Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 8  |  Issue : 2  |  Page : 139-142

Esthetic and phonetic rehabilitation with combined maxillofacial prosthesis


1 Department of Dentistry, Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
2 Private Practitioner, Brasilia, Brazil

Date of Web Publication16-Dec-2016

Correspondence Address:
Aline Śrsula Rocha Fernandes
Department of Dentistry, Faculty of Health Sciences, University of Brasilia, Campus Darcy Ribeiro, Asa Norte. Brasilia, DF, 70910-900
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-8844.195910

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  Abstract 

Basal cell carcinoma is the most common malignant neoplasia affecting the skin. Its prevalence is higher in the face, mainly in the nasal and zygomatic areas. In several cases, the treatment requires surgical intervention which causes facial deformities that impair basic functions (i.e., sight and smell), social interaction, and self-esteem of the patient. Maxillofacial prosthesis is an important way to rehabilitate and reintegrate these patients to their private and social life. The present clinical report aimed to present a prosthetic rehabilitation with combined oculopalpebral and nasal prosthesis of a patient to replace the nasal, zygoma, and orbital tissues after basal cell carcinoma surgical treatment. In addition, the patient was treated with conventional complete dentures to replace the lost teeth due to chemotherapy. The present treatment restored the chewing and speech functions and improved the self-esteem, social life, and quality of life of the patient.

Keywords: Artificial eye, dentistry, maxillofacial prosthesis


How to cite this article:
Fernandes AŚ, dos Santos MV, de Medeiros RA, Lopes PF. Esthetic and phonetic rehabilitation with combined maxillofacial prosthesis. J Orofac Sci 2016;8:139-42

How to cite this URL:
Fernandes AŚ, dos Santos MV, de Medeiros RA, Lopes PF. Esthetic and phonetic rehabilitation with combined maxillofacial prosthesis. J Orofac Sci [serial online] 2016 [cited 2017 May 23];8:139-42. Available from: http://www.jofs.in/text.asp?2016/8/2/139/195910


  Introduction Top


Malignant neoplasias of the skin are the most common neoplastic lesion,[1] and the basal cell carcinoma presents the highest prevalence. Epidemiological studies have shown that around 65%–75% of skin carcinomas are from basal cells.[1] This type of cancer predominantly affects male over 40 years old, with light skin, and with a history of repetitive exposure to sunlight.[1] Greater predominance in the face and neck regions mainly in the two-third upper facial area has been observed.[2] Although this type of neoplasia is considered less aggressive due to its limited metastatic potential, the basal cell carcinoma has a recurrent character, local invasion, and destruction.[3]

Due to those characteristics, the treatment requires surgical intervention to remove the affected tissue, causing facial deformities that impair esthetic, function, psychological state and social life of the patient.[4] For this reason, it is very important to recover patient's functions. After surgery, reconstruction of the defects can be accomplished either surgically or prosthetically.[5] Some conditions such as size of the affected area, severity, patient's age, and patient's expectation will determine the better rehabilitation method (either surgical or prosthetic).[2]

Head and neck cancer treatment frequently leaves the patient with some facial deformity due to extensive muscle and bone loss which, in turn, can cause the patient to become depressed and isolated.[6] Reconstruction of large defects remains a challenge in spite of recent advances in surgical reconstruction methods. The necessity to restore the complex three-dimensional anatomy of the lost structures with a suitable cover, lining, and support often requires multistage procedure and the healthy local tissue availability. Silicone prostheses are reliable alternatives to surgery and should be considered in selected cases,[7] providing an appropriate alternative solution for the large midfacial defects to restore function and esthetics.[8] These prostheses make it possible to inspect the affected area, shorten surgery and hospitalization time, and lower treatment cost and allow the patient to be psychosocially reintegrated more quickly.[9]

The present clinical report aimed to present a case of a 73-year-old man, light skin, admitted at the University Hospital of Brasilia. The patient has extensive maxillofacial defects, for which no surgical procedure promotes satisfactory results.


  Case Report Top


Patient was seeking treatment to minimize the consequences of the surgical treatment performed in 2006 to remove the tumor on the right nasal and orbital regions. Besides not being satisfied to use a bandage to hide the facial defect, the patient was undergoing a psychological treatment to control his depression and social exclusion. The patient seemed prepared to start the treatment. On clinical examination, great sequela due to tissue resection during surgical treatment was observed [Figure 1],[Figure 2],[Figure 3]. There was a small communication oronasal. Into the defect, the healing process was satisfactory, which ratified the medical clearance to start the rehabilitation. Taking into account that the patient was edentulous, it was decided to fabricate conventional complete dentures simultaneously with the combined nasal and oculopalpebral prosthesis.
Figure 1: Patient with maxillofacial defect

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Figure 2: Right side view of the face

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Figure 3: Left side view of the face

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After clinical examination, a facial rehabilitation with combined nasal and oculopalpebral prosthesis made in silico ne RTV (Rhodiastic 303, Brazil) was chosen. Initially, an impression of the patient's face using irreversible hydrocolloid (Jeltrate Plus; Dentsply Ind. Com. Ltd, Brazil) and individual tray in dental stone (Gesso-Rio; Orlando Antônio Bussioli-ME, Rio Claro-SP, Brazil) was performed. A face's model [Figure 4] in Type III dental stone was obtained, and the facial prosthesis was carved in pink wax number 7 (Wilson Polidental Ind. Com. Ltd, Cotia-SP, Brazil). Both the anatomical shape and profile of the prosthesis were based on the opposite side of patient's face, pictures, and information given by the patient and family. The skin texture was obtained using instruments (Wax Spatula 7 and Lecron) and gauze.
Figure 4: Face of gypsum model

