A Contemporary Review of the Role of Facial Prostheses in Complex Facial Reconstruction

Abstract

Background: Maxillofacial prostheses provide effective rehabilitation of complex facial defects as alternatives to surgical reconstruction. Although facial prostheses provide aesthetically pleasing reconstructions, multiple barriers exist that prevent their routine clinical use. The accessibility of facial prostheses is limited by the scarce supply of maxillofacial prosthodontists, significant time commitment and number of clinic appointments required of patients during prosthesis fabrication, short lifespan of prostheses, and limited outcomes data. Methods: A literature review was completed using PubMed and Embase databases, with search phrases including face and maxillofacial prostheses. Patient cases are included to illustrate the use of facial prostheses to reconstruct complex facial defects. Results: The clinical use of facial prostheses requires a multidisciplinary team including a reconstructive surgeon, a maxillofacial prosthodontist, and an anaplastologist, if available, to provide patients with aesthetically appropriate facial prostheses. Developing technology including computer-aided design and three-dimensional printing may improve the availability of facial prostheses by eliminating multiple steps during prosthesis fabrication, ultimately decreasing the time required to fabricate a prosthesis. In addition, enhanced materials may improve prosthesis durability. Long-term outcomes data using validated measures is needed to support the continued use of facial prostheses. Conclusions: Facial prostheses can be used to reconstruct complex facial defects, and bone-anchored prostheses are associated with high patient satisfaction. Multiple barriers prevent prostheses from being used for facial reconstruction. New technologies to assist the design and fabrication of prostheses, and cost reduction measures, may allow their use in the appropriately selected patient.

Oculopalpebral prosthesis prototype design using the additive manufacturing technique: A case study

“…The objective of this study was to evaluate a strategy for manufacturing a prototype for the rehabilitation of oculopalpebral deformity in a specific patient. For this, the comprehensive methodology proposed in 10 was adopted. The necessary craniomaxillofacial tomographic study of the patient was developed.…”

“…Computerized tomography scans have helped to obtain complete and detailed view of the affected bone structure and soft tissues, giving way to personalized treatment plans and greater precision in reconstruction. 10 The medical images (tomographic study of the patient) were stored in DICOM format to carry out the segmentation process, and based on this, the modeling for the reconstruction of the area of interest and planning of the ocular prototype design were carried out. To achieve this objective, the 3D Slicer software (v.4.11) was used.…”

“…The applied methodology is described in. 10 The resulting high-definition model was exported to STL format.…”

“…The edition of the model in STL format was developed using basic commands: select , to perform the separation of tissues; invert, plane, and cut , to divide the model, obtain the volume of interest, and prepare the 3D additive manufacturing, respectively. 10 Figure 4 shows the critical path of the process to obtain the 3D digital prototype model, with a filling density of 10% and a resolution of 0.05 mm. This procedure helps to minimize misfits during the design of the custom external implant.…”

“…Table 2 shows the mechanical characteristics of the impression material and parameters supported by other studies on anatomical models. 10 …”