Combination prosthetic design providing a superior retention for mid-facial defect rehabilitation: A Case Report

Abstract

Large maxillofacial defects from malignant tumor treatment are rarely rehabilitated by surgical reconstruction alone. Ameloblastic carcinoma, a rare aggressive odontogenic malignant tumor, requires wide surgical excision to gain a tumor-free margin. In the post-surgical defect, prosthetic rehabilitation is the treatment of choice to restore function and esthetics. Moreover, an intra-oral prosthesis such as an obturator restores speech, mastication and deglutition. Retention of the obturator is a major problem while rehabilitating large defects. The existing anatomical structures from the defect with the help of magnet attachments are suitable to enhance retention, stability and support of the prostheses. This case report presents a patient with an intraoral and extra-oral combination defect following surgical resection of ameloblastic carcinoma and describes the prosthetic techniques and design considerations for a magnet-retained obturator and mid-facial prosthesis. An implant-retained mid-facial prosthesis was fabricated. The retention of combined prostheses was obtained from the remaining right posterior teeth only. The patient had an unfavorable defect due to the large size and presence of scar contracture that vertically tends to dislodge the obturator. Magnet attachments were used to combine the facial and oral prosthesis, minimize the vertical dislodging forces and enhance retention. In addition, the retention was also gained from the scar band at lower border of mid-facial defect that avoided the need for more implants surgery. Magnet attachment with anatomical structure of the mid-facial defect provides an acceptable means of retention in large extraoral-intraoral combinations defects, improving the function, esthetic and the patients' quality of life.

Prosthetic Rehabilitation of Rhino Orbital Mucormycosis Associated with COVID-19: A Case Series

“…Surgical resection alters facial appearances, imposes psychological and social disability, hampers functions like mastication, swallowing, and speech, however, a carefully designed obturator prosthesis improves masticatory efficiency, speech intelligibility, and relieves psychological distress. 27,28 Such extensive defects are best rehabilitated by an obturator retained by zygomaticus and nasal implants. However, the presence of absolute contraindications like an underlying systemic immunocompromise, a small volume of residual bone in both cases made the outcome biomechanically dubious.…”

“…Surgical resection alters facial appearances, imposes psychological and social disability, hampers functions like mastication, swallowing, and speech, however, a carefully designed obturator prosthesis improves masticatory efficiency, speech intelligibility, and relieves psychological distress. 27 , 28 …”

Orbital rehabilitation of a COVID-19-induced mucormycotic defect – A case report

“…The labial flange was modified in such a way to maintain the labial fullness and generate adequate esthetics and also reduce the lateral displacing forces owing to the function of the upper lip. [ 5 ]…”

Palatomaxillary Obturation and Facial Prosthetics in Head and Neck Reconstruction

“…Readers may refer to a comprehensive guide on prosthetic stability and framework design by Aramany and Parr et al 13,14 Additionally, the intraoral obturator can be the basis for attachment of facial prostheses should there be a combined facial and maxillary defect allowing for enhanced retention of both intraoral and extraoral prostheses. 17,18 ►Fig. 2A-D shows a patient with a partial rhinectomy and palatal defect rehabil-itated with a magnet retention combination nasal prosthesis and palatal obturator.…”