Welcome to Advanced Prosthetic Restorations
We welcome you and your family to schedule a consultation to meet with our certified clinical Anaplastologist, Suzanne Verma. At APR we use an interdisciplinary approach, and collaborate with specialists in medicine, dentistry, and rehabilitative medicine to plan your specific treatment within the ideal timeline for your needs.
Ms. Verma regularly partners with plastic surgeons, head and neck surgeons, ENT specialists, oncologists, oral maxillofacial surgeons, prosthodontists, speech therapists, audiologists, nurses, and other health to provide optimal outcomes.
Our Process:
Each patient’s journey through their rehabilitative experience is unique. Some treatment may have a longer or shorter timeline depending on the method of retaining the prosthesis to the body.
The primary goal of prosthetic rehabilitation is to help patients improve their quality of life and uphold their self-image during their traumatic psychological adjustment.
In fact, a truly successful prosthesis may go unnoticed, allowing patients to go about life without drawing attention to that aspect of their physical appearance
Auricular Prosthesis
(ear)
An Auricular prostheses is a custom-made silicone removable device restoring a patient’s ear that is missing due to cancer, trauma or birth defect.
(Nose)
A nasal prosthesis is a removable device that artificially restores the nose and surrounding bone and skin lost as a result of cancer surgery.
Orbital Prosthesis
(Eye including lids and surrounding anatomy)
A custom orbital prosthesis is a removable silicone device that restores a patient’s eye, eyelids and surrounding tissue lost as a result of trauma or surgery.
Midface Prostheses
(This could include any combination of nose, cheeks, orbit, or upper lip)
A midface or hemifacial prosthesis can restore anatomy, function and self-confidence to patients who have lost a significant portion of their face from trauma, surgery, or birth defect.
Therapeutic Devices
Custom Tracheostomy Housing
A custom tracheostomy housing is a device that can been created from an impression of the patient’s unique irregular skin contours surrounding their tracheostoma defect and speech appliance. This device is made in collaboration with a patient’s speech pathologist.
Patient Specific Solutions
Using Digital Technology
We work with medical and dental professionals to provide virtual pre-surgical planning for the placement of craniofacial implants using computer assisted navigational surgery technology.
Types of Prosthesis
Auricular (Ear) Prosthesis
An Auricular (Ear) prosthesis can aesthetically restore an ear or a portion of an ear. The natural looking silicone prosthesis is custom created to mimic the form, texture, and color of the missing anatomy. Wearing a prosthesis helps to improve function, such as supporting eyeglasses and safety masks, as well as self-confidence.
Our patients may be missing their ear due to traumatic injury (such as car accidents, incidents at the workplace, or severe burns). In this case, the patient may already be working with a surgeon for skin grafting procedures following the trauma. We can work with the team to assess and discuss any additional treatments that could be beneficial for a future prosthetic restoration.
Our patients may have lost a portion of their entire ear due to a surgical procedure to remove a cancerous growth. In this case, we will collaborate with your team to discuss your specific treatment plans and timeline for a future prosthetic restoration.
Some patients may have a malformed or underdeveloped external ear from birth. This congenital malformation is called microtia, and can be associated with various craniofacial syndromes. Microtia can occur in four different grades of severity, and can affect one ear, or both ears (bilateral microtia.) Treatment options for prosthetic replacement may depend on the shape and location of the remaining lobule. In many cases, the remaining lobule may need to be surgically removed in order to achieve a more successful and realistic prosthetic outcome.
An auricular prosthesis can be retained on to the face through different methods. Each method has its limitations and benefits. Our team will discuss options with your family to determine which method is a best fit for your lifestyle and needs. Regardless of the etiology and anatomical area, we work with our surgical colleagues to assess if you are a candidate for an implant retained (bone anchored) prosthesis
Midface Prostheses
A midfacial, or hemifacial prosthesis can restore anatomy, function, and self-confidence to those patients who have lost a significant portion of their face due to trauma, surgery, or birth defect. Midfacial or hemifacial defects may include combinations of the nose, orbit, cheek, forehead and upper lip.
Depending on the facial structures involved in the surgical resection, the midface prosthesis may also have a communication with the oral cavity through an opening in the palate (roof of mouth). These patients may have a dental prosthesis called a maxillary obturator. An obturator is a dental device made by a dental specialist (Prosthodontist) that can prosthetically close a defect in the hard or soft palate.
Depending on the size and location of the palatal defect, it may be possible to create a midface prosthesis that snaps onto the dental device with magnets that are housed inside the obturator. When creating this type of facial prosthesis, we will work closely with your dental specialist. In these cases we will work closely with your Prosthodontist or dentist to coordinate your treatment and options for retaining the prosthesis.
Therapeutic Devices, Custom Tracheostomy Housing
A custom tracheostomy housing is a device that can been created from an impression of the patient’s unique irregular skin contours surrounding their tracheostoma defect and speech appliance. These devices would be created in coordination with your speech pathologist.
Nasal Prosthesis
Patient’s who have lost their nose, or a portion of their nose may consider the non-surgical reconstructive option of a nasal prosthesis. This can be a definitive restoration or an interim solution to mask a defect for those who are delaying a surgical reconstruction with their own tissue.
A nasal prosthesis is a removable silicone device that naturally restores the nose and surrounding skin lost as a result of surgery (rhinectomy) or trauma. A nasal prosthesis is medically necessary to help protect the underlaying structures, and in some cases, open sinuses. The nasal prosthesis also helps enable patients to wear their prescription eye glasses or safety glasses and protective masks.
