Preliminary study of the impact of loss of part of the face and its prosthetic restoration
Identifieur interne : 003B72 ( Istex/Corpus ); précédent : 003B71; suivant : 003B73Preliminary study of the impact of loss of part of the face and its prosthetic restoration
Auteurs : J. Timothy Newton ; Janice Fiske ; Oliver Foote ; Coralie Frances ; Iona M. Loh ; David R. RadfordSource :
- The Journal of Prosthetic Dentistry [ 0022-3913 ] ; 1999.
English descriptors
- KwdEn :
- Abnormality, Clinical implications, Congenital loss, Data analysis, Dent, Dentistry, Dentofacial abnormalities, Disfigurement, Facial, Facial abnormalities, Facial disfigurement, Facial part, Facial prostheses, Facial prosthesis, Future research, Honorary consultant, Initial reaction, Interview schedule, Intimate relationships, Male respondent, Nose jokes, Oral health, Oral health services research, Oral maxillofac implants, Other people, Participant, Personality characteristics, Practical issues, Preliminary investigation, Primary cancer treatment, Prosthesis, Prosthet dent, Prosthetic, Prosthetic dentistry, Prosthetic replacement, Prosthetic restoration, Psychologic, Psychologic impact, Qualitative methods, Qualitative research, Quantitative methods, Social adjustment, Social skills training, Social stigma, Special care dentistry.
- Teeft :
- Abnormality, Clinical implications, Congenital loss, Data analysis, Dent, Dentistry, Dentofacial abnormalities, Disfigurement, Facial, Facial abnormalities, Facial disfigurement, Facial part, Facial prostheses, Facial prosthesis, Future research, Honorary consultant, Initial reaction, Interview schedule, Intimate relationships, Male respondent, Nose jokes, Oral health, Oral health services research, Oral maxillofac implants, Other people, Participant, Personality characteristics, Practical issues, Preliminary investigation, Primary cancer treatment, Prosthesis, Prosthet dent, Prosthetic, Prosthetic dentistry, Prosthetic replacement, Prosthetic restoration, Psychologic, Psychologic impact, Qualitative methods, Qualitative research, Quantitative methods, Social adjustment, Social skills training, Social stigma, Special care dentistry.
Abstract
Abstract: Statement of problem. Loss of a part of the face or having a congenitally missing ear, nose, or eye is likely to have both a social and a psychologic impact on those affected. The nature and extent of this impact has not been explored previously. The provision of facial prostheses is an increasingly viable and beneficial treatment option, but the psychologic and social adjustment to the prosthesis has not been described. Purpose. This study performed a preliminary investigation of patients’ responses to loss of part of the face, and their perceptions of the prosthetic restoration of their missing facial part. Methods. Nine individuals who had experienced prosthetic replacement of an ear, nose, or eye were interviewed. Interviews were semistructured, each respondent was interviewed individually and the interviewer followed a predetermined interview schedule. Themes emerging in the interviews were identified. Results. The main themes relating to the loss of the facial part were the importance of the story of the loss, coping through bargaining, and the impact of the loss on relationships. The important themes identified in regard to the prosthesis were issues in the maintenance of the prosthesis and the reactions of other people to the prosthesis. Conclusion. Loss of part of the face requires great adjustment. The reactions of other people were marked. Provision of a facial prosthesis can assist in the process of adjustment. (J Prosthet Dent 1999;82:585-90.)
Url:
DOI: 10.1016/S0022-3913(99)70058-2
Links to Exploration step
ISTEX:78E7E5E9A3130FA1E79E408F4BC6B4E4EF10AD87Le document en format XML
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Timothy Newton</name><affiliation><mods:affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</mods:affiliation></affiliation><affiliation><mods:affiliation>Lecturer in psychology in relation to dentistry, Division of Dental Public Health and Oral Health Services Research</mods:affiliation></affiliation></author><author><name sortKey="Fiske, Janice" sort="Fiske, Janice" uniqKey="Fiske J" first="Janice" last="Fiske">Janice Fiske</name><affiliation><mods:affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</mods:affiliation></affiliation><affiliation><mods:affiliation>Senior Lecturer, Honorary Consultant in Special Care Dentistry, Division of Sedation and Special Care Dentistry</mods:affiliation></affiliation></author><author><name sortKey="Foote, Oliver" sort="Foote, Oliver" uniqKey="Foote O" first="Oliver" last="Foote">Oliver Foote</name><affiliation><mods:affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</mods:affiliation></affiliation><affiliation><mods:affiliation>Dental Technical Instructor</mods:affiliation></affiliation></author><author><name sortKey="Frances, Coralie" sort="Frances, Coralie" uniqKey="Frances C" first="Coralie" last="Frances">Coralie Frances</name><affiliation><mods:affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</mods:affiliation></affiliation><affiliation><mods:affiliation>Research Assistant, Division of Dental Public Health and Oral Health Services Research</mods:affiliation></affiliation></author><author><name sortKey="Loh, Iona M" sort="Loh, Iona M" uniqKey="Loh I" first="Iona M." last="Loh">Iona M. 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Timothy" last="Newton">J. Timothy Newton</name><affiliation><mods:affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</mods:affiliation></affiliation><affiliation><mods:affiliation>Lecturer in psychology in relation to dentistry, Division of Dental Public Health and Oral Health Services Research</mods:affiliation></affiliation></author><author><name sortKey="Fiske, Janice" sort="Fiske, Janice" uniqKey="Fiske J" first="Janice" last="Fiske">Janice Fiske</name><affiliation><mods:affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</mods:affiliation></affiliation><affiliation><mods:affiliation>Senior Lecturer, Honorary Consultant in Special Care Dentistry, Division of Sedation and Special Care Dentistry</mods:affiliation></affiliation></author><author><name sortKey="Foote, Oliver" sort="Foote, Oliver" uniqKey="Foote O" first="Oliver" last="Foote">Oliver Foote</name><affiliation><mods:affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</mods:affiliation></affiliation><affiliation><mods:affiliation>Dental Technical Instructor</mods:affiliation></affiliation></author><author><name sortKey="Frances, Coralie" sort="Frances, Coralie" uniqKey="Frances C" first="Coralie" last="Frances">Coralie Frances</name><affiliation><mods:affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</mods:affiliation></affiliation><affiliation><mods:affiliation>Research Assistant, Division of Dental Public Health and Oral Health Services Research</mods:affiliation></affiliation></author><author><name sortKey="Loh, Iona M" sort="Loh, Iona M" uniqKey="Loh I" first="Iona M." last="Loh">Iona M. Loh</name><affiliation><mods:affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</mods:affiliation></affiliation><affiliation><mods:affiliation>Business Manager (Research), Division of Dental Public Health and Oral Health Services Research</mods:affiliation></affiliation></author><author><name sortKey="Radford, David R" sort="Radford, David R" uniqKey="Radford D" first="David R." last="Radford">David R. Radford</name><affiliation><mods:affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</mods:affiliation></affiliation><affiliation><mods:affiliation>Senior Lecturer, Honorary Consultant, Division of Prosthetic Dentistry</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">The Journal of Prosthetic Dentistry</title><title level="j" type="abbrev">YMPR</title><idno type="ISSN">0022-3913</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1999">1999</date><biblScope unit="volume">82</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="585">585</biblScope><biblScope unit="page" to="590">590</biblScope></imprint><idno type="ISSN">0022-3913</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0022-3913</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Abnormality</term><term>Clinical implications</term><term>Congenital loss</term><term>Data analysis</term><term>Dent</term><term>Dentistry</term><term>Dentofacial abnormalities</term><term>Disfigurement</term><term>Facial</term><term>Facial abnormalities</term><term>Facial disfigurement</term><term>Facial part</term><term>Facial prostheses</term><term>Facial prosthesis</term><term>Future