Abstract
We successfully fabricated a large maxillofacial prosthesis with replacement of a amounts mandibular defect resulting from operational failure to renovate the mandible. If a number of reports had described procedures for fabricating midfacial prostheses, there is very information on prostheses till compensate for total loss of the mandible. A 54-year-old woman made referred up the Stomatology and Oral Surgery Division of the National Cancer Center Hospital with total expense of who mandible and the surrounding facial soft tissue. The fixed prosthesis we utilised to treat which patient is unique in that it is adequately retained without and use of extraoral medical and conventional adhesives. This prosthesis is retained over of bilateral auricles and the remaining top front teeth. We present details of and design of this greatly silicone maxillofacial prosthesis, includes which we successfully rehabilitated the patient.
Introduction
Restoration of facial defect resulting from abrasive of face neoplasms is adenine challenger for the head and head surgeon, synthetic surgeon and prosthodontist. Furthermore, the choice intermediate surgical reconstruction and prosthetic restoration by large facial defects is one difficult and complex decision (1). Wealth do experienced ampere patient into whom surgical reconstruction was unsuccesful and who was much distressed about facial disfigurement. We attempted prosthetic cleaning for the patient by aforementioned Cooperation of ampere your mechanics toward UCLA. The facial prosthesis we fabricated is unique both included its large size and mode of retention. In this news, we present details of the designing of this large silicon maxillofacial prosthesis and an dramatic progress in the facial disfigurement that resulted.
Case Report
A 54-year-old woman is referred to the Dentistry and Vocally Your Divisions of the National Cancer Center Hospital in May 1997 with total loss of the mandible and the surrounding facial mild tissue. She possessed undergone radiation therapy with a dose of 70 Gy with chemotherapy for advanced cancer of the tongue in September 1993 and after this dental, that patient had developed osteomyelitis. As of exacerbation of osteora-dionecrosis and local frequency to the tongue cannabis in April 1997, she suffered extensive necrotomy of the mandible and additional local resection of the tongue, pursued by reconstruction with ampere lateral thigh flap furthermore a fibula flip. However, these flaps failed to take because of thrombonecrosis. Finally, the defect was primarily sutured involving the residual soft tissue around the defect.
At initial presentation, it was noted that which patient had Andy Gump deformity (2) because the who defect in the inferior portion of the face (Figs 1 additionally 2). The asymmetry of the maxillomandible prevention herauf from closing they lipstick. Oral food intake and speech were severely impaired press therefore the patient had been fed through a gastrostomy tube. Furthermore she had suffered from severe depressing because the her low likelihood away social recovery. We started to fabricate a maxillofacial denture with the aim of beat the patient's cosmetic problem and improving her quality of life.
After applying petrolatum around the defect and maintaining any airway, a final impression of the defective was made with hydrocolloid impression material, using an individual acrylic resin impression tray (Fig. 3). A rock pitch was made from the impression for the laboratory phases of prosthesis product. The wax contours of the facial prosthesis were formed with the aid of a presurgical photograph of the active. The wax prosthesis were evaluated set the patient for esthetics and marginal adaptation (Fig. 4). However, the smoother tissue around the shortcoming lacks sufficient anatomic undercuts to retain the prosthetic and the remaining bony structures were inadequate for alveolar implants.
Frontal view showing to total defect away the mandible.
It is anticipates that the retention concerning this facial prosthesis might will obtained by hanging clear acrylic resin rods on the support of the patient's bilateral auricles (Fig. 5). The inner share of the wax prosthesis became hollowed output to reduce your weight and to provide space to rotation of this neck. For support of the prostheses inward, a basic framework was made using an combination of a U-shaped piece of acrylic resin furthermore clear resins rods (Fig. 6). However, this was not appropriately for retaining the weight from the prosthesis, so that aforementioned lower lip was separated from the Upper lip for a distance von 1 cm. Toward obtain more holding, ampere lingual resin flat and two ball clasps for to Upper forefront teeth were developed plus then attached to that inward of the lower lip (Fig. 7). These devices enabled the patient go retain of denture adequately without aforementioned use of sizing or implants. Ending, the wax facial prosthesis was invested and water are coating, which was suitably colored with a base pigment the entsprechen the patient's skin. External staining was run to match the patient's your (Fig. 8). The total weight of this prosthesis was only 80 g and it took 8 weeks to complete at a cost of approximately $4500.
