Midfacial prosthesis for a combination case.

A combination case involves both a dental and a facial prosthesis. Pictured is the nasal prosthesis connected to the dental obturator prosthesis by magnets.

Patient has lost her nose as well as part of her cheek and upper palate. Restoring midfacial cases involving both dental and facial prostheses necessitates good teamwork between the maxillofacial prosthodontist (a specialized dentist) and the maxillofacial prosthetist (a facial prosthesis specialist).

The patient’s dental obturator prosthesis is retained by clasps anchoring it to the patient’s remaining teeth. Because the patient is missing hard palate and nose, there is a communication between her oral cavity and her nasal cavity. Magnets are placed in both prostheses and the nasal prosthesis is mechanically retained by the magnets which connect it to the dental obturator prosthesis. The patient needs no adhesives to keep her prosthesis in place.

Large midfacial defect with metal implant superstructure.

The patient is missing his entire nose and upper jaw due to cancer surgery. Titanium implants were placed in the bone during a separate surgical procedure. The superstructure is connected to the implants by skin-penetrating abutments. A facial and a dental prosthesis will attach to the superstructure. Without the prostheses the patient cannot chew or speak intelligibly.

This prosthesis replaces the patient's upper jaw. This prosthesis improves the patient's ability to speak and chew. Without implants this prosthesis could not be effectively retained.

The facial prosthesis fits over the obturator prosthesis. With both prostheses in place, he can speak well and disguise his defect making social interaction possible. This prosthetic rehabilitation greatly improves the patient's quality of life. A restoration such as this would not have been possible without implants. The team to restore a case like this includes a surgeon (to place the implants), a maxillofacial prosthodontist (to make the obturator) and a maxillofacial prosthetist (to make the facial prosthesis).

Large midfacial defect with implants placed for magnetic retention.

The patient sustained an accidental gunshot wound to his face and is missing both his eyes, his nose, and a portion of his forehead. Four titanium implants were placed into the bone. Magnets designed specifically for prostheses will be used to attach the prosthesis to the bone-integrated implants. (The patient uses a clasp retained dental obturator prosthesis for a hard palate defect. The dental prosthesis is not connected to facial prosthesis.)

The facial prosthesis is securely retain to the implants by the magnets. The prosthesis covers the large facial defect and the glasses disguise the fact that the patients eyes do not move or blink. The strong lines of the dark glasses also draw attention away from the margins of the prosthesis effectively making the edges less noticeable. The patient is blind and dark glasses are commonly worn by the blind to hide eye abnormalities.

The naturalistic contours and final appearance of the prosthetic restoration are possible because of the multidisciplinary teamwork and cooperation between the surgeons who places the implants in the proper location with guidance from the maxillofacial prosthetist and the maxillofacial prosthodontist. The maxillofacial prosthetist specializes in facial prostheses and has the technical and artistic ability to create functional and esthetically excellent prostheses.

The prosthesis is made of a combination of medical grade silicone rubber and hard acrylic resin. The skin is silicone and the eyes and the back of the prosthesis are acrylic. The maxillofacial prosthetist masterfully manipulates and colors these durable synthetic materials to recreate what the patient is missing.