research</term><term>Honorary consultant</term><term>Initial reaction</term><term>Interview schedule</term><term>Intimate relationships</term><term>Male respondent</term><term>Nose jokes</term><term>Oral health</term><term>Oral health services research</term><term>Oral maxillofac implants</term><term>Other people</term><term>Participant</term><term>Personality characteristics</term><term>Practical issues</term><term>Preliminary investigation</term><term>Primary cancer treatment</term><term>Prosthesis</term><term>Prosthet dent</term><term>Prosthetic</term><term>Prosthetic dentistry</term><term>Prosthetic replacement</term><term>Prosthetic restoration</term><term>Psychologic</term><term>Psychologic impact</term><term>Qualitative methods</term><term>Qualitative research</term><term>Quantitative methods</term><term>Social adjustment</term><term>Social skills training</term><term>Social stigma</term><term>Special care dentistry</term></keywords><keywords scheme="Teeft" xml:lang="en"><term>Abnormality</term><term>Clinical implications</term><term>Congenital loss</term><term>Data analysis</term><term>Dent</term><term>Dentistry</term><term>Dentofacial abnormalities</term><term>Disfigurement</term><term>Facial</term><term>Facial abnormalities</term><term>Facial disfigurement</term><term>Facial part</term><term>Facial prostheses</term><term>Facial prosthesis</term><term>Future research</term><term>Honorary consultant</term><term>Initial reaction</term><term>Interview schedule</term><term>Intimate relationships</term><term>Male respondent</term><term>Nose jokes</term><term>Oral health</term><term>Oral health services research</term><term>Oral maxillofac implants</term><term>Other people</term><term>Participant</term><term>Personality characteristics</term><term>Practical issues</term><term>Preliminary investigation</term><term>Primary cancer treatment</term><term>Prosthesis</term><term>Prosthet dent</term><term>Prosthetic</term><term>Prosthetic dentistry</term><term>Prosthetic replacement</term><term>Prosthetic restoration</term><term>Psychologic</term><term>Psychologic impact</term><term>Qualitative methods</term><term>Qualitative research</term><term>Quantitative methods</term><term>Social adjustment</term><term>Social skills training</term><term>Social stigma</term><term>Special care dentistry</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Abstract: Statement of problem. Loss of a part of the face or having a congenitally missing ear, nose, or eye is likely to have both a social and a psychologic impact on those affected. The nature and extent of this impact has not been explored previously. The provision of facial prostheses is an increasingly viable and beneficial treatment option, but the psychologic and social adjustment to the prosthesis has not been described. Purpose. This study performed a preliminary investigation of patients’ responses to loss of part of the face, and their perceptions of the prosthetic restoration of their missing facial part. Methods. Nine individuals who had experienced prosthetic replacement of an ear, nose, or eye were interviewed. Interviews were semistructured, each respondent was interviewed individually and the interviewer followed a predetermined interview schedule. Themes emerging in the interviews were identified. Results. The main themes relating to the loss of the facial part were the importance of the story of the loss, coping through bargaining, and the impact of the loss on relationships. The important themes identified in regard to the prosthesis were issues in the maintenance of the prosthesis and the reactions of other people to the prosthesis. Conclusion. Loss of part of the face requires great adjustment. The reactions of other people were marked. Provision of a facial prosthesis can assist in the process of adjustment. (J Prosthet Dent 1999;82:585-90.)</div></front></TEI><istex><corpusName>elsevier</corpusName><keywords><teeft><json:string>prosthesis</json:string><json:string>prosthetic</json:string><json:string>facial part</json:string><json:string>psychologic</json:string><json:string>facial</json:string><json:string>facial prosthesis</json:string><json:string>disfigurement</json:string><json:string>other people</json:string><json:string>abnormality</json:string><json:string>prosthetic restoration</json:string><json:string>dentistry</json:string><json:string>facial prostheses</json:string><json:string>prosthet dent</json:string><json:string>prosthetic dentistry</json:string><json:string>facial disfigurement</json:string><json:string>male respondent</json:string><json:string>interview schedule</json:string><json:string>oral health services research</json:string><json:string>qualitative research</json:string><json:string>initial reaction</json:string><json:string>intimate relationships</json:string><json:string>qualitative methods</json:string><json:string>dent</json:string><json:string>participant</json:string><json:string>personality characteristics</json:string><json:string>social stigma</json:string><json:string>facial abnormalities</json:string><json:string>social adjustment</json:string><json:string>primary cancer treatment</json:string><json:string>clinical implications</json:string><json:string>quantitative methods</json:string><json:string>psychologic impact</json:string><json:string>honorary consultant</json:string><json:string>special care dentistry</json:string><json:string>data analysis</json:string><json:string>preliminary investigation</json:string><json:string>nose jokes</json:string><json:string>prosthetic replacement</json:string><json:string>dentofacial abnormalities</json:string><json:string>congenital loss</json:string><json:string>practical issues</json:string><json:string>future research</json:string><json:string>social skills training</json:string><json:string>oral health</json:string><json:string>oral maxillofac implants</json:string></teeft></keywords><author><json:item><name>J.Timothy Newton BA, PhD</name><affiliations><json:string>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</json:string><json:string>Lecturer in psychology in relation to dentistry, Division of Dental Public Health and Oral Health Services Research</json:string></affiliations></json:item><json:item><name>Janice Fiske BDS, MPhil</name><affiliations><json:string>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</json:string><json:string>Senior Lecturer, Honorary Consultant in Special Care Dentistry, Division of Sedation and Special Care Dentistry</json:string></affiliations></json:item><json:item><name>Oliver Foote</name><affiliations><json:string>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</json:string><json:string>Dental Technical Instructor</json:string></affiliations></json:item><json:item><name>Coralie Frances BSc</name><affiliations><json:string>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</json:string><json:string>Research Assistant, Division of Dental Public Health and Oral Health Services Research</json:string></affiliations></json:item><json:item><name>Iona M. Loh BDS, MBA, BSc</name><affiliations><json:string>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</json:string><json:string>Business Manager (Research), Division of Dental Public Health and Oral Health Services Research</json:string></affiliations></json:item><json:item><name>David R. Radford BDS, PhD, MRD</name><affiliations><json:string>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</json:string><json:string>Senior Lecturer, Honorary Consultant, Division of Prosthetic Dentistry</json:string></affiliations></json:item></author><arkIstex>ark:/67375/6H6-R475CKC8-9</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>Abstract: Statement of problem. Loss of a part of the face or having a congenitally missing ear, nose, or eye is likely to have both a social and a psychologic impact on those affected. The nature and extent of this impact has not been explored previously. The provision of facial prostheses is an increasingly viable and beneficial treatment option, but the psychologic and social adjustment to the prosthesis has not been described. Purpose. This study performed a preliminary investigation of patients’ responses to loss of part of the face, and their perceptions of the prosthetic restoration of their missing facial part. Methods. Nine individuals who had experienced prosthetic replacement of an ear, nose, or eye were interviewed. Interviews were semistructured, each respondent was interviewed individually and the interviewer followed a predetermined interview schedule. Themes emerging in the interviews were identified. Results. The main themes relating to the loss of the facial part were the importance of the story of the loss, coping through bargaining, and the impact of the loss on relationships. The important themes identified in regard to the prosthesis were issues in the maintenance of the prosthesis and the reactions of other people to the prosthesis. Conclusion. Loss of part of the face requires great adjustment. The reactions of other people were marked. Provision of a facial prosthesis can assist in the process of adjustment. (J Prosthet Dent 1999;82:585-90.)