impression technique in the management of an unusual facial defect: a clinical report.
J Prosthet Dent 2000; 84: 458-61.

Reprint request to:
Dr. Naomi Tanoue
Prosthodontics, General Dentistry Department, Nagasaki University Hospital of Dentistry
1-7-1, Sakamoto, 852-8588, Japan
Fax: +81-95-849-7689
E-mail: t-naomi@net.nagasaki-u.ac.jp
Received on March 15, 2002. Revised on March 25, 2002. Accepted on May 5, 2002.
Copyright ©2002 by the Editorial Council of the International Chinese Journal of Dentistry.

91