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An Update on
Maxillofacial Prosthodontics
"If the eyes are the windows of the soul, then the smile is the window of the heart."
Author Unknown
In a day and age where patients want function and quality of life just as much as cure, the MUSC Maxillofacial Prosthodontics Clinic's mission is to improve the quality of life and function of patients through patient care, teaching, and discovery of knowledge. Founded in 1994, the MUSC Maxillofacial Prosthodontic Clinic has three focus areas - rehabilitation of head and neck cancer patients, definitive restoration of the craniofacial/congenital patient, and nasoalveolar molding for cleft palate babies. The speciality is an integral part of the multidisciplinary head and neck team and the department.
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Figure 1. Surgical reconstruction of a hard palate defect rehabilitated with a dental implant supported prosthesis.
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Although head and neck cancers make up less than 5% of all cancers, it is perhaps the most devastating. The resulting hard and soft tissue deficits, either intraorally or extraorally, can present a difficult challenge to the reconstructive surgeon and the maxillofacial prosthodontist. Bodily functions of speaking, swallowing, and chewing are often compromised with this patient population. With advances in microvascular surgery, vascularized free flaps, distraction osteogenesis, and other improvements in hard and soft tissue grafting, surgical reconstruction is a viable option in many cases. Today, defects are often closed and restored with a dental implant supported prosthesis (Figure 1).
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Figure 2. Virtually planned mandibular reconstruction
(Courtesy of Materialise)
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For soft palate defects, there are
promising studies from Rieger et al (1) and Seikaly et al (2) which show excellent functional outcomes with surgical reconstruction. However, not all situations are amenable to surgery alone. Surgical reconstruction may be limited by the size or location of the defect, quantity and quality of available tissue, the patient's physical and/or mental health, or their personal wishes regarding reconstructive surgery. Prosthetic rehabilitation instead of, or in conjunction with, reconstructive surgery may be a viable alternative to achieve the goals of functional, esthetic, and psychosocial normalcy. The critical component is having the maxillofacial prosthodontist work in concert with the resection and reconstructive surgeon. Other advances include the use of digital technology to virtually plan surgical reconstruction with the fibula for both maxillary and mandibular defects (Figure 2) and for facial prostheses (Figures 3 and 4).
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Figure 3. Example of virtually planned surgical guide
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Figure 4. Example of wax pattern by rapid prototyping
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The use of digital technology to plan implant placement and prosthesis design has been shown to result in a significant reduction in patient time (3). The second focus of the clinic - definitive restoration of the craniofacial/congenital patient includes close collaboration with the facial plastic surgeon and the oral and maxillofacial surgeon. The use of digital technology to virtually plan reconstruction, implant placement, and prosthesis fabrication allows patients to literally have "teeth in a day". For example, patients with amelogenesis imperfecta with defective enamel and the resulting loss of dentition can receive both surgical and prosthetic rehabilitation in a day. It is possible to virtually plan implant placement and interim prosthesis fabrication so that surgical placement of implants and prostheses delivery can occur on the same day. After adequate healing, his definitive prostheses can be fabricated. (Figures 5 and 6). |
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Figure 5. Definitive Prosthesis
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Figure 6. Definitive Rehabilitation
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The third focus of the clinic is on nasoalveolar molding with cleft palate babies. Nasoalveolar molding came into fruition in the 1990's with the purpose of the nasoalveolar molding (NAM) to reduce the severity of the cleft in the alveolar ridges and reduce the deformity of the nose prior to surgery. Studies have shown that the NAM appliance helps cleft babies develop a more symmetrical columella (4) and reduce the need for a second nasal reconstructive surgery(5).
References:
- Rieger JM, Zalmanowitz J, Li S, Tang, JL, Williams D, Harris J, Seikaly H(2008) Speech outcomes after soft palate reconstruction with the soft palate insufficiency repair (SPIR) procedure. Head Neck. 30:1439.
- SeikalyH, Rieger JM, Zalmanowitz JG, Tang JL, Alkantani K, Ansari K, O'Connell D, Moysa G, Harris J (2008) Functional soft palate reconstruction: A comprehensive surgical approach. Head Neck. 30:1615.
- Davis BK. The use of technology in maxillofacial prosthetic setting. Printed Biomater 2010; 111-120.
- Nasoalveolar Molding Improves Long-term Nasal Symmetry in Complete Unilateral Cleft Lip-Cleft Palate patients. Barillas et al. Plast. Reconstr. Surg. 123:1002, 2009
- Nasoalveolar Molding Improves Appearance of Children with Bilateral Cleft Lip-Cleft Palate. Lee et al. Plast. Reconstr. Surg. 122:1131, 2008
Betsy K. Davis, D.M.D., M.S.
Associate Professor
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