</abstract><qualityIndicators><score>9.276</score><pdfWordCount>4504</pdfWordCount><pdfCharCount>27187</pdfCharCount><pdfVersion>1.3</pdfVersion><pdfPageCount>6</pdfPageCount><pdfPageSize>612 x 792 pts (letter)</pdfPageSize><refBibsNative>true</refBibsNative><abstractWordCount>231</abstractWordCount><abstractCharCount>1490</abstractCharCount><keywordCount>0</keywordCount></qualityIndicators><title>Preliminary study of the impact of loss of part of the face and its prosthetic restoration</title><pmid><json:string>10559731</json:string></pmid><pii><json:string>S0022-3913(99)70058-2</json:string></pii><genre><json:string>research-article</json:string></genre><serie><title>Successful focus groups: advancing the state of the art.</title><language><json:string>unknown</json:string></language><pages><first>3</first><last>19</last></pages></serie><host><title>The Journal of Prosthetic Dentistry</title><language><json:string>unknown</json:string></language><publicationDate>1999</publicationDate><issn><json:string>0022-3913</json:string></issn><pii><json:string>S0022-3913(05)X7070-6</json:string></pii><volume>82</volume><issue>5</issue><pages><first>585</first><last>590</last></pages><genre><json:string>journal</json:string></genre></host><namedEntities><unitex><date><json:string>1999</json:string></date><geogName></geogName><orgName><json:string>Department of Prosthetic Dentistry, United Medical and Dental Schools</json:string></orgName><orgName_funder></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Coralie Frances</json:string><json:string>I. Characteristics</json:string><json:string>David R. Radford</json:string><json:string>Previous</json:string><json:string>Oliver Foote</json:string><json:string>Themes</json:string><json:string>Problems</json:string><json:string>Iona M. Loh</json:string><json:string>Janice Fiske</json:string></persName><placeName></placeName><ref_url></ref_url><ref_bibl><json:string>Rozen et al</json:string><json:string>Fiske et al.</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/6H6-R475CKC8-9</json:string></ark><categories><wos><json:string>1 - science</json:string><json:string>2 - dentistry, oral surgery & medicine</json:string></wos><scienceMetrix><json:string>1 - health sciences</json:string><json:string>2 - clinical medicine</json:string><json:string>3 - dentistry</json:string></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Dentistry</json:string><json:string>3 - Oral Surgery</json:string></scopus><inist><json:string>1 - sciences appliquees, technologies et medecines</json:string><json:string>2 - sciences biologiques et medicales</json:string><json:string>3 - sciences medicales</json:string></inist></categories><publicationDate>1999</publicationDate><copyrightDate>1999</copyrightDate><doi><json:string>10.1016/S0022-3913(99)70058-2</json:string></doi><id>78E7E5E9A3130FA1E79E408F4BC6B4E4EF10AD87</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/78E7E5E9A3130FA1E79E408F4BC6B4E4EF10AD87/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/78E7E5E9A3130FA1E79E408F4BC6B4E4EF10AD87/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/78E7E5E9A3130FA1E79E408F4BC6B4E4EF10AD87/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Preliminary study of the impact of loss of part of the face and its prosthetic restoration</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>ELSEVIER</publisher><availability><p>©1999 Editorial Council of The Journal of Prosthetic Dentistry.</p></availability><date>1999</date></publicationStmt><notesStmt><note>This research was supported by a grant awarded by Professor DE Gibbons, Department of Dental Public Health, King’s College London.</note><note>Reprint requests to:, DR J. T. NEWTON, FLOOR 18, GUY’S TOWER, GUY’S HOSPITAL, LONDON, SE1 9RT, UNITED KINGDOM, FAX: (44)171-955-8873, E-MAIL: j.newton@umds.ac.uk</note><note>0022-3913/99/$8.00 + 0. 10/1/102518</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Preliminary study of the impact of loss of part of the face and its prosthetic restoration</title><author xml:id="author-0000"><persName><forename type="first">J.Timothy</forename><surname>Newton</surname></persName><roleName type="degree">BA, PhD</roleName><affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</affiliation><affiliation>Lecturer in psychology in relation to dentistry, Division of Dental Public Health and Oral Health Services Research</affiliation></author><author xml:id="author-0001"><persName><forename type="first">Janice</forename><surname>Fiske</surname></persName><roleName type="degree">BDS, MPhil</roleName><affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</affiliation><affiliation>Senior Lecturer, Honorary Consultant in Special Care Dentistry, Division of Sedation and Special Care Dentistry</affiliation></author><author xml:id="author-0002"><persName><forename type="first">Oliver</forename><surname>Foote</surname></persName><affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</affiliation><affiliation>Dental Technical Instructor</affiliation></author><author xml:id="author-0003"><persName><forename type="first">Coralie</forename><surname>Frances</surname></persName><roleName type="degree">BSc</roleName><affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</affiliation><affiliation>Research Assistant, Division of Dental Public Health and Oral Health Services Research</affiliation></author><author xml:id="author-0004"><persName><forename type="first">Iona M.</forename><surname>Loh</surname></persName><roleName type="degree">BDS, MBA, BSc</roleName><affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</affiliation><affiliation>Business Manager (Research), Division of Dental Public Health and Oral Health Services Research</affiliation></author><author xml:id="author-0005"><persName><forename type="first">David R.</forename><surname>Radford</surname></persName><roleName type="degree">BDS, PhD, MRD</roleName><affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</affiliation><affiliation>Senior Lecturer, Honorary Consultant, Division of Prosthetic Dentistry</affiliation></author><idno type="istex">78E7E5E9A3130FA1E79E408F4BC6B4E4EF10AD87</idno><idno type="DOI">10.1016/S0022-3913(99)70058-2</idno><idno type="PII">S0022-3913(99)70058-2</idno></analytic><monogr><title level="j">The Journal of Prosthetic Dentistry</title><title level="j" type="abbrev">YMPR</title><idno type="pISSN">0022-3913</idno><idno type="PII">S0022-3913(05)X7070-6</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1999"></date><biblScope unit="volume">82</biblScope><biblScope unit="issue">5</biblScope><biblScope unit="page" from="585">585</biblScope><biblScope unit="page" to="590">590</biblScope></imprint></monogr></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>1999</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Statement of problem. Loss of a part of the face or having a congenitally missing ear, nose, or eye is likely to have both a social and a psychologic impact on those affected. The nature and extent of this impact has not been explored previously. The provision of facial prostheses is an increasingly viable and beneficial treatment option, but the psychologic and social adjustment to the prosthesis has not been described. Purpose. This study performed a preliminary investigation of patients’ responses to loss of part of the face, and their perceptions of the prosthetic restoration of their missing facial part. Methods. Nine individuals who had experienced prosthetic replacement of an ear, nose, or eye were interviewed. Interviews were semistructured, each respondent was interviewed individually and the interviewer followed a predetermined interview schedule. Themes emerging in the interviews were identified. Results. The main themes relating to the loss of the facial part were the importance of the story of the loss, coping through bargaining, and the impact of the loss on relationships. The important themes identified in regard to the prosthesis were issues in the maintenance of the prosthesis and the reactions of other people to the prosthesis. Conclusion. Loss of part of the face requires great adjustment. The reactions of other people were marked. Provision of a facial prosthesis can assist in the process of adjustment. (J Prosthet Dent 1999;82:585-90.)