Maxillofacial prosthetics .pdf
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Prosthetic rehabilitation offers the choice of regaining cosmesis and functional integrity while improving
an individual's quality of life after or during surgical management of neck and head cancer. The
prosthesis utilized to shut an opening of a patient's hard palate is referred to as an obturator. The
primary goals of prosthetic rehabilitation includes providing an obturator prosthesis which restores
orofacial functions, like control of secretions, deglutition, mastication and phonetics, and additionally to
aesthetically replace orofacial structures that are missing. Maxillofacial prosthetics
Planning for Treatment
Initial preparation for patients planning to undergo treatment of neck and head cancer ought to include
assessment by a prosthodontist. Even if the surgical reconstruction is pre-planned, a dental prosthesis
might be considered as a portion of the definitive rehabilitation.A full orofacial exam must be done. The
surgical preparation and the postsurgical complications which must be addressed prosthodontically
ought to be explained to a patient. During this time, an in-depth assessment of the existing
dentoalveolar condition must be undertaken. Periodontal and restorative treatments and extractions
must be planned. Depending upon the preliminary resection design, even compromised teeth must
potentially be considered as supports for the prosthesis.Splinting teeth using a traditional bridge or
supracrestal bar may prove advantageous for retention, support, as well as stability of the removable
obturator. But, torquing forces must be assessed and the design changed accordingly. Preexisting
conditions which might impact upon successful prosthodontic outcome also should be assessed and
corrected before definitive surgery. Preexisting fixed partial dentures which cross the planned resection
cut easily are sectioned before the planned operation.
Considerations for Surgery
The main goal of surgery includes the full eradication of a tumor that requires enough surgical margins
to decrease the local recurrence risk. Adjacent structures must be resected if needed to reach negative
margins. But, some surgical precautions taken may result within a postoperative defect which may be
efficiently obturated prosthetically.
Palatal mucosal incision- An easy consideration which possesses a positive impact upon prosthesis
function includes providing for a band of keratinized palatal mucosa in order to cover the medial
element of an exposed residual bony palate. It may be achieved by making the main palatal mucosal
incision at the minimum of 5 millimeters lateral to an osseous incision. The loose band of dense
keratinized tissue then can be sutured to the nasal floor, covering the bony palate that is medially
exposed. The space will form the fulcrum for rotation of an obturator prosthesis, as well as keratinized
tissue is going to more favorably accept friction from a prosthesis than the non-keratinized nasal
mucosa. The split-thickness skin graft must be considered if the keratinized palatal mucosa isn't
Teeth preservation- Teeth that are strategically positioned, like terminal molars and canines, must be
preserved if adjacent negative margins may be accomplished. It must be emphasized that even the
weaker teeth may be considered as probable abutments for the obturator prosthesis. Even if a few of
the teeth eventually will be pulled, they'll have offered a service, allowing adaptation to a removable
prosthesis, as well as transition from the tooth-supported prosthesis to the soft tissue-supported
Osseous structure (disease-free) preservation- Attempts must be made at conserving the premaxilla if
the defect or lesion is posteriorly situated. Conversely, if the anterior defect is going to be created,
saving as much of a posterior hard palate as you can maximizes prosthetic support, retention, and
stability, and offers a sound osseous structure for endosseous implant placement.
Split-thickness skin graft- If the lip flap or cheek is sutured following surgery, as well as left to granulate,
the resulting inner mucosa offers a poorly tolerant surface for prosthesis frictional abrasion, particularly
if radiation therapy is involved within the plan of treatment. For this purpose, a split-thickness graft
must be considered in order to line the interior surface of a reflected lip, and potentially the whole
intraoral defect surface.
Considerations for the soft palate- The whole soft palate must be resected if less than 1/3 of its
posterior aspect is going to remain postresection. The remnant might lack normal function and/or
innervation, and may compromise prosthetic function within deglutition and speech. But for an
individual who has an edentulous maxilla, the intact posterior soft palate band, even if compromised
neuromuscularly, provides extra support and retention for the obturator.
Nasal turbinate elimination- Nasal turbinates must be removed. It's due to these anatomic structures
oftentimes preventing maximum extension over remaining palatal shelf as well as nasal cavity in order
to receive a maximum seal.
Posterolateral support- The well-supported, stable prosthesis requires 3 different anchoring contact
points. Certain surgical attention must be provided to the posterolateral elements of the defect to offer
an osseous space for prosthesis support. Prosthesis function is enhanced if a zygomatico-temporal bone
may be utilized in this way.
Vestibular depth- Some attention must be directed to the rest of the alveolar ridge during closure time.
Cautious stitching of the flaps to develop a labioalveolar vestibule of appropriate depth, as well as
minimizing second intention healing of the tissues also will enable maximum prosthetic outcome. A
surgical obturator prosthesis might have a flange which extends inside the vestibule, preventing
unwanted fibrous attachment to the alveolar ridge crest. Maxillofacial prosthetics
Implants- Numerous procedures might considerably aid in restoring oro-dento-face function, and be
done instantly following resection, or after a healing time depending upon the defect's size, residual
supporting structures presentation, and the patient's desires. They involve, but aren't limited to: AOreconstruction plate, THORP (titanium hollow screw reconstruction plate), transzygomatic Steinmann
implantation, and craniofacial or endosseous dental implants.
Coronoid process of mandible removal- The mandibular coronoid might interfere with optimal
posterolateral prosthesis extension, particularly in individuals who have contralateral mandibular
defects that are coexisting. Within some instances, if additional obturator prosthesis retention means
aren't obtainable, coronoid process removal might prove advantageous.