This prosthesis is custom made to reproduce the shape, color, and texture of the missing anatomy. The silicone nasal prosthesis is custom made to recreate the shape that can best represent what the patient’s nose looked like before surgery. This form is created based on our knowledge of anatomy, expertise and experience and from previous photographs that the patient can provide.
Once you are pleased with the form, position and unique shape of the wax prototype, the wax is the set in a stone mold. Silicone is pigmented to match your unique skin tones and the mold is painted in layers to recreate the characteristics in your surrounding skin.
The day you receive your nasal prosthesis we will teach you how to place it in the correct location and how to care for the prosthesis and your skin. Our goal is to have you feel comfortable with the process and confident to begin integrating your prosthesis into your life.
Nasal prostheses can be retained by medical adhesives formulated specifically for facial prosthetics. Some patients may be candidates for a bone anchored (implant retained) prosthesis. In some instances, a nasal prosthesis may be retained through mechanical retention to an outside device such as eyeglasses or a dental prosthesis called a maxillary obturator. An obturator is a dental device made by a dental specialist (Prosthodontist) that can prosthetically close a defect in the hard or soft palate. Depending on the size and location of the palatal defect, it may be possible to create a nasal prosthesis that snaps onto the dental device with magnets that are housed inside the obturator. When creating this type of nasal prosthesis, we will work closely with your dental specialist.
Orbital Prosthesis
An orbital (eye) prosthesis includes prosthetic restoration of the eyeball and its surrounding bone and soft tissue structures. Patients who have undergone a surgical resection of the orbit (orbital exenteration) are candidates for an orbital prosthesis. When a patient has only had the eyeball removed (enucleation), and has their eyelids in-tact, they can benefit from a different type of prosthesis called an indwelling ocular.
To create an orbital prosthesis, an impression is made of the defect including the unaffected orbital region, in order to assess symmetry and correct position of the pupil in the prosthetic eye. A wax prototype of the missing tissue and lids is custom sculpted to create symmetry with the other side.
The custom ocular piece is set in the wax in a position of a natural gaze. The ocular does not move within the orbital, therefore the eye is looking in one direction. We will work with you to learn various mannerisms and head positions to help you in keeping both your natural eye and the prosthesis looking in the same direction when speaking to people in social situations.
Once you are pleased with the form, position and unique shape of the wax prototype, the wax is the set in a stone mold. Silicone is pigmented to match your unique skin tones and the mold is painted in layers to recreate the characteristics in your surrounding skin. Eyelashes and eyebrows are inserted and extrinsic color touch ups can be added.
The day you receive your prosthesis we will teach you how to place it in the correct location, how to care for the prosthesis and your skin. Our goal is to have you feel comfortable with the process and confident to begin integrating your prosthesis into your life.
Types of Retention
Adhesive Retention
An adhesive retained prosthesis is held onto the face by a layer of medical adhesive that is painted on the back of the prosthesis. The prosthesis is then positioned in the correct anatomical area by the patient.
The prosthesis must always be removed every evening, to allow for the device and underlying skin to be cleaned. The adhesive is specifically formulated to be used with silicone and adhere to skin.
This retention method is non-invasive, and an ideal method for those who want to wear a prosthesis while still keeping their reconstructive options open.
Mechanical Retention:
In some instances, a nasal prosthesis may be retained through mechanical retention to an outside device such as eyeglasses or a dental prosthesis called a maxillary obturator. An obturator is a dental device made by a dental specialist (Prosthodontist) that can prosthetically close a defect in the hard or soft palate. Depending on the size and location of the palatal defect, it may be possible to create a nasal prosthesis that snaps onto the dental device with magnets that are housed inside the obturator. When creating this type of nasal prosthesis, we will work closely with your dental specialist.
Implant Retention:
An implant retained prosthesis is a removable prosthesis that snaps onto either magnets or a bar framework that is connected to bone anchored craniofacial implants.
Small titanium screws called craniofacial implants are surgically implanted into the surrounding bone during an outpatient surgical procedure. We will collaborate with the team (Otolaryngologists, Oral Maxillofacial Surgeons and Plastic/Craniofacial surgeons) to plan the optimal locations for the craniofacial implants to achieve good retention and an aesthetically pleasing result.
The implants are left to join with the bone for 3-6 months, a biological process called “osseointegration.” Once the implants are stable in the bone, and your surrounding skin has healed completely, we will begin the process of fabricating your custom prosthesis. The first step in fabrication is to either create a custom bar or connect magnets to the implants. The prosthesis will then be made to snap on to the connection.
You must always remove the prosthesis daily in order to clean the back of the silicone, as well as the underlying skin surrounding the implants. One of the great benefits of an implant retained prosthesis is that you will always be able to place it in the same location and position daily, being guided by the magnet or bar and clip connection.
Patient Specific Solutions
Using Digital Technology
Thorough preoperative planning is a pre-requisite to achieve a successful treatment outcome regardless of whether the patient’s final restoration will be achieved surgically or prosthetically. Various technologies allow interactive 3D planning and surgical simulation in a virtual environment.
With surgical navigation, or computer assisted image guided surgery we eliminate the need for a physical surgical guide. With navigational surgery, or “GPS” in the operating room (OR), the planning data is uploaded into the OR. When the surgical instruments touch the registered patient, the virtual wand on screen navigates to the exact location within the CT and planning in real time. The protocol for this innovative technique was developed and published by our founder.
Advanced Prosthetic Restorations is home to Ms. Suzanne Verma, a board certified clinical anaplastologist practicing in facial prosthetic reconstruction for 19 years. Her treatment and caring nature brings self-confidence back to her patients with facial disfigurement dur to cancer, trauma, and birth defect
For inquiries regarding patients in need of a facial prosthesis, please call Suzanne Verma directly at (972)696-9497.
