Prosthetic Rehabilitation

A prosthesis is a synthetic replacement of part of your face that has been affected by ablative surgery, such as the eye, ear, nose, hard palate or teeth. The prosthesis is made from a special material and is designed and created specifically for you by a specialist, called a maxillofacial prosthodontist. Maxillofacial prosthodontics is an area of dentistry, and specialists in this area are few in number.

A prosthesis can supplement another reconstructive method or, in cases such as hard palate and maxilla defects, replace the need for undergoing a major tissue reconstruction.

The advantages of a prosthesis are that it keeps you from a major surgery and in some cases is the best cosmetic outcome for certain structures such as an ear, a nose or an eye. Your surgeon might recommend a prosthesis in order to closely monitor an area for any signs of tumor recurrence such as in the maxillary sinus cavity after a maxillectomy. However, with the advent of newer and better imaging modalities, this is becoming less important.

The disadvantage is you have to remove it to keep it clean, especially for prostheses that replace portions of the palate and teeth that sit inside your mouth all day. In addition, these prosthetics are expensive and your insurance company may not pay for one.

The creation of a custom-made prosthesis can take a number of visits to your prosthodontist to get it just right. The first step is to create a mold of the face or area that requires a prosthesis and a subsequent plaster model. Then your prosthodontist will start sculpting your prosthesis out of wax. After a number of refinements of the wax model of the prosthesis, a plaster mold is made of the prosthesis and the wax is melted away, creating the template to create the prosthesis. Finally, the prosthesis is painted to look as natural as possible. This whole process can take a few weeks. You might need future refinements as the wound changes or if it does not sit perfectly.

A prosthesis can be tissue-borne or implant-borne:

  • Tissue-borne prosthesis: The prosthesis is secured to the area requiring reconstruction by clasping to normal tissue in the area such as adjacent teeth or by being held in place by adhesives.
  • Implant-borne prosthesis: In this form of prosthesis, a surgery is required to screw titanium implants near the area where the prosthesis will be sitting. After a period of a few weeks to months, the titanium implant becomes integrated into the bone, and the prosthesis can be secured to the implant. The advantage of an implant-borne prosthesis is that glues and adhesives are not required to secure the prosthesis in place. They can generally snap on and snap off.

A prosthesis can be used in the following cases:

  • Palate and maxilla prosthesis: For tumors of the sinuses, maxilla and/or hard palate, you will likely undergo a maxillectomy. Following this surgery, rehabilitation is required either by reconstruction with tissue replacement or with a prosthetic obturator. If an obturator is decided to be the best option, you will see a prosthodontist prior to surgery to have an impression made of your palate. A temporary obturator secured to the remaining hard palate or remaining teeth will be placed immediately following the tumor removal. Then a series of obturators will be specially designed for you as the wound contracts and changes over time. A maxillary prosthesis is typically a tissue-borne prosthesis. It must be removed and cleaned quite frequently.

A hard palate augmentation prosthesis might also be used in cases of partial or total glossectomy when removal of part of your tongue makes it difficult to move food products back into your throat. By augmenting the roof of the mouth, the remaining or reconstructed tongue can make contact and make it easier to move food back into your throat.

  • Auricular prosthesis: An artificial ear can be created to look just like the ear on the normal side. This is best done by way of an implant-borne prosthesis, in which implants are drilled into the temporal bone. Once the implants are integrated, the prosthesis can be clicked on and off as needed to keep it clean. Medical-grade glue can be used instead of implants to keep the prosthesis in place.
  • Nasal prosthesis: An artificial nose can be created to look just like your original nose if all or part of it is removed for the treatment of cancer. Adhesives are generally used to keep the prosthesis in place, but implants can be applied to the floor of the nose or frontal bone in certain cases.
  • Orbital prosthesis: If your cancer surgery requires removal of an eye, an orbital prosthesis is an option to give the appearance of an eye. In this case, a flap or skin graft will typically be used to fill most of the space in the eye socket, and a temporary orbital spacer will be placed to preserve a pocket for a prosthesis to be placed at a later date. This is usually a tissue-borne prosthesis, but implants can be drilled into facial (frontal) bones to help secure the prosthesis.
  • Dental rehabilitation: When the upper jaw (maxilla) or lower jaw (mandible) is removed along with teeth, you might consider dental rehabilitation. This is the placement of prosthetic teeth to improve your quality of life by helping you eat normally. It will improve your appearance after undergoing a major ablative surgery.

Tissue-borne prostheses for dental rehabilitation are known to be difficult to keep in place because of the forces of chewing, constant motion and moist environments. Therefore, implant-borne prostheses are the favored method to restore teeth after resection of the upper or lower jawbones for cancer. Because an implant must be placed into healthy bone and integrated into the bone itself over a period of months, dental rehabilitation is best accomplished in conjunction with a bone-containing free flap.

For example, after removal of part of the mandible along with the teeth, you might undergo a fibula bone free flap to restore continuity of the lower jawbone and provide a place to insert implants for a dental prosthesis. The timing of implant placement and denture placement will depend on the timing of radiation. Your surgeon will not place implants immediately before or after radiation because the chance of the implant taking—integrating into the bone—is much less due to the effects of radiation. However, if implants are placed at the time of reconstructive surgery or soon thereafter, this allows healing of the implant for several weeks before the onset of radiation.

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