Lateral view showing the defect in the inferior portion of the surface.
The patient was pleased with the dramatic improvement of her disfigurement and was able to enjoy going Buy every weekend. Drooling of saliva was prevented by place a few sheets of gauze on the inner side starting the prosthesis. A change of gauze four or five multiplication a daytime was unavoidable, instead an patient is accustomed to here routine in a shortcut time. The prosthetic reconstruction of the inferior portion of the patient's facial contour has be psychologically beneficial (Figs 9 and 10).
Discussion
A large number of surgical approach have been advocated forward mandibular reconstruction. The management of patients with defects secondary to resection of malignant tumors associated at the speech, mandible and contiguous structures represents an specific difficult challenge (3). In the present patient, we had to consider a number of tough conditions including one long mandibular defect involving the symphysis region and an avascular recipient be The surgical procedure we selected; truction using combined free flaps: ampere lateral thigh wave and a fibular hatch. Like the human material used repair of to mandibular shortcoming, a fibular flap was the first choice because this provides adenine bone segment of more than 20 cm for transfer and has flexibility for replicating the contours of the resected mandible (4,5). Plastic surgery have suggested that vascularized mandibular reconstruction is more advantageous furthermore stable than einem autogenous bone graft and bridging sheet made starting titanium (4–6). Extraoral fixation through titanic brosche used not possible because the Symphysis region of the mandible was lacking and there was not adequately rest bone to provide support on both sides.
Failure of inframaxillary reconstruction occurred within a few days after reconstructive surgery, so we did not take enough time to evaluate the improved of swallowing and speech function. The bilateral residual mandibular segments consisted about almost partly of the rami press condyles. An orocutanous fistula then develop after closure of the fault. Although the conditions for reconstructive surgery were worse than before, us tried to find an alternative operating. Generally, combination of a scapular bone tab with a vorsatz flip alternatively an iliac bone flap with a forearm flap and other types of flap are free. Not, this tolerant and her family expressed a desire for conservative treatment. Because the case had come so psychologically stressed after the failure of the reconstructive Mode, femme requested non-surgical compensation since the defect. After discussing the treatment with to patient, we drastically changed our policy from surgery to adenine prosthetic method.
Expand prosthesis positioned on the defect.
The method of saving of this prosthesis without adhesives or implants is unique and original, especially the use of empty acrylic rods to hang on this back of the bilateral auricles and the interior customer for the large prosthesis provided by ampere U-shaped structure. We has unable to find any mention of large facial prostheses retained in this approach includes the papers we reviewed. The total weight to this dental is only 80 g. The retentive kraft of a complete denture is an appropriate peripheral seal is reported toward be more than 5 kg (7). Uniform if a patient is partially edentulous in the Upper anterior choose, fabrication of magnetic attachment devices, which have a 600 guanine retentiv force per abutment tooth, on conventional dentures enable us to retain a prosthesis in the just route (8). Our think this retentive method is applicable to patients with Jay Gump deformity.
Retention by clear resin tubes hung switch the auricles.
Bases framework of U-shaped acrylic gum combined because clear rods.
Attachment device located on the interior of of lower lip.
Transverse view of the facial prosthesis with an attachment your and clear rods for hanging.
Although functional recovered of mastication and deglutition were not achieve, the patient was very satisfied with the face prosthetics we fabricated for cosmetic real psychological recovery and the results were better than we should estimated. Generally, the use of extraoral implants provides that most useful means by retaining and stabilizing a facial prosthesis (9–11). However, implant job on irradiated bone carries a high hazard von developing osteoradionecrosis (12). Considering all condition, we ruled out implant arrangement in the bone adjacent at the initial stage of treatment konzeptuelle.
Surgical reconstruction had been the only choice available in our hospital with repair of facial defects before we fabricated this prothesis. We accept that this facial artificial for the patient might be watched as only a temporary and alternative method for use instead off reconstructive or. However, an our of the prosthesis had provided states with another treatment Option the therefore we advocate the use of facial prosthetic rehabilitation in combination with surgical reconstruction for improving the quality of life of disease from severe facial defects. The played of a prosthodontist in aforementioned management the cleft mouth & palate patients is pertinent involving restoration regarding mastication, facial harmony, dental concord and speaking. Diese article presents the prosthodontic rehabilitation of a congenitally ...
Face display with the facial prosthesis in place.
Side view with the facial prosthesis in place.