</p></abstract></profileDesc><revisionDesc><change when="1999">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/78E7E5E9A3130FA1E79E408F4BC6B4E4EF10AD87/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier doc found" wicri:toSee="Elsevier, no converted or simple article"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 5.0.1//EN//XML" URI="art501.dtd" name="istex:docType"></istex:docType><istex:document><article docsubtype="fla" xml:lang="en"><item-info><jid>YMPR</jid><aid>102518</aid><ce:pii>S0022-3913(99)70058-2</ce:pii><ce:doi>10.1016/S0022-3913(99)70058-2</ce:doi><ce:copyright type="other" year="1999">Editorial Council of The Journal of Prosthetic Dentistry.</ce:copyright></item-info><head><ce:article-footnote><ce:label>☆</ce:label><ce:note-para>This research was supported by a grant awarded by Professor DE Gibbons, Department of Dental Public Health, King’s College London.</ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>☆☆</ce:label><ce:note-para>Reprint requests to:, DR J. T. NEWTON, FLOOR 18, GUY’S TOWER, GUY’S HOSPITAL, LONDON, SE1 9RT, UNITED KINGDOM, FAX: (44)171-955-8873, <ce:inter-ref xlink:href="mailto:j.newton@umds.ac.uk">E-MAIL: j.newton@umds.ac.uk</ce:inter-ref></ce:note-para></ce:article-footnote><ce:article-footnote><ce:label>★</ce:label><ce:note-para>0022-3913/99/$8.00 + 0. <ce:bold>10/1/102518</ce:bold></ce:note-para></ce:article-footnote><ce:title>Preliminary study of the impact of loss of part of the face and its prosthetic restoration</ce:title><ce:presented>Part of the results described in this article were presented at the 76th session of the International Association of Dental Research, Nice, France, June 1998; and at the 22nd conference of the European Prosthodontic Society, Turku, Finland, August 1998.</ce:presented><ce:author-group><ce:author><ce:given-name>J.Timothy</ce:given-name><ce:surname>Newton</ce:surname><ce:degrees>BA, PhD</ce:degrees><ce:cross-ref refid="aff1"><ce:sup>∗</ce:sup></ce:cross-ref><ce:cross-ref refid="aff2"><ce:sup>a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Janice</ce:given-name><ce:surname>Fiske</ce:surname><ce:degrees>BDS, MPhil</ce:degrees><ce:cross-ref refid="aff1"><ce:sup>∗</ce:sup></ce:cross-ref><ce:cross-ref refid="aff3"><ce:sup>b</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Oliver</ce:given-name><ce:surname>Foote</ce:surname><ce:cross-ref refid="aff1"><ce:sup>∗</ce:sup></ce:cross-ref><ce:cross-ref refid="aff4"><ce:sup>c</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Coralie</ce:given-name><ce:surname>Frances</ce:surname><ce:degrees>BSc</ce:degrees><ce:cross-ref refid="aff1"><ce:sup>∗</ce:sup></ce:cross-ref><ce:cross-ref refid="aff6"><ce:sup>d</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>Iona M.</ce:given-name><ce:surname>Loh</ce:surname><ce:degrees>BDS, MBA, BSc</ce:degrees><ce:cross-ref refid="aff1"><ce:sup>∗</ce:sup></ce:cross-ref><ce:cross-ref refid="aff5"><ce:sup>e</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>David R.</ce:given-name><ce:surname>Radford</ce:surname><ce:degrees>BDS, PhD, MRD</ce:degrees><ce:cross-ref refid="aff1"><ce:sup>∗</ce:sup></ce:cross-ref><ce:cross-ref refid="aff7"><ce:sup>f</ce:sup></ce:cross-ref></ce:author><ce:affiliation id="aff1"><ce:label>∗</ce:label><ce:textfn>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</ce:textfn></ce:affiliation><ce:affiliation id="aff2"><ce:label>a</ce:label><ce:textfn>Lecturer in psychology in relation to dentistry, Division of Dental Public Health and Oral Health Services Research</ce:textfn></ce:affiliation><ce:affiliation id="aff3"><ce:label>b</ce:label><ce:textfn>Senior Lecturer, Honorary Consultant in Special Care Dentistry, Division of Sedation and Special Care Dentistry</ce:textfn></ce:affiliation><ce:affiliation id="aff4"><ce:label>c</ce:label><ce:textfn>Dental Technical Instructor</ce:textfn></ce:affiliation><ce:affiliation id="aff5"><ce:label>e</ce:label><ce:textfn>Business Manager (Research), Division of Dental Public Health and Oral Health Services Research</ce:textfn></ce:affiliation><ce:affiliation id="aff6"><ce:label>d</ce:label><ce:textfn>Research Assistant, Division of Dental Public Health and Oral Health Services Research</ce:textfn></ce:affiliation><ce:affiliation id="aff7"><ce:label>f</ce:label><ce:textfn>Senior Lecturer, Honorary Consultant, Division of Prosthetic Dentistry</ce:textfn></ce:affiliation></ce:author-group><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para><ce:bold>Statement of problem.</ce:bold> Loss of a part of the face or having a congenitally missing ear, nose, or eye is likely to have both a social and a psychologic impact on those affected. The nature and extent of this impact has not been explored previously. The provision of facial prostheses is an increasingly viable and beneficial treatment option, but the psychologic and social adjustment to the prosthesis has not been described. <ce:bold>Purpose.</ce:bold> This study performed a preliminary investigation of patients’ responses to loss of part of the face, and their perceptions of the prosthetic restoration of their missing facial part. <ce:bold>Methods.</ce:bold> Nine individuals who had experienced prosthetic replacement of an ear, nose, or eye were interviewed. Interviews were semistructured, each respondent was interviewed individually and the interviewer followed a predetermined interview schedule. Themes emerging in the interviews were identified. <ce:bold>Results.</ce:bold> The main themes relating to the loss of the facial part were the importance of the story of the loss, coping through bargaining, and the impact of the loss on relationships. The important themes identified in regard to the prosthesis were issues in the maintenance of the prosthesis and the reactions of other people to the prosthesis. <ce:bold>Conclusion.</ce:bold> Loss of part of the face requires great adjustment. The reactions of other people were marked. Provision of a facial prosthesis can assist in the process of adjustment. (J Prosthet Dent 1999;82:585-90.)</ce:simple-para></ce:abstract-sec></ce:abstract></head><body><ce:sections><ce:para><ce:display><ce:textbox><ce:textbox-body><ce:sections><ce:para><ce:italic>This study describes the psychologic and social effects of absence of a facial part. Patient reactions to their loss are not predictable. Providing a prosthesis to replace the missing facial part is of great benefit to the majority of patients. Some patients may require advice on managing their reactions and the reactions of other people, during and after treatment.</ce:italic></ce:para></ce:sections></ce:textbox-body></ce:textbox></ce:display></ce:para><ce:para>There has been increasing attention focused on the physical, social, and psychologic impact of oral and facial disorders.<ce:cross-refs refid="bib1 bib2"><ce:sup>1,2</ce:sup></ce:cross-refs> Studies of the impact on the person with a missing facial part have been limited. The nearest parallels that are to be found in the literature have addressed the effects of dentofacial abnormalities. This research has established that there are profound social consequences for persons with dentofacial abnormalities. These persons experience greater degrees of social avoidance and are perceived as possessing more negative personality characteristics. McGrouther<ce:cross-ref refid="bib3"><ce:sup>3</ce:sup></ce:cross-ref> concludes that even minor facial abnormalities can result in social stigma. In a series of studies, Bull and Rumsey<ce:cross-ref refid="bib4"><ce:sup>4</ce:sup></ce:cross-ref> used researchers given cosmetic facial abnormalities as stooges so the behavior of the general public could be observed. Members of the public showed marked avoidance of the stooges, and rated persons with facial abnormalities as less intelligent, less friendly, and less sociable than persons without facial abnormalities. Further, the extent of malocclusion has been found to influence the ratings of personality characteristics of people depicted in photographs.<ce:cross-refs refid="bib5 bib6"><ce:sup>5,6</ce:sup></ce:cross-refs> There is some evidence to suggest that facial disfigurements acquired through trauma or disease are equally distressing. Rozen et al<ce:cross-ref refid="bib7"><ce:sup>7</ce:sup></ce:cross-ref> found that the effect of primary cancer treatment was a marked reduction in meeting both friends and acquaintances in private and in public places, with some patients becoming socially isolated. Given the social stigma associated with facial abnormality, it has been suggested that persons with a facial abnormality experience greater psychologic disturbance such as low self-esteem, depression, and dissatisfaction with appearance. Both experimental and case study evidence support this suggestion.