Closure of surgical defects of the maxilla with free flaps is considered to be clinically important in order to physically separate the oral and nasal cavities. However, bulky flaps often disturb not only speech but also the fabrication of prostheses. The aim of this study was to evaluate the speech of patients reconstructed with free flaps. Six patients participated in this study. Speech and conversation intelligibility and a blowing test were performed with and without their prostheses. Scores for the speech evaluation showed a clinically relevant level independent of the insertion of the prostheses. Articulation analyses revealed lateral articulations and alveolar sounds in flap reconstructed patients, and the prostheses improved these sound articulations in several cases. It is suggested that speech evaluation for flap reconstructed patients after maxillary resection is important and that an appropriate palatal design of the prosthesis should be considered.

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The aim of this study conducted by the Medical Committee of the Japanese Academy of Maxillofacial Prosthetics was to research the present state of facial prosthetic treatment in Japan.
A questionnaire on the actual state of facial prosthetic treatment was sent to 150 institutions, of which 89 responded. Forty-four institutions had treated patients with facial prostheses, but 45 did not perform this treatment. In the past 5 years, there were 91 cases treated with facial prostheses in these 44 institutions. The restoration of 36 cases involved facial defects which included the orbital region, 25 involved facial defects without orbit, 10 involved the auricular region and 9 involved nasal defects. Only 25 institutions had cases with facial defects in the past few years, and the mean number of cases with facial defects in each institution was 1.8 cases per year.
The greatest problem of facial prosthetic treatments is the difficulty or inability of acquiring materials and adhesives for facial prostheses in Japan. The committee members would like the Japanese Academy of Maxillofacial Prosthetics to resolve the present situation including inaccessibility of materials and adhesives for facial prostheses and facial implants, and to take an active part in increasing public awareness in patients with maxillofacial defects and in the medical departments involved in treating malignant tumors of the head and neck.

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In case of maxillectomy, maxillofacial prosthodontists fabricate surgical obturators before surgery. Prosthetic rehabilitation can be performed after the surgery, but in the case of mandibulectomy, it is sometimes difficult to start the restoration of functional disorders early after the surgery because it takes a lot of time to fabricate an interim prosthesis.
A 74-year-old female underwent a marginal mandibular resection due to squamous cell carcinoma. One month after the surgical resection, the patient was referred to the Maxillofacial Prosthetic Clinic of Tokyo Medical and Dental University. From the oral surgeons’ information, the patient’s mandible had become edentulous due to the surgical resection. We asked whether the patient had an old removable partial denture or not. Because there was the old denture, the removable partial denture was modified using tissue conditioner to fabricate an interim prosthesis. It took about 1 hour to modify, and restoration of functional disorders could be started promptly. Six months after the surgery, a duplicate prosthesis was fabricated to transfer the shape of the interim prosthesis to the definitive dento-maxillary prosthesis. The final impression was taken with the duplicate prosthesis and the definitive dento-maxillary prosthesis was fabricated and adjusted only a few times. In this case, the postoperative prosthodontic rehabilitation could be started early because the old denture was modified as an interim prosthesis.

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The accuracy of facial impressions depends on several factors. It is suggested that inaccuracy of facial impressions might be partially due to the weight of impression materials and the patient’s posture. Therefore, we adopted a technique of using a light-weight tray made of casting tape for taking facial impressions. The aim of this study was to evaluate the accuracy of the facial impression technique using casting tape in the upright position. Facial impressions of four volunteers were made with alginate and using the tray in both the upright and supine positions. Laser surface scanning of the face was also performed on the same day in the upright position by a 3-D digitizer. The discrepancies between the two measurements were calculated after data matching.
By using the casting tape tray, the weight of the facial impressions was dramatically decreased. Moreover, there was little discrepancy between the laser scanned face and the face mold fabricated using this impression technique. In terms of the effect of posture, the accuracy did not differ between both positions.
In conclusion, the casting tape method was useful because it was easy to make light-weight individual trays and to make accurate facial impressions in the upright position.

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In order to reduce the weight of silicone auricular prostheses, we tried to inject foaming polyurethane resin in the inside of the prosthesis. As a result, we were able to reduce the weight by about 33％. We consider that the stress on the living body can be reduced by making lightweight prostheses.

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A questionnaire survey on the scope of clinical practice for maxillofacial prosthetics in Japan was carried out, and on the scope of work perceived by maxillofacial prosthetics specialists to be their responsibility.
The questionnaire was sent to four types of institutions related to maxillofacial prosthetics treatment: 1. Oral and maxillofacial surgery-related institution in dental school, 2. Dental prosthetics in dental school, 3. Oral and maxillofacial surgery in medical school, and 4. Oral and maxillofacial surgery in regional secondary hospitals.
Prosthetics works in the human body are categorized as follows: a） oral, extra-stitial, b） oral, intra-stitial, c） pharyngeal, extra-stitial, d） pharyngeal, intra-stitial, e） maxillofacial, extra-stitial, f） facial, epi-stitial, g） head and neck, extra-stitial, h） head and neck, intra-stitial, i） other than head and neck, extra-stitial, j） other than head and neck, intra-stitial.
The questionnaire was sent to 209 specialists, and responses were received from 105 （50.0％）. From the answers, categories a） and b） were actually treated by 80％ of respondents, c） was performed by 50％, and e） by 60％.
The scope of treatment varied among the four types of institute. The majority of institutes consider category g） or less as their responsibility.
Maxillofacial prosthetics should be more closely related with other specialties like proplastology.

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