Academic literature on the topic 'Maxillo-facial prosthetic'

AbstractSino-nasal mycosis is a known complication in patients with immunological or metabolic compromise. Mainstay of treatment includes reversal of the compromised state, systemic antifungals and repeated radical debridements assisted by serial imaging. Salvage is possible provided no cerebral extension exists on presentation. The resultant deformity following debidement causes gross morbidity and psycho-social embarrassment. Surgical reconstruction is difficult on account of co-morbid diseases. Non-surgical prosthetic rehabilitation gives fairly accurate correction in these patients. We report a case of a 48 yrs. male diabetic with sino-orbital mycosis where debridement resulted in a gross morbid defect. However effective rehabilitation was achieved using three piece maxillo-facial prosthesis.

Atrophic edentulous mandible fractures are a challenge for maxillo-facial surgeons because of low vascularization, low bone regeneration, and lack of occlusion. Whereas occlusion is the main guide in the reduction of mandibular fractures, the aim of our study is to show the advantages of using virtual surgical planning (VSP) in surgery when the occlusal guide is absent. This work is a prospective study that shows the in-house digital workflow for the management of these fractures in the Maxillo-Facial Surgery Unit of Federico II University Hospital of Naples. Four patients who satisfied the criteria were included in the study. For each patient, the same defined CAD/CAM-based was applied. The workflow followed four steps: (1) bone segmentation and virtual reduction of fracture fragments; (2) three-dimensional printing of virtually reduced mandible and modelling of 2.4 reconstruction plate on printed resin model; (3) surgery aided by the pre-formed plate; (4) digital and clinical outcomes analysis. In the last step, a distance colour map was conducted to compare the virtual planning and postoperative CT outcome. In all cases, the discrepancies values between the two images were lower than 1.5 mm, and good clinical outcomes in terms of facial symmetry, absence of sensory disturbance, and possibility of prosthetic rehabilitation were obtained. In conclusion, the VSP, with our in-house workflow brings benefits in the management of atrophic edentulous mandible fractures in terms of the high accuracy of bone repositioning.

The materials used in the treatment of an adult patient with severe cleft palate need to be choose very carefull, according with the biological aspects. First of all, is mandatory to choose a proper material for endodontic treatment and use a correct technique. Second, the cement used in order to fix a RPD (rapid palatinal disjunctor) has to be glass-ionomer cement, because the oral and nasal cavity are still communicating. On the other hand, the dental ceramic material used in the prosthetic treatment has to be a special one, pink-colored in those regions where cleavage is present. For this reason, the cases with cleavage need a complex treatment, usually during a few years and several steps. They need a good collaboration between doctors of different specialities: maxillo-facial surgery, orthodontics, prosthetics and plastic surgery. The aim of the present study is to underline the assessment of ceramic dental materials during the laborious treatment in the case of an adult with cleft palate, in order to obtain the best results.

Patients who undergo surgical resection of the maxillo-mandibular structures as a result of trauma, infection or malignancy, suffer from psycho-social setbacks which has a profound impact on their over-all quality of life. 1,2 These defects, especially those following maxillectomy, result in oroantral communication, facial deformation, impaired speech and difficulty in deglutition. For the rehabilitation of patients with such defects, surgical and prosthetic treatment options are available. As, not all patients can be successfully rehabilitated with reconstructive surgeries due to postoperative complications like graft rejection, the extent of the surgical defect and high psychological impact factor associated with repeated surgeries, prosthetic rehabilitation proves to be an alternative treatment option. The prosthetic rehabilitation of such patients is challenging as it requires restoration of the lost form, function and aesthetics, under constantly changing state of post-surgical intraoral tissues, with limited mouth opening. The maxillofacial prosthesis designed to close congenital or an acquired tissue opening, primarily of the hard palate, is known as an obturator. 3 The obturator has two functional components, one seals the surgical defect and the other replaces the lost dentoalveolarstructures.4-7 The design of an obturator may vary depending on the extent of the defect, remnant dentoalveolar complex, soft tissue undercuts and existent muscle physiology.8,9 Among the two designs, solid and hollow, hollow obturators are widely used. The bulb portion of the hollow obturator, which accommodates the surgical defect, can be open or closed9,10and its selection depends on the prosthodontist’s clinical decision-making skills and the ease of fabrication. In this article we have discussed the rehabilitated patients with single-piece, openhollow bulb definitive obturator. Patients undergo extensive maxillary surgical resections due to aggressive lesions like malignancies and deep fungal infections. Prosthetic rehabilitation of such patients with an obturator becomes of paramount importance as it separates the oropharynx from the nasopharynx, reduces the risk of recurrent infections, replaces lost dentoalveolar structures, permits intelligible speech, reinstates mastication and deglutition, restores facial contour and patient’s self-esteem. The bulb portion of the obturator extends into the defect and accommodates it, forming a hermetic seal. In this clinical report, we highlight the success of prosthetic rehabilitation of maxillectomy patients using single-piece, open-hollow bulb definitive obturator. The meticulous follow-up carried out reveals the success of the prosthesis and adds practice-based evidence to the maxillectomy rehabilitation outcome.

