Maxillofacial Prosthesis

(Practical lecture)
Maxillofacial Prosthodontics
The art and science of anatomic, functional, or cosmetic reconstruction
by means of nonliving substitutes of those regions in the maxilla,
mandible, and face that are missing or defective.

Maxillofacial prosthesis:
artificial device use to replace missing facial or oral structures.
Objectives of Maxillofacial Prosthesis:
•MFP are often needed to restore oral function such as deglutition,
speech and mastication. In other instance, prosthesis may be needed
for cosmetic and psychological reasons or to protect facial structures
during radiotherapy of head and neck cancer patient.
•Also protect the adjacent tissue, teeth & other structures from direct
injury.
•Improve the healing process (as stent), may or may not carry a
medication.
Indications of maxillofacial prosthesis
1. For realignment and fixation of mandibular fragment in adequate
dental occlusal relationship with the opposing jaw.
2. As obturator for the occlusion of defects of the palate and maxillary
bone.
3. For maintenance of facial form and contour and prevention of
contraction during healing period.
4. For restoration of facial features such as the nose, eye and auricle.
Contraindication of the maxillofacial
prosthesis
1. Advanced age of the patient.
2. Poor health of the patient (contraindicated for surgical intervention).
3. Very large deformity, that need to replaced with the help of grafts or
living structures.
4. Poor blood supply in the deformity site.
5. Susceptibility to recurrence of malignant lesions.
6. Operation expenses, if high.
Classification of Maxillofacial Defects:
1. Acquired defects: include those defects that are the result of
trauma, or disease and its treatment. These may include soft and/or
hard palate
2. Congenital defects: are typically craniofacial defects that are
present from birth. The most common of these include cleft defects of
the palate that may in the form of an opening into the antrum and/ or
nasopharynx.
3. Developmental defects: are those defects that occur because of
some genetic predisposition that is expressed during growth and
development.
Maxillofacial prosthesis are classified to:
Intraoral (involving the oral cavity)
Extraoral (cranial or facial replacement)
Combination of intra &extraoral types
Radiotherapy prosthesis.
Intraoral Prosthesis:
A. Maxillary Prosthesis
Obturator Prosthesis:
An obturator can be defined as, “A prosthesis used to close a congenital
or acquired tissue opening, primarily of the hard palate and/or
contiguous alveolar structures (i.e., gingival tissue, teeth).
Feeding Aid Prosthesis
A prosthesis which maintains the right &left maxillary segments of an
infant cleft palate patient in their proper orientation until surgery is
performed to repair the cleft. It closes the oronasal cavity defect, thus
enhancing sucking & swallowing.
Speech aid Prosthesis
A prosthesis used to restore the soft palate with a portion extending
into the pharynx to separate the oropharynx and nasopharynx during
phonation and deglutition.
Maxillary Saliva Stimulating Prosthesis
Can be made with a reservoir to hold artificial saliva.
Palatal Lift Prosthesis
A maxillofacial prosthesis which elevates the soft palate superiorly
&aids in restoration of soft palate functions which may be lost due to
an acquired, congenital or developmental defect.
B- Mandible Prosthesis
Mandibulectomy prosthesis
A maxillofacial prosthesis used to maintain a functional position for the
jaw, improve speech & deglutition following trauma or/and surgery to
the mandible or/and adjacent structures.
Mandibular guide flange
If mandibular continuity is not restored during surgical closure of
wound and the mandibular guide flange prosthesis not used, the
remaining mandibular segment will retrude and deviate toward the
surgical side at the vertical dimension of rest. When mouth is opened,
the deviation increases, leading to an angular pathway of opening and
closing.
C. Tongue Prosthesis
In patients with extensive lesions of the tongue, the resections may
include the floor of the mouth and the bone of the mandible in
addition to the tongue.
In such patients prosthetic restoration becomes a necessity and it also
poses a challenge for the prosthodontist because of physiological and
functional reasons.
Extraoral Prosthesis
General Principles:
Goal is cosmetic.
Retained with :
1. Adhesives.
2. Implants.
3. Skin grafting as a base & smooth edges.
4. Glasses or exrtra equipments can help also.
Facial Prosthesis
The choice between surgical reconstruction and prosthetic restoration
of large facial defects remains a difficult one and depends on the size
and etiology of the defect, as well as on the wishes of the patient.

Extraoral facial Prosthesis using extraoral implant

Extraoral Prosthesis – Orbit

Skin graft provides base for prosthesis.

Sun glasses help to hide the defect margin.

Extraoral Prosthesis – Nose

Skin graft provides Glasses helps for

base for prosthesis. retention
Extraoral Prosthesis – Ear

Tragus hides attachment

Combination Prosthesis
Resection of nasal cavity in tumors leads to defects in nose, upper lip,
and orbit with extension into oral cavity.
The prognosis depends on
the presence and condition of the teeth, amount and contour of the
remaining hard palate, the functional status of lower lip, and the
motivation and adaptability of the patient.
The oral prosthesis is completed first. The oral prosthesis should be
fabricated such that it restores most functions of speech, mastication,
swallowing and esthetics also distribute forces as efficiently as possible
Radiotherapy ProsthesisRadiation (stent &
Carrier)
Radiation or Shielding stents are basically
antiradiation that protect areas
other than the operated site from
harmful gamma radiation.
Carrier stent
It is used to carry skin or mucous membrane graft
in vestibule, palate or mouth floor in approximation to
periosteum during initial healing and
prevent formation of hematoma
between the graft and the underlying
bone and periosteum.
Thank you