<ce:cross-refs refid="bib8 bib9"><ce:sup>8,9</ce:sup></ce:cross-refs></ce:para><ce:para>Persons who have undergone prosthetic restoration of a missing facial part present researchers and clinicians with a complex set of experiences, which are an important area for psychologic and social research. Though this group of patients is not necessarily homogenous, most will experience a phase of adjustment to the loss; preparation for the provision of a facial prosthesis (including expectations of the treatment); adjustment to the reactions of other people after the provision of the prosthesis; and long-term coping with their new facial prosthesis. However, there is little research on the psychologic and social consequences of the provision of facial prostheses.</ce:para><ce:para>There have been many recent advances in the provision of maxillofacial prostheses for those persons who have experienced loss of a facial part through disease or congenital deficit. Advances have included the use of osseointegrated implants to retain the prosthesis,<ce:cross-ref refid="bib10"><ce:sup>10</ce:sup></ce:cross-ref> analysis of the materials used in the construction of prostheses,<ce:cross-refs refid="bib11 bib12"><ce:sup>11,12</ce:sup></ce:cross-refs> and the development of new techniques for modeling the prosthetic facial part.<ce:cross-refs refid="bib13 bib14 bib15"><ce:sup>13-15</ce:sup></ce:cross-refs> Implicit in this treatment approach is the assumption that the provision of such prostheses improves the psychologic and social adjustment of the patient. Previous reports have alluded to the benefits of prosthetic restoration. Lowental and Sela<ce:cross-ref refid="bib16"><ce:sup>16</ce:sup></ce:cross-ref> asked respondents to indicate their psychologic adjustment after maxillofacial restoration by agreeing or disagreeing with a series of statements. In a series of 52 patients, all but 3 of the respondents indicated a healthy adjustment to the prosthesis. The patient’s adjustment after the provision of the prosthesis is related to the nature of the loss they have experienced, those patients who received prosthetic treatment after trauma improved more than those who required a prosthesis after treatment for neoplasia.</ce:para><ce:para>The aim of this study was to perform a preliminary investigation of patients’ responses to loss of part of the face, and their perceptions of the prosthetic restoration of their missing facial part.</ce:para><ce:section><ce:section-title>METHODS</ce:section-title><ce:para>A qualitative method was chosen as most appropriate to achieve this aim. Morgan and Krueger<ce:cross-ref refid="bib17"><ce:sup>17</ce:sup></ce:cross-ref> suggested that qualitative methods are most appropriate when the phenomenon under study is complex, furthermore, Blinkhorn<ce:cross-ref refid="bib18"><ce:sup>18</ce:sup></ce:cross-ref> suggested that qualitative methods can be used to help clarify important dimensions present in complex phenomena, which can then be analyzed subsequently with quantitative methods. Both these criteria apply to this study. Specifically, a series of individual in-depth interviews were carried out. The interviewer followed a predetermined interview schedule, and used additional probing questions to seek clarification of points raised by the interviewee. The method was devised following the guidelines for qualitative research by Mays and Pope.<ce:cross-ref refid="bib19"><ce:sup>19</ce:sup></ce:cross-ref></ce:para><ce:para>A total of 11 people were approached to participate in the study, all of whom had received care in the Department of Prosthetic Dentistry, United Medical and Dental Schools. All the participants, except 1, at the time of the interview routinely wore their prosthesis. Two participants had an implant-retained prosthesis, the remainder were provided with adhesive-retained prostheses. The characteristics of the sample are presented in Table I.
<ce:display><ce:table colsep="0" rowsep="0" frame="topbot"><ce:label>Table I</ce:label><ce:caption><ce:simple-para>Characteristics of the sample</ce:simple-para></ce:caption><tgroup cols="5"><colspec colname="col1" colsep="0"></colspec><colspec colname="col2" colsep="0"></colspec><colspec colname="col3" colsep="0"></colspec><colspec colname="col4" colsep="0"></colspec><colspec colname="col5" colsep="0"></colspec><thead><row><entry></entry><entry align="center">Gender</entry><entry align="center">Age</entry><entry align="center">Nature of prosthesis</entry><entry align="center">Nature of loss</entry></row></thead><tbody><row><entry>1</entry><entry align="center">Male</entry><entry align="center">71</entry><entry align="center">Nose</entry><entry align="center">Tumor</entry></row><row><entry>2</entry><entry align="center">Male</entry><entry align="center">31</entry><entry align="center">Eye and ear</entry><entry align="center">Trauma</entry></row><row><entry>3</entry><entry align="center">Female</entry><entry align="center">67</entry><entry align="center">Nose</entry><entry align="center">Tumor</entry></row><row><entry>4</entry><entry align="center">Male</entry><entry align="center">39</entry><entry align="center">Eye</entry><entry align="center">Trauma</entry></row><row><entry>5</entry><entry align="center">Male</entry><entry align="center">51</entry><entry align="center">Nose</entry><entry align="center">Tumor</entry></row><row><entry>6</entry><entry align="center">Male</entry><entry align="center">62</entry><entry align="center">Nose</entry><entry align="center">Tumor</entry></row><row><entry>7</entry><entry align="center">Male</entry><entry align="center">16</entry><entry align="center">Ear</entry><entry align="center">Congenital</entry></row><row><entry>8</entry><entry align="center">Female</entry><entry align="center">74</entry><entry align="center">Eye</entry><entry align="center">Tumor</entry></row><row><entry>9</entry><entry align="center">Male</entry><entry align="center">36</entry><entry align="center">Ear</entry><entry align="center">Congenital</entry></row></tbody></tgroup></ce:table></ce:display>All participants gave their written, informed consent for the interview.</ce:para><ce:para>Interviewees were given the choice to be interviewed either in their own home or in the Dental Hospital. One interviewer, experienced in the technique, conducted all interviews. An individual semistructured interview technique was adopted, based on that described by Fiske et al.<ce:cross-ref refid="bib2"><ce:sup>2</ce:sup></ce:cross-ref> In this type of interview, the investigator has a set of questions on an interview schedule but the interview is guided by the schedule rather than following it strictly. Smith<ce:cross-ref refid="bib20"><ce:sup>20</ce:sup></ce:cross-ref> identified the important characteristics of this approach as the following (contrasting this approach with more structured interview approaches):</ce:para><ce:para><ce:list><ce:list-item><ce:label>1.</ce:label><ce:para>—there is an attempt to establish rapport with the respondent;</ce:para></ce:list-item><ce:list-item><ce:label>2.</ce:label><ce:para>—the ordering of questions is less important [than in structured interviews];</ce:para></ce:list-item><ce:list-item><ce:label>3.</ce:label><ce:para>—the interviewer is freer to probe interesting areas that arise;</ce:para></ce:list-item><ce:list-item><ce:label>4.</ce:label><ce:para>—the interview can follow the respondent’s interests or concerns.<ce:cross-ref refid="bib20"><ce:sup>20</ce:sup></ce:cross-ref></ce:para></ce:list-item></ce:list></ce:para><ce:para>Participants were free to give any responses they wished. The topics identified for discussion were feelings about loss of a facial part; preparation for the loss; effects of the loss on appearance, self-image, and self-confidence; effects of the loss on behavior (socializing and intimate relationships); expectations of the prosthesis; experiences with the prosthesis (difficulties, concerns, and maintenance); talking about the prosthesis; wearing the prosthesis; effects of the prosthesis on appearance, self-image, and self-confidence; effects of the prosthesis on behavior (socializing and intimate relationships); whether the expectations of the prosthesis had been met; advice to those having similar prostheses; and advice to others on coping techniques.