Keys of maxillofacial prosthetics

Abstract

The degree of difficulty of maxillofacial prosthetic treatment depends greatly on the presence or absence of trismus and remaining teeth and the state of the surrounding soft tissue. The size of the bone defect, the presence or absence of any connection to outside the oral cavity, and the presence or absence of skin grafting are major factors in maxillary defects, while mandibular continuity and deviations are additional major factors in mandibular defects. 　The primary objective of prosthetic treatment for maxillary defects is closure of the bone defect, but highly accurate impressions need to be taken of areas surrounding the bone defect when manufacturing maxillofacial prostheses, so care must be taken to safely remove the impression material after hardening. 　Meanwhile, the primary objective in the case of mandibular defects is ensuring occlusion. Mandibular continuity of the defective area is restored using metal plates, autologous bone, or other materials, and the lower alveolar ridge is surgically reconstructed in a proactive manner using a skin flap. However, recreating the original jaw and masticatory movements that existed before surgery is extremely difficult. 　We are endeavoring to take impressions using different materials depending on the area, and to fabricate prostheses that are in harmony with the dynamics of the movements of the tongue and surrounding tissues. 　This kind of treatment can be followed by a relatively good postoperative course, although a lack of continued oral health care can lead to loss of remaining teeth over time, changes to occlusion, and a requirement for re-fabrication of the prosthesis. Maxillofacial prosthetic treatment therefore requires thorough postoperative management of the patient together with treatment policies decided at preoperative conferences using a team-based approach, including dental hygienists, dental technicians, and speech therapists, as well as prosthetic and oral surgeons.