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Wax try-in was carried out to verify both esthetic and function parameters, evaluating whether the sculpture of facial prosthesis had the same characteristics of the region on the opposite side, presence of harmony, and facial similarity of the patient's face before tumor presence [Figure 5]. Adaptation of sculpture edge on the maxillofacial defect was also tested.
Figure 5: Sculpture of facial prosthesis

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For the facial prosthesis, an artificial eye was fabricated. The nasal-oculopalpebral prosthesis in the wax was positioned on the facial mask, and its edge was sealed with wax number 7 and the thickness in this area was reduced to disguise the prosthesis clinically. The wax pattern was covered with Type III dental stone to create a mold. After dental stone set, the wax pattern was removed and the negative space was filled with colorless silicone (Rhodiastic303, Brazil). Ceramic pigments were used for pigmentation. The pigmented silicone was manually pressed between the facial mask and the covered dental stone until silicone leakage and total closure of the mold. This assembly was kept under environment temperature during 24 h for silicone polymerization.

After polymerization, the silicone was removed from the mold and finishing procedures with scissors to remove the silicone excess was performed. The artificial eye was fixed on the facial prosthesis using colorless silicone. Since the included prosthesis was monochromatically made and the skin has different nuances, extrinsic pigmentation was conducted with colorless silicone, ceramic pigments, and oil paint. Artificial hairs were fixed on the eyebrows and eyelashes region to mimic the real situation.

The present study showed a satisfactory maxillofacial rehabilitation of a patient with nasal and oculopalpebral prosthesis. Prosthesis showed similar characteristics in relation to the patient's facial opposite side.

The facial prosthesis was fixed with a specific adhesive used for maxillofacial prosthesis (Pro-Aide Adhesive, USA) [Figure 6]. The patient was instructed to perform prosthesis hygiene daily and to reapply adhesive. Follow-ups should be done to evaluate the prosthesis and the defect.
Figure 6: Facial rehabilitation

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  Discussion Top


Patients with head and neck cancer should be treated with surgery, radiotherapy, chemotherapy, or combination of these modalities. Each type of treatment can negatively influence the swallowing, chewing, speech, hard and soft tissues around the carcinoma and can affect the quality of life and the psychological conditions of the patient. Based on an epidemiological study with 300 patients from Uberlandia (Minas Gerais, Brazil), nasal (26%) and malar/zygoma (18.1%) are the most common affected areas in the face.[1]

This valuable service provided by maxillofacial prosthodontist lifts the morale of the patient and thus aids in physical well-being and quality of life.[2] Despite the inherent limitations of the materials used and physical conditions, an improvement of psychological state and reinsertion of the patient in society can be obtained. The matching of the esthetic, functional, and psychosocial results of a facial deformity may produce devastating effects in its carriers, especially if the lesion is extensive or the treatment is aggressive.[4]

Unlike of cases reported by other authors,[6],[7],[9] where the palatal obturator denture and facial prosthesis were linked by magnets, the obturator portion of the total maxillary prosthesis did not show sufficient length to support a magnet, in the present case. The prostheses were installed in contact internally without any association with restraint systems.

The prognosis this case was poor, as reported in another case,[8] for prosthetic rehabilitation because of the extensive size of the defect, radiation to the area, poor mucosal quality, minimal bony supporting structures, and lack of natural dentition. Since the treatment options for some patients may be restricted by various health conditions and other limitations, including a history of radiation therapy and financial issues, other options that suit individual demands are required.[3]

The rehabilitation of the patient with maxillofacial prosthesis is a challenge to the dental surgeon and involves not only functional and esthetic issues but also social and psychological factors. The success of the rehabilitation can be measured by satisfaction of the patient and increase of the quality of life.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Chinem VP, Miot HA. Epidemiology of basal cell carcinoma. An Bras Dermatol 2011;86:292-305.  Back to cited text no. 1
    
2.
Rao PL, Parkash H, Jain V, Raut A. Prosthetic rehabilitation of a patient with a large mid face defect secondary to basal cell carcinoma. J Indian Prosthodont Soc 2011;11:137-41.  Back to cited text no. 2
    
3.
Koyama S, Sasaki K, Hanawa S, Sato N. The potential of cohesive silicone for facial prosthetic use: A material property study and a clinical report. J Prosthodont 2011;20:299-304.  Back to cited text no. 3
    
4.
Goiato MC, de Carvalho Dekon SF, de Faria Almeida DA, Sánchez DM, dos Santos DM, Pellizzer EP. Patients' satisfaction after surgical facial reconstruction or after rehabilitation with maxillofacial prosthesis. J Craniofac Surg 2011;22:766-9.  Back to cited text no. 4
    
5.
Karakoca S, Aydin C, Yilmaz H, Bal BT. Radiation-induced leiomyosarcoma of the maxillofacial region: Facial reconstruction with implant-retained prosthesis. J Craniofac Surg 2010;21:262-6.  Back to cited text no. 5
    
6.
Goiato MC, Fernandes AU, dos Santos DM, Barão VA. Positioning magnets on a multiple/sectional maxillofacial prosthesis. J Contemp Dent Pract 2007;8:101-7.  Back to cited text no. 6
    
7.
Buzayan MM. Prosthetic management of mid-facial defect with magnet-retained silicone prosthesis. Prosthet Orthot Int 2014;38:62-7.  Back to cited text no. 7
    
8.
Brignoni R, Dominici JT. An intraoral-extraoral combination prosthesis using an intermediate framework and magnets: A clinical report. J Prosthet Dent 2001;85:7-11.  Back to cited text no. 8
    
9.
Nair A, Regish KM, Shah FK, Prithviraj DR. Reconstruction of a midfacial defect using an intraoral-extraoral combination prosthesis employing magnets: A clinical report. J Clin Exp Dent 2012;4:e186-8.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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