</ce:para><ce:para>These topics were based on the experience of topics discussed by patients with the clinicians responsible for their prosthetic care. Each topic was phrased into a question; for example, “How did you feel about losing your nose?”; “How has the loss of your nose affected your friendships?” The interviewer was careful to avoid leading questions or the anticipation of patient responses. The interviews, which lasted between 40 and 90 minutes, were tape recorded with the permission of participants. The tape recordings were transcribed and the transcripts were then read by 2 researchers who made independent analyses of the themes that emerged, within an interpretative phenomenologic analysis approach.<ce:cross-ref refid="bib21"><ce:sup>21</ce:sup></ce:cross-ref> This approach to the analysis of qualitative data involves both inductive and deductive stages. In the first, inductive phase of data analysis, each transcript is read in turn and themes identified from the respondent’s speech. The themes identified in all the interviews are collated into a single list, duplications are removed.</ce:para><ce:para>In the second deductive phase of data analysis, the comprehensive list of all themes is incorporated into a coding structure that is applied to all the interviews. The strength of this approach lies in its ability to identify those themes that emerge from the respondents’ own view of their experience while at the same time identifying the degree to which those themes are common to the group under study. The interviews were coded and analyzed with NUD*IST software (Sage Publications Software, Thousand Oaks, Calif.).</ce:para></ce:section><ce:section><ce:section-title>RESULTS</ce:section-title><ce:para>Two of those approached were unwilling to take part in the study. Interviews were carried out with a sample of 9 persons. The themes identified from the analysis of the interviews are outlined in Table II.
<ce:display><ce:table colsep="0" rowsep="0" frame="topbot"><ce:label>Table II</ce:label><ce:caption><ce:simple-para>Themes identified from the interviews</ce:simple-para></ce:caption><tgroup cols="1"><colspec colname="col1" colsep="0"></colspec><thead><row><entry>1. The history of the problem</entry></row></thead><tbody><row><entry>2. Reactions</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>2.1 Of others</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>2.2 Own</entry></row><row><entry>3. Coping</entry></row><row><entry>4. Practical issues</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>4.1 Maintenance</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>4.2 Glue</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>4.3 Problems</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>4.4 Joint working—surgical and prosthetic team</entry></row><row><entry>5. Impact</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>5.1 Friends and family</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>5.2 Intimate relationships</entry></row><row><entry><ce:hsp sp="1.0"></ce:hsp>5.3 Work</entry></row></tbody></tgroup></ce:table></ce:display>In discussing their experiences, the participants did not draw a distinction between their reactions and feelings about the loss of a facial part, and their reactions to the provision of the prosthesis. The themes identified include aspects of both these experiences. In the tradition of qualitative research, quotes representing each theme will be used to illustrate the participants’ experience.</ce:para><ce:section><ce:section-title>The history of the problem</ce:section-title><ce:para>All patients gave a history of their problem, including the origin of the problem, the treatment, and the making of the prosthesis. Most of the respondents were practiced in giving this story to people, including health care personnel, friends, and relatives. Some included jokes as a way of breaking up the serious nature of the discussion: “…all my mates at work they go ‘oh, what happened there’ so I say ‘well, I went to get a bone out of the dog’s kennel’ I said ‘and he bit me’ and then they start to laugh, they say ‘Come on, what happened?’ Then I say, ‘Well I had a small cancer there’ I said ‘Surgeon had to cut it out’” (male respondent with loss of his nose). Another person, who had also lost part of his nose, reflected that having found jokes irksome to start with, he now found them useful. He explained: “I’ve heard all the nose jokes, and all the no nose jokes over the last 3 years. They don’t affect me any more and I come back with some of my own which breaks the ice… and it creates a happy situation.”</ce:para><ce:para>Jokes were commonly reported as a method for dealing with people’s questions about the facial prosthesis (4 respondents, all men). Jokes would be made about how the facial part was lost, and about the prosthesis. The use of jokes was linked with giving the story of how the facial part was lost.</ce:para><ce:para>The telling and retelling of the history of a disorder has been suggested as important in creating a sense of the place of the illness in a person’s life, and as a technique for making sense of the arbitrary nature of accidents or illness. Patients will create their own understanding of situations, which may be at odds with that of the health care professional.<ce:cross-ref refid="bib22"><ce:sup>22</ce:sup></ce:cross-ref> This was clearly the case for 1 of the participants who lost his nose. “They [the surgeons] put it down to smoking; they said I used to walk about with a cigarette in my mouth… but personally I don’t think it is, this is my own opinion, because we used to have diesels [lorries] and that, and there used to be 18 diesels pumping out in the morning and that and it used to be murder to walk into.”</ce:para></ce:section><ce:section><ce:section-title>Reactions of other people</ce:section-title><ce:para>The most commonly reported response of other people to facial disfigurement was staring at the prosthesis. Of the 9 patients, 8 recorded being upset by people staring at them, particularly when the prosthesis was new or when their loss was relatively recent. This was commonly thought to happen more with children who were seen as unlikely to turn away or feign lack of interest. This was considered to be more acceptable, and easier to cope with, than adults staring. A female participant who lost her nose explained: “…children are children. They always stare and say ‘what have you done to your nose?’”</ce:para></ce:section><ce:section><ce:section-title>Own reactions</ce:section-title><ce:para>The initial reactions of the respondents were variable according to whether they had lost a facial part as the result of trauma or disease, or whether the “loss” was congenital. For those who had disease, the initial reaction was often one of relief that the disease had been removed, and it was often viewed as being a life-saving experience (4 of the 5 cases). In 1 case, the initial reaction was anger that an unexpected amount of tissue had been removed. Two participants had been involved in accidents, one felt lucky to be alive, the other was “shocked.” Two participants had congenital loss of a facial part and, thus did not report an initial reaction to loss.</ce:para><ce:para>Long-term reactions could be viewed as either positive coping strategies or resignation. Resignation was epitomized with comments such as “I just got on with it” or “I thought it could have been worse.” Only 2 participants reported more positive coping strategies in an attempt to cope with their “loss,” such as: “I’ve started work, that did give me more of a sense of normality” (male respondent with loss of his eye and ear). Two respondents voiced fears as part of their long-term adjustment. One feared insects entering her eye socket during sleep. The other feared losing the prosthesis.</ce:para></ce:section><ce:section><ce:section-title>Coping</ce:section-title><ce:para>The most commonly reported coping style was a fatalistic acceptance of the prosthesis combined with “bargaining.” This was typified by suggestions that, “It could have been worse” or “There are lots of other people worse off.” Two subjects had not accepted their prosthesis and were still angry about the loss. One had rejected the fatalistic bargaining that other respondents showed. “There could be thousands of people worse off, millions of people worse off than you but it don’t make you feel better” (male respondent with loss of his nose).