The progress of fundamental medical sciences, of other medical and surgical specialties enabled a fast development pace of modern maxilla-facial surgery. Oro-maxilla-facial surgery bring together science and art in order to prevent, diagnose and cure disease, to reconstitute shapes and restore functions of the oro-maxilla-facial area often by surgery. Apical surgery is a standard surgical procedure including incision of the apex and resection of the apical and periapical diseased site, preceded or not by the correct endodontic treatment and the adequate root canal obturation. Periapical pathology is maintained in an endodontic treatment considered correct, being resolved by endodontic surgery with apicoectomy and avoiding extracting the causal tooth. In this way the area is kept as favorable as possible for future prosthetic works. It is achieved mostly in monoradicular teeth and this intervention is suitable for molars, yet the topography and the morphology of the molars make the surgery more difficult. Oral surgery and endodontics have accumulated a rich experience in maintaining the teeth on the arch for as long as possible. The study material for endodontic case selection, examination and resolving is gathered from the Clinic of Oral and Maxillo-Facial Surgery of the Spiridon Teaching Hospital over a period of two years, from 2014 to 2016; the study group for endodontic therapy and surgery comprises 59 patients. To receive apicoectomy, the tooth and its periodontium should meet certain conditions after apicoectomy, the operated root needs to keep an osseous implantation length equal to two thirds or at least half its initial length. Complex oral rehabilitation of various clinical cases met in dental surgery is a challenge for the dental surgeon due to the various degrees of impairment of all system elements. The emerging malfunction is difficult to diagnose and to treat, asking for dental surgeon�s special experience and clinician skills.

Use of antibiotic prophylaxis (AP) in trauma patients is a common practice. However, considering the increasing rates of antibiotic resistance, AP use should be questioned and limited only to specific cases. We performed a systematic review of recent literature (from year 2000), aiming to summarize the state of the art on efficacy and appropriateness of AP in patients with traumatic injuries of torso, maxillofacial complex and skin (including burns). Twenty-six articles were selected. In thoracic trauma, AP could be useful in reducing infective complications in tube thoracostomy for penetrating trauma. In maxillo-facial trauma, AP could find a role in the peri-operative trauma setting in the case of a graft or prosthetic implant. In abdominal trauma, there is a lack of consensus on the definition of contamination, infection, antibiotic therapy, and prophylaxis. In burned patients, routine AP is not suggested. In the case of human bites to the extremities, AP could find an indication. Future studies should focus on the subcategories of patients at higher risk of infection, identifying those who would benefit from AP. Attention to antimicrobial stewardship and guidelines focused on AP in trauma are required, to reduce antibiotic abuse, and increase quality research.

To improve the maxillofacial surgery outcome, modern manufacturing methods such as rapid prototyping (RP), reverse engineering (RE) and medical imaging data have been utilised to manufacture custom-made prostheses after previous failed reconstructive surgery. After acquisition of data, an individual computer-based 3D model of the bony defect was generated and transferred into RE software to create the prosthesis CAD model. Then the physical model of the prosthesis was fabricated by RP technique. The precise fit of the prosthesis was evaluated using the prosthesis and skull models. The prosthesis was then directly used in investment casting such as “Quick Cast” pattern to produce the titanium model. In the clinical reports presented here, reconstructions of one patient with large mandible bone defects were performed using this method. The custom prostheses perfectly fit the defects during the operations, and surgery time was reduced. These cases showed that the prefabrication of a prosthesis using modern manufacturing technology is an effective method for maxillofacial defect reconstruction.

