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History
Artificial facial parts found on Egyptian mummies Ancient Chinese known to have made facial restorations Grover Cleveland and Sigmund Freud 1953 -- American Academy of Maxillofacial Prosthetics founded
Overview
Maxillofacial prosthetics: A branch of prosthodontics. General prosthodontics a branch of dentistry. Goal is functional and Esthetic / cosmetic rehabilitation.
Maxillofacial Prosthetics
The art and science of anatomic, functional, or cosmetic reconstruction by means of non-living substitutes of those regions in the maxilla, mandible, and face that are missing or defective because of surgical intervention, trauma, pathology, or developmental or congenital malformations
Types of Rehabilitation
Preventative Restorative Supportive Palliative
Extra-oral -- cosmetic
Ear Nose Orbit Skull
CASE REPORT
Clinical and laboratory procedures involved in the: - Rehabilitation of an Edentulous patient with hemi-maxillectomy defect: - Using a closed bulb hollow obturator.
Impression recorded in compo And wash-corrected in alginate (impression adhesive used for sticking alginate to compo & tray surface.
Duplicate master cast with a double layer of modeling wax lining adapted in the defect area. Over this wax lining, a silicone putty index is adapted to hollow the obturator bulb
Two separate denture flasks used for acrylization of the hollow obturator. The waxed up maxillary denture is being flasked in first flask to obtain mold for maxillary denture. The second flask is used to pack the duplicate cast with the putty index for the hollow bulb.
The hollow bulb and a lid for the bulb have been prepared separately. Both the bulb to the denture base and the lid to the bulb were attached using sel-curing acrylic resin.
Finished and polished maxillary denture with the closed hollow bulb obturator and the mandibular denture.
Psychosocial Issues
Ultimate goal is restoration of quality of life Functional deficits may be as isolating as cosmetic ones:
- Patient avoids eating in front of others:
Psychosocial Issues
Psychosocial Issues
Preoperative Evaluation
Discussion of patients expectations and desires. Consultation with appropriate services. Preoperative imaging. Status of current teeth. History of Radiotherapy.
Radiation
Speech
Complex process. Oral-nasal partition. Palatal augmentation prosthesis can lower palate to provide better function for a structurally deficient / missing tongue.
Soft Palate
Serves to intermittently couple and uncouple oral and nasal cavities during:
- Production of consonant phonemes. - Deglutition.
Soft Palate
Mastication
Necessary before swallowing food (Precursor to deglutition). Involves:
Reduction of food particle size. Sorting of food particles.
Mastication
Masticatory efficiency related to occlusal surface. Superior masticatory efficiency leads to greater reduction of particle size at swallowing threshold. Afferent sensory input improves efficiency
Experiment: unilateral anesthesia.
Oral Anatomy
Oral Anatomy
Cut through tooth socket. Use palatal mucosa if possible / skin graft. May need to take turbinates.
Premaxilla Preserved
Premaxilla Preserved
Obturator
Restores oro-nasal partition. At times can be added to an existing denture.
Maxillary Prosthesis
Articulates with scar band. Hollowed to be lightweight.
Maxillary Prosthesis
Can be made with a reservoir to hold artificial saliva
Timing
Immediate (Intra-operative):
- holds in place the surgical packs. - provides early function Interim: Definitive
- to 6 months after surgery.
Prosthetic Materials
Acrylic resins (Hard and Soft). Polyurethanes. Silicone Elastomers.
Room-temperature vulcanizing (Self-curing) High-temperature vulcanizing (Heat-curing)
Mandible
Mandibular reconstruction revolutionized by microvascular and plating techniques. Prosthetic rehabilitation mainly restores occlusion and occlusal surface. Implants able to restore high degree of function.
Mandible
Postoperative Malocclusion
Maxillary Ramp
Physiotherapy
Vestibuloplasty
Edentulous Mandible
Mental Foramen
Implants
Implants
Branemark in the 50s studying bone temperature during drilling. Found temperature measuring probe couldnt be removed from bone without fracturing. Led to study of osseointegration.
Implants
Made of titanium. Have to be drilled at low speed. Oxide on metallic surface is dipole. Plasma proteins adhere.
Implants
Implant placed first -- closed primarily Abutment placed 4-6 months later Appliance attached may be:
Fixed. Removable. Samarium-cobalt magnets or other Precision Retainers ehance prosthesis retention.
Implants
Factors that influence success of Implant Supported MFPs:
Material. Macrostructure. Microstructure. implant bed. surgical technique. loading conditions.
Implants
Implants
Implants
Implants
Extraoral Prostheses
Extraoral Prostheses: General Principles: Goal is cosmetic. Retained with: - adhesives. - implants. Skin grafting may help. Smooth edges better.
Extraoral Prostheses: Ear: Retain tragus if possible (Will hide attachment.. Will camouflage anterior border.
Conclusion
Restore function and cosmesis. Use techniques during surgery to aid prosthetic management. Surgeons must consult maxillofacial prosthodontist for optimal rehabilitation.
Case Presentation