</ce:para><ce:para>Respondents were asked how they had prepared for their facial prosthesis and the loss of part of their face (where appropriate). Preparation was limited, with most reporting that they were given insufficient time to prepare. One respondent reported making practical arrangements in preparation (painting the house, paying the bills).</ce:para></ce:section><ce:section><ce:section-title>Practical issues</ce:section-title><ce:para>Participants spent much time relating practical issues. Maintenance of the prosthesis includes the day-to-day routine cleaning of the prosthesis, and its renewal when it is no longer functional or no longer matches the skin tones. Rituals for cleaning the prosthesis and the area affected were reported by 2 of the respondents, both of whom had a prosthetic eye. In one situation, this cleaning was performed by the patient’s partner, and this was interpreted as a demonstration of acceptance of her disfigurement through sharing the “work” of the prosthesis. “He’s better at it than me. Sometimes I can’t be bothered, but he’ll always do it for me” (female respondent with loss of her eye).</ce:para><ce:para>The respondents varied in the extent to which they were concerned by a lack of color match with their prosthesis. All were concerned that the prosthesis did not change color when they were in the sun, which made the prosthesis more obvious. “This one I got last Tuesday, it’s the best ear I’ve had, yes shape, color. Because of the sunshine, it hasn’t been the right color” (male respondent with loss of his ear).</ce:para><ce:para>Preparation time for putting the prosthesis in place was mentioned as a constraint. A number of people had constructed “patches” or “bandages” that could be used as an alternative to the prosthesis if they were short of time. The glue used to fix prostheses was mentioned by all those respondents who used it. Problems with glue or differences between glue were the most common topics. The main concern was a lack of trust in the glue, resulting in decreased confidence in certain situations, such as going out in hot weather and playing sports. Problems with the prosthesis were most commonly mentioned by those respondents with prosthetic noses. In particular, they raised issues related to colds, allergies, and swimming.</ce:para><ce:para>Problems reported in the treatment were most commonly about delays waiting for appointments and instances when information had been lost in the transfer between surgical and restorative teams (2 cases). In 3 cases, the respondents suggested that there should be closer working liaison between these teams. Other patient suggestions for improving the service included the provision of a mutual support network. One patient emphasized the importance of meeting people who have had similar experiences; 2 others suggested greater patient involvement in decision making; and another person proposed the provision of a book of photographs to show themselves before and after prosthetic rehabilitation.</ce:para></ce:section><ce:section><ce:section-title>Impact</ce:section-title><ce:para>The impact of loss of part of the face and the provision of a prosthesis on social functioning was slightly dependent on the nature of the “loss.” Those respondents who had a congenital loss reported the least necessity for adjustment, because they were in many ways accustomed to being without their facial part. For those who had lost a part of their face though disease or trauma, minor adjustments were made in interactions with family and friends, usually requiring them to explain the loss, and only 1 respondent reported being less sociable since the loss of his eye and ear.</ce:para><ce:para>Intimate relationships showed more marked impact, with the prosthesis having a reported influence in 6 of the cases. Three respondents reported avoiding showing their partner their face without the prosthesis. One now slept in a separate room from his wife as a result of fear that she might see him at night without the prosthesis. There was also an effect for those without current partners, as indicated in the statement by a man who lost an eye and ear: “I haven’t been in a steady relationship for years anyway, that’s a sort of mute point really so, er, I had a steady girlfriend before the accident, I haven’t had one since.”</ce:para><ce:para>Those respondents who were working (3 persons) reported varying amounts of impact on their working life. One had experienced discrimination in the workplace. Others had found problems with the interpersonal aspects of work. For 1 male respondent who lost his nose: “I work with a heck of a lot of women and they are talking to you and they say, ‘Well, yes, could you, you know, put your signature on that?’ and all the time they’re like that (peers at interviewer’s nose).”</ce:para></ce:section></ce:section><ce:section><ce:section-title>DISCUSSION</ce:section-title><ce:para>Qualitative methods of data collection and analysis allow for the in-depth description of the views of participants and are particularly useful for the preliminary exploration of phenomena that have a wide ranging impact on a person. The loss of part of the face and its prosthetic restoration might be expected to have an impact on the physical and psychologic health of a person and affect their social interactions. In addition, qualitative techniques are useful in instances where there are relatively small groups of persons who share a common characteristic. The findings described in our study will be useful in the development of a larger study, adopting both qualitative and quantitative methods. The sample size is small and cannot be representative of all persons who have experienced loss of a facial part. However, the aim of the study was not to take a representative sample to provide quantitative findings, but instead to investigate patients’ responses to loss of part of the face, and their perceptions of the prosthetic restoration of their missing facial part. Such information is of value in identifying key dimensions for future research into persons with missing facial parts and facial prostheses.</ce:para><ce:para>Loss of part of the face requires social and psychologic adjustment.<ce:cross-refs refid="bib3 bib23"><ce:sup>3,23</ce:sup></ce:cross-refs> Given that the respondents do not routinely distinguish between adjustment to this loss and adjustment to the provision of a facial prosthesis, it is suggested that there is a single process of adjustment to having a missing facial part. This process is manifest in both social and psychologic terms, and is influenced by several factors, including the provision of a prosthesis; the nature of the loss; the patient’s perception of the treatment (whether appropriate or inappropriate, life-saving or not); and the coping strategy the person adopts. An alternative interpretation that is also compatible with the findings of this study is that the 2 phases of adjustment exist (adjustment to loss of a facial part, and adjustment to the provision of a facial prosthesis), and that both phases have occurred in this patient population. Future research should study patients both before and after prosthetic intervention to identify the independent impact of the prosthesis.</ce:para><ce:para>The effect of missing a facial part on social interactions acts at 3 levels—intimate relationships, interactions with family and friends, and interactions with acquaintances. Intimate relationships show the greatest impact, whereas interactions with family and friends appear to require least modification. Interactions with acquaintances and people outside the person’s immediate social circle are marked by a certain awkwardness manifest as “staring.” This latter finding contrasts with the reports of Bull and Ramsey<ce:cross-ref refid="bib4"><ce:sup>4</ce:sup></ce:cross-ref> who suggest that avoidance was the most commonly observed response to facial disfigurement, including greater social distance and averting the gaze. The reasons for this difference are unclear, although it may relate to the uncertainty surrounding the facial prosthesis. Observers may be unsure whether the person has a prosthesis and therefore “stare” in an attempt to discern the nature of the facial part. In our study, the range of coping strategies adopted by the participants in the light of other people’s reactions was narrow, being generally confined to accepting the behavior or making jokes about their loss. Previous work in the field of facial disfigurement has used social skills training to provide persons with strategies to use in these situations. Such interventions have been found to be highly successful.