Através do fato de que os silicones pigmentados utilizados na confecção de aloplastias para a reabilitação de pacientes portadores de defeitos faciais apresentam alteração cromática com o decorrer do tempo na experiência clínica, e pela escassez na literatura específica de trabalhos experimentais relacionados ao tema, principalmente quanto aos silicones industriais de cura acética, o presente trabalho tem como objetivo verificar o comportamento de três tipos de silicones diferentes coloridos com um determinado pigmento (pó para maquiagem facial), usados rotineiramente no atendimento de próteses faciais. Os silicones usados foram um de cura por calor (HTV) para finalidades médicas, um de cura acética (RTV) para fins industriais com especificações de normas alimentícias e outro também de cura acética (RTV), porém somente de normas industriais. Para a realização do experimento confeccionou-se 30 corpos de prova, sendo 10 para cada tipo de silicone, que foram analisados por espectrofotômetro. Após análise, cada grupo foi dividido em 2 subgrupos, de 5 unidades cada, um grupo exposto (E) e um grupo controle (C). Os 3 grupos (E) passaram por envelhecimento acelerado em exposição ambiental, enquanto os 3 grupos (C) ficaram acondicionados em um lugar totalmente escuro em temperatura ambiente. A leitura inicial foi considerada padrão, enquanto as seguintes foram aos 45 e 90 dias. Os dados obtidos nas três medições foram usados para avaliação das alterações cromáticas. Com os resultados estatísticos após análise, concluímos que todos os silicones expostos apresentaram alteração na cor clinicamente inaceitável, sendo que nos grupos controle somente o silicone de cura acética (RTV), industrial com especificações de normas alimentícias, apresentou mudanças cromáticas clinicamente aceitáveis, enquanto os outros dois se mantiveram estáveis.
Owing to the fact that pigmented silicons used in the making of facial prosthesis or the rehabilitation of patients with facial flaws present , in clinical experience, chromatic alteration as time passes by, and due to the shortage of experimental papers in the specific literature, specially in relation to industrial silicon of acetic cure, the present paper targets to verify the behavior of three types of different silicons colored with a determined pigment (facial make up powder), used as routine in facial prosthesis. The used silicons were: one of cure by heat (HTV) with medical purposes , one of acetic cure (RTV) for industrial purposes with specific nutritious rules and another one of acetic cure (RTV) with industrial rules only. To perform the experiment thirty bodies of proof were made , ten to each silicon type, which were analyzed through spectrophotometer. After analyzing, each group was divided into two sub groups, five units each, one group exposed (E) and one group control (C). The three groups (E) passed through accelerated environmental exposure aging, while the three groups (C) stayed in a totally dark place at normal temperature. The initial reading was considered pattern, while the following readings were within 45 and 90 days. The data from the three measurements were used for evaluating the chromatic alterations. With the statistic results at hand, we came to the conclusion that all silicons exposed showed unacceptable clinical color alteration, and in the control groups only the industrial acetic cure silicon (RTV) with specific nutritious rules, showed acceptable clinical chromatic changes while the other two remained stable.

Eye loss has been a feature of mankind’s existence down through the ages, and whilst significant amounts of research have been undertaken to discuss monocular vision at an ophthalmic and optometric level, little or no research has been undertaken to discuss the benefits or otherwise of prosthetic reconstruction of the empty palprebal fissure. Most of this has been left at an artistic or anecdotal level. To the author’s knowledge, no research of this kind has been undertaken within Australia, and little or no research has been undertaken, to this extent, around the world. The overall aim of this research is to define the optimum benefit with the minimum risk for the different types of eye loss and ocular replacement. This thesis attempts to research and document the reasons for eye loss and some of the more prevalent issues that arise as a result of wearing an artificial eye, whether they be negative or positive. A questionnaire was developed, to research and quantify various experiences of individual artificial eye wearers; their reasons for eye loss, the role the prosthetic eye played in their life, both prosthetically, socially and psychologically. Every attempt has been made to accurately represent the responses based upon feelings of a number of patients over a number of years. The point of commonality in this study is that all patients have had their artificial eyes made by a single ocular prosthetist. It was found that eye loss was indiscriminate as to gender, age or ethnicity. The results showed that more people lost their right eye than those who lost their left, and over 50 age bracket lost their eye through disease more commonly. It was also hypothesized and confirmed that smokers lost their eye due to disease related issues more often than non-smokers. Prosthetic rehabilitation dramatically increased patients’ sense of wellbeing, emotionally, psychologically and socially. It is concluded that more than just being a cosmetic solution to what is otherwise a medical problem that an ocular prosthesis plays a more important, and vital, psychological role to those suffering eye loss.
Thesis (MClinSc) -- University of Adelaide, Adelaide Dental School, 2018