maxillofacial prosthesis (2021)

MAXILLOFACIAL PROSTHESIS
The face is a significant social stimulus &is regarded as a clue to identity &personality through various facial expression.
Maxillofacial prosthodontics: is an art and science of anatomic, functional and esthetic reconstruction by means of non-living substitutes of those regions in the maxilla, mandible and the face that are missing or defective .
Maxillofacial prosthesis: artificial device use to replace missing facial or oral structures.
These causes result in defect in:
1. Intra-oral (maxilla &mandible) which will effecting the speech, mastication, swallowing, &esthetic.
2. Extra-oral (eye, nose, ear, cranial bones) which will effecting the esthetic.
Indications of maxillofacial prosthesis:
1. When plastic surgery is contraindicated.
2. When recurrence of malignancy is expected.
3. When radiotherapy is being instituted, radium appliance and radium protector shield can be used.
4. Temporary maxillofacial prosthesis can be used when plastic surgery requires various steps.
Aim of maxillofacial prosthodontist( objectives):
Reconstruction of missing parts in maxilla &mandible &face with nonliving substitutes (prosthesis) to achieve:
1. Improvement in esthetic or cosmetic appearance of the patient which is of prime importance for everybody.
2. Restoration of function (as in cleft palate) that include:
a. Speech functions in patient with palatal lost part of the jaw.
b. Nutritional function in patient with lost part of the jaw.
c. Avoid escape of food to nasal cavity in children with cleft and overcome feeding problem.
3. Preservation of residual structure:
a. To protect the adjacent tissue as in radium protective, also to protect wound, stop bleeding and carry medication after surgery.
b. Protect the teeth as in mouth guard contact sport.
4. Therapeutic or healing effect( such as placement of radium applicator).
5. Psychological therapy: to raise the moral of the patient and help in healing fracture segments in cases of fracture face.
Essentials of maxillofacial prosthetic appliance:
1. The appliance must be easily seated in place comfortably and securely and securely as much as possible.
2. The appliance must be durable and easily clean.
3. The material must be inert and biocompatible.
4. The material must be easily adjusted and altered if needed.
Maxillofacial classification:
Patient can be categorized by maxillofacial defects or Causes:
1. Congenital deformations: are typically craniofacial defects that are present from birth. The most common of these include cleft defects of the palate that may include the premaxillary alveolus.
2. Traumatic or acquired that are result of trauma, or of disease and its treatment (gun shot or accidental), these include a soft and or hard palate defect resulting from removal of a squamous cell carcinoma.
3. Developmental defects are those defects that occur because of some genetic predisposition that is expressed during growth and development.
Maxillofacial prosthesis are classified according to location into:
Extra-oral prosthesis: includes:-
1. Ocular prosthesis-eye.
2. Nasal prosthesis –nose.
3. Auricular prosthesis- ear.
4. Part of the face.
5. Nasal stent-prevent nasal septum collapse.
6. Cranial prosthesis – cranial bone.
7. Radiation stent- direct the radiation beam.
All the above are either fabricated as hard material(acrylic)(1,4,5,6) or soft material (silicon, RTV)(2,3).
Intra-oral prosthesis:
1. Obturators-simple palatal defect, hemi or total maxilloctomy.
2. Speech prosthesis for cleft palate patients.
3. Palatal lift prosthesis for incompetent palate patient.
4. Mandibular prosthesis to replace any missing part of the mandible may be guiding flange to direct mandible to normal closure.






? Extra-oral prosthesis:

The choice between surgical reconstruction &prosthetic restoration of large facial defects remains a difficult one &depends on the size &etiology of the defect, as well as on the wishes of the patient. Rehabilitation efforts can be successful only when patients can appear in public without fear of attracting unwanted attention. A replacement Facial prosthesis made from the original mold. A replacement prosthesis does not require fabrication of a new mold in most of facial prosthesis replacement. Generally, several prosthesis can be made from the same mold assuming no changes occur in the tissue bed due to further surgery or age related topographical variations. Since long time; these prosthesis are retained by an adhesive. These adhesives may give good result but the duration of their activity &care for the adherence to prosthesis may complicate the treatment. Facial prosthesis using dental implant &ball attachments, bars or magnetic abutments may improve the results greatly; although these attachments may requires additional surgical & technical steps.
Osseointegrated implants have various advantages over either adhesive or spectacle retained prosthesis for the reconstruction of the facial defects:-
1. They provide better retention of the prosthesis, so that the prosthesis is properly positioned &the patient can wear it more confidently.
2. There is no skin irritation from adhesive & the prosthesis does not need to have adhesive cleaned off each time it is used.
3. The prosthesis can be made thinner, with feathered edges that blend with the skin, which offers the patient improved aesthetics.
4. A pre-operative planning meeting with the patient &working team shows not only different prosthetic options but also e.g. cleaning of the abutments &prosthesis.
Furthermore reports have shown that implants are not uniformly successful, the failures &complications appear to be site specific &radiation &time dependent.