<ce:cross-ref refid="bib8"><ce:sup>8</ce:sup></ce:cross-ref></ce:para><ce:para>Patients’ stories about their loss and the provision of a prosthetic replacement are important in helping the patient come to terms with their loss and as a technique for dealing with the reactions of other people. The patient’s framework for understanding their illness may differ from that of their health care professionals. It is important that patients are given sufficient information and time to develop and discuss their understanding. The process of understanding their loss is part of a movement toward acceptance of the loss.<ce:cross-ref refid="bib24"><ce:sup>24</ce:sup></ce:cross-ref> The process of adjustment to loss is described as following 5 stages: denial, anger, depression, bargaining, and acceptance. The participants in this study were mainly at the stage of bargaining, telling themselves that things are not as bad as they might appear. Their progress toward acceptance may be enabled through interventions that allow them to discuss their loss and their prostheses more openly. Such an intervention could be a mutual support or self-help group. Such groups have been found to be useful for complete denture wearers.<ce:cross-ref refid="bib25"><ce:sup>25</ce:sup></ce:cross-ref></ce:para><ce:para>Several practical issues were mentioned by the participants, including concerns about their prosthesis becoming detached during wear, and in particular worries that the skin adhesive might not be sufficiently strong. The fear of being “let down” by the prosthesis and thus being “discovered” has also been reported for denture wearers.<ce:cross-ref refid="bib2"><ce:sup>2</ce:sup></ce:cross-ref> Similarly, the participants expressed some concerns about the color of the prosthesis and the fact that it did not change with changes in their own skin tone. Again, this makes the “false” nature of the prosthesis more evident. Other practical issues included a perceived lack of communication between surgical and prosthetic teams.</ce:para></ce:section><ce:section><ce:section-title>CONCLUSIONS</ce:section-title><ce:para>This study has provided an example of the application of qualitative methods to a clinical phenomenon. It illustrates that such methods can act as a link between clinical experience and future quantitative research, by providing information about the likely impact of clinical interventions that such research may guide in future investigations. For example, we are planning a larger scale multicenter investigation of the impact of the provision of facial prostheses on quality of life. The data provided here will guide the choice of outcome measures; for instance, patients place great emphasis on the impact on relationships, and less on the functional benefits of prostheses. It will be important to reflect this in measuring outcome. Furthermore, there are clinical implications to the results reported here. 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restoration</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Preliminary study of the impact of loss of part of the face and its prosthetic restoration</title></titleInfo><name type="personal"><namePart type="given">J.Timothy</namePart><namePart type="family">Newton</namePart><namePart type="termsOfAddress">BA, PhD</namePart><affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</affiliation><affiliation>Lecturer in psychology in relation to dentistry, Division of Dental Public Health and Oral Health Services Research</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Janice</namePart><namePart type="family">Fiske</namePart><namePart type="termsOfAddress">BDS, MPhil</namePart><affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</affiliation><affiliation>Senior Lecturer, Honorary Consultant in Special Care Dentistry, Division of Sedation and Special Care Dentistry</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Oliver</namePart><namePart type="family">Foote</namePart><affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</affiliation><affiliation>Dental Technical Instructor</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Coralie</namePart><namePart type="family">Frances</namePart><namePart type="termsOfAddress">BSc</namePart><affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</affiliation><affiliation>Research Assistant, Division of Dental Public Health and Oral Health Services Research</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Iona M.</namePart><namePart type="family">Loh</namePart><namePart type="termsOfAddress">BDS, MBA, BSc</namePart><affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</affiliation><affiliation>Business Manager (Research), Division of Dental Public Health and Oral Health Services Research</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">David R.</namePart><namePart type="family">Radford</namePart><namePart type="termsOfAddress">BDS, PhD, MRD</namePart><affiliation>Guy’s, King’s and St Thomas’ School of Medicine and Dentistry, King’s College, London, United Kingdom</affiliation><affiliation>Senior Lecturer, Honorary Consultant, Division of Prosthetic Dentistry</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">1999</dateIssued><copyrightDate encoding="w3cdtf">1999</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract lang="en">Abstract: Statement of problem. Loss of a part of the face or having a congenitally missing ear, nose, or eye is likely to have both a social and a psychologic impact on those affected. The nature and extent of this impact has not been explored previously. The provision of facial prostheses is an increasingly viable and beneficial treatment option, but the psychologic and social adjustment to the prosthesis has not been described. Purpose. This study performed a preliminary investigation of patients’ responses to loss of part of the face, and their perceptions of the prosthetic restoration of their missing facial part. Methods. Nine individuals who had experienced prosthetic replacement of an ear, nose, or eye were interviewed. Interviews were semistructured, each respondent was interviewed individually and the interviewer followed a predetermined interview schedule. Themes emerging in the interviews were identified. Results. The main themes relating to the loss of the facial part were the importance of the story of the loss, coping through bargaining, and the impact of the loss on relationships. The important themes identified in regard to the prosthesis were issues in the maintenance of the prosthesis and the reactions of other people to the prosthesis. Conclusion. Loss of part of the face requires great adjustment. The reactions of other people were marked. Provision of a facial prosthesis can assist in the process of adjustment. (J Prosthet Dent 1999;82:585-90.)</abstract><note>This research was supported by a grant awarded by Professor DE Gibbons, Department of Dental Public Health, King’s College London.</note><note>Reprint requests to:, DR J. T. NEWTON, FLOOR 18, GUY’S TOWER, GUY’S HOSPITAL, LONDON, SE1 9RT, UNITED KINGDOM, FAX: (44)171-955-8873, E-MAIL: j.newton@umds.ac.uk</note><note>0022-3913/99/$8.00 + 0. 10/1/102518</note><relatedItem type="host"><titleInfo><title>The Journal of Prosthetic Dentistry</title></titleInfo><titleInfo type="abbreviated"><title>YMPR</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">199911</dateIssued></originInfo><identifier type="ISSN">0022-3913</identifier><identifier type="PII">S0022-3913(05)X7070-6</identifier><part><date>199911</date><detail type="volume"><number>82</number><caption>vol.</caption></detail><detail type="issue"><number>5</number><caption>no.</caption></detail><extent unit="issue-pages"><start>8A</start></extent><extent unit="issue-pages"><start>499</start><end>623</end></extent><extent unit="pages"><start>585</start><end>590</end></extent></part></relatedItem><identifier type="istex">78E7E5E9A3130FA1E79E408F4BC6B4E4EF10AD87</identifier><identifier type="ark">ark:/67375/6H6-R475CKC8-9</identifier><identifier type="DOI">10.1016/S0022-3913(99)70058-2</identifier><identifier type="PII">S0022-3913(99)70058-2</identifier><accessCondition type="use and reproduction" contentType="copyright">©1999 Editorial Council of The Journal of Prosthetic Dentistry.</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-HKKZVM7B-M">elsevier</recordContentSource><recordOrigin>Editorial Council of The Journal of Prosthetic Dentistry., ©1999</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/document/78E7E5E9A3130FA1E79E408F4BC6B4E4EF10AD87/metadata/json</uri></json:item></metadata></istex></record>Pour manipuler ce document sous Unix (Dilib)
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