A removable prosthesis attached to the skin which artificially restores part or all of the nose. Fabrication of a nasal prosthesis requires creation of an original mold. Additional prosthesis usually can be made from the same mold, &assuming no further tissue changes occur, the same mold can be utilized for extended periods of time.




An artificial ear produced from a previously made mold. A replacement prosthesis does not require fabrication of a new mold. Generally, several prosthesis can be made from the same mold, &assuming no further tissue bed changes occur, due to surgery or age related topographical variations. Unfortunately, the presence of hair &the absence of anatomic irregularities often result in unfavorable adhesive retention of an auricular prosthesis. Endosseous implants, may permit positive retention of auricular prosthesis.

A biocompatible, permanently implanted replacement of a portion of the skull bones; an artificial replacement for a portion of the skull bone.

Loss of eye is emotional and physical problem to the patient. In smaller defects adhesive retention of the prosthesis may be satisfactory &the limited size of the defect may prevent implant placement without interference with the prosthesis margins. As orbital defects increase in size, the need for implant support becomes greater.

Synonymous terminology: radiotherapy prosthesis, carrier prosthesis, radiation applicator, radium carrier, intracavity carrier, intracavity applicator. A device used to administer radiation to confined areas by means of capsules, beads or needles of radiation emitting materials such as radium or cesium. Its function is to hold the radiation source securely in the same location during the entire period of treatment. It achieve close approximation &controlled application of radiation to a tumor deemed to eradication.

It is used to carry skin or mucous membrane graft in vestibule, palate or mouth floor in approximation to periosteum during initial healing and prevent formation of hematoma between the graft and the underlying bone and periosteum.
Intra-oral prosthesis:

A maxillofacial prosthesis used to close, cover or maintain the integrity of the oral &nasal compartments resulting from a congenital, acquired or developmental disease process. The prosthesis facilitates speech °lutition by replacing those tissues lost due to the disease process &can, as a result, reduce nasal regurgitation &hypernasal speech, improve articulation, deglutition & mastication. An obturator prosthesis is classified as surgical, interim or definitive.

A prosthesis which maintains the right &left maxillary segments of an infant cleft palate patient in their proper orientation until surgery is performed to repair the cleft. It closes the oral- nasal cavity defect, thus enhancing sucking &swallowing. Used on an interim basis, achieves separation of the oral &nasal cavities in infants born with wide clefts necessitating delayed closure. It is eliminated if surgical closure can be affected or alternatively, with eruption of the deciduous dentition, a pediatric speech aid may be made to facilitate closure of the defect.

A removable maxillofacial prosthesis used to restore an required or congenital defect of the soft palate with a portion extending into the pharynx to separate the oropharynx &nasopharynx during phonation °lutition, thereby completing pharyngeal sphincter.
Such a prosthesis consist of:
? A palatal component which contacts the teeth to provide stability and anchorage for retention; a palatal extension, which crosses the residual soft palate.
? And a pharyngeal component which fills the palatopharyngeal port during muscular function, serving to restore the speech valve of the palatopharyngeal region.

A maxillofacial prosthesis used to maintain a functional position for the jaw, improve speech °lutition following trauma or/and surgery to the mandible or/and adjacent structures.

A maxillofacial prosthesis which elevates the soft palate superiorly &aids in restoration of soft palate functions which may be lost due to an acquired, congenital or developmental defect.
Teamwork for maxillofacial prosthetics :
1. Maxillofacial prosthodontist-play a major role in the treatment planning &rehabilitation.
2. Skilled general dentist
3. Maxillofacial surgeon.
4. Neurosurgeon-cranail defect.
5. Special nursing team.
6. Radiologist.
7. Chemotherapeutics.
8. Maxillofacial good technician.
9. Speech pathologist.
10. Biocomunication therapy (community).
11. Psychotherapist.