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 Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 9  |  Issue : 2  |  Page : 187-190

Prosthetic rehabilitation of an extraoral lateral midfacial defect with a silicone prosthesis


Department of Prosthodontics and Crown and Bridge, Luxmi Bai Institute of Dental Sciences and Hospital, Patiala, Punjab, India

Date of Submission04-Mar-2022
Date of Decision29-Mar-2022
Date of Acceptance17-Apr-2022
Date of Web Publication22-Aug-2022

Correspondence Address:
Disha Sharma
V.P.O- Bhoa, Tehsil and Distt, Pathankot - 145 025, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrr.jdrr_39_22

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  Abstract 


Midface malignancies result in cosmetic alterations that can affect not only the patient's function and quality of life but also their mental health and social behavior. Maxillofacial prostheses are crucial in restoring damaged structure and function. This case report illustrates a simple and cost-effective prosthetic rehabilitation approach for a patient with an extraoral midfacial deformity where multiple surgical repair attempts to correct the deformity had failed. A heat temperature vulcanized silicone prosthetic, which was easy to produce, was used to rehabilitate the deformity. The patient was pleased with the esthetic results of prosthesis and it helped in restoring her confidence.

Keywords: Esthetic, heat temperature vulcanized silicone prosthesis, maxillofacial prostheses, midfacial defect


How to cite this article:
Kaur A, Sharma D, Samra RK, Sharma A, Garg K. Prosthetic rehabilitation of an extraoral lateral midfacial defect with a silicone prosthesis. J Dent Res Rev 2022;9:187-90

How to cite this URL:
Kaur A, Sharma D, Samra RK, Sharma A, Garg K. Prosthetic rehabilitation of an extraoral lateral midfacial defect with a silicone prosthesis. J Dent Res Rev [serial online] 2022 [cited 2022 Sep 28];9:187-90. Available from: https://www.jdrr.org/text.asp?2022/9/2/187/354204




  Introduction Top


A person's identity and personality are represented by their face.[1] Any deformation of the face can play a vital role in an individual's esthetics and have a negative impact on one's personality, causing self-consciousness, and a lack of self confidence. Congenital or developmental abnormalities, unintentional injuries, or acquired disfigurements resulting from tumor excision during surgical therapy in the mouth or nose region are all possible causes of midfacial deformities.[2] Midfacial defects are divided into two types: midline defects and lateral defects. Midline defects refer to the complete or partial involvement of the nose and/or upper lip, along with intraoral maxillary defects.[2] A lateral defect may involve complete or partial contents of the cheek and or orbit as well as an intraoral defect of the maxilla.[2]

Large defects caused by cancer treatments typically necessitate the use of a maxillofacial prosthesis in conjunction with a surgical reconstruction procedure to restore esthetics and function. Any prosthesis used to replace a part or all of the stomatognathic and/or craniofacial structures is referred as a maxillofacial prosthesis.[3] It is a significant challenge for maxillofacial prosthodontists to rehabilitate such defects in esthetic areas.[4] Acrylic resins, acrylic copolymers, vinyl polymers, polyurethane elastomers, and silicone elastomers are some of the common materials used to fabricate facial prostheses. Silicone elastomers is the most widely used material for facial restorations because of its good surface texture and hardness.[1],[4] This case report presents a case of prosthetic rehabilitation of a left lateral midfacial defect using a silicone-based maxillofacial prosthesis.


  Case Report Top


A 55-year-old female patient was reported to the department of prosthodontics and crown & bridge for prosthetic rehabilitation of a lateral midfacial defect. The patient presented a 2-year-old history of ethmoidectomy following transitional cell carcinoma, creating a perforation lateral to the lateral wall of the nose and extending up to the malar prominence on the left side of the face. Postradiation therapy, the patient had been operated on thrice for reconstruction of the defect by a skin grafting procedure, but a desirable outcome was not achieved. Loss of the midfacial component had a huge psychological impact on the patient, and she often used to cover her face.

Extraoral examination of the patient revealed a triangular-shaped perforation of dimensions 2.5 cm, 2.5 cm, and 2.2 cm extending from the medial border of the defect to lateral and inferior borders [Figure 1], [Figure 2], [Figure 3]. The boundaries of the defect were completely healthy. On examination, the left eye showed impaired vision with watery discharge. An intraoral examination revealed restricted mouth opening with no communication with the extraoral defect. After consulting with the plastic surgeon and considering the patient's financial status, chief complaint, and time constraints, it was decided to rehabilitate the patient with a superficial extraoral silicone prosthesis that does not involve much of the deeper extension of the defect.
Figure 1: Pretreatment frontal view of patient

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Figure 2: Pretreatment lateral view of the patient

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Figure 3: Dimensions of the defect extending from medial border of the defect to lateral and inferior borders

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The diagnostic impression was made with irreversible hydrocolloid (Dentsply Zelgan 2002, India) impression material. A custom tray of autopolymerizing acrylic resin (Coltene Cold Cure, Whaledent Pvt. Ltd., Mumbai) was fabricated to make a functional impression.

It was important to make a functional impression because the defect borders were partly on the nose, extending to the medial canthus of the left eye and partly on the cheek, which had functional movements. A custom tray was checked on the patient for its adaptation and extensions. A thin layer of tray adhesive (Zhermack, Dentsply, India) was applied with a brush and allowed to dry as advised by the manufacturer's instructions. Molding of the border was done with the putty consistency of addition silicone impression material (Flexceed, GC India, Telangana) to record various functional movements, followed by making a final impression with light body addition silicone material (Flexceed, GC India, Telangana) [Figure 4]. The anatomic undercut evident on the inferior wall of the defect close to the lateral wall of the nose was ensured to be well recorded in the impression. Then, the impression was poured with Type IV gypsum [Figure 5]. The patient was asked to perform all the functional movements to assess the wax pattern's adaptability [Figure 6]. The shape, size, contour, fit, and surface texture of the wax pattern on the face were verified and ensured that it was acceptable to both the patient and the practitioner. The chairside shade matching was done using a trial and error method [Figure 7] by adding intrinsic color pigments (MP Sai Enterprises, Mumbai) to heat temperature vulcanized (HTV) silicone material as per the selected skin shade of the patient (Technovent, Bridgend).
Figure 4: Final impression of the defect made with polyvinyl siloxane impression material

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Figure 5: Cast of the defect poured with type IV gypsum

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Figure 6: Wax pattern try in

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Figure 7: Shade verification by trial and error method

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Following the try-in, the flasking and dewaxing procedures were carried out as usual. Equal quantities of part A and part B HTV silicone gels were dispensed and blended with intrinsic color pigments until the required shade was achieved. Following that, the mixed material was packed and processed for 1 h at 100°C, as indicated by the manufacturer. After curing, the excess silicone extending beyond the prosthesis's borders was cut away with sharp scissors.

The silicone prosthesis was positioned over the defect by utilizing the anatomical undercut on the defect's inferior wall lateral to the nose. Spectacles were worn to hide the silicone prosthesis limits, which helped to improve the prosthesis esthetics and retention [Figure 8]. The procedure for inserting and removing the prosthesis was explained to the patient. Detailed instructions regarding the care and use of the prosthesis were given. The patient was recalled after 1 week, 14 days, and 1 month to assess the condition of the defect and prosthesis. The patient was satisfied with the prosthesis and had regained her confidence as a result.
Figure 8: Patient with maxillofacial prosthesis

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  Discussion Top


This patient in the case report had limited her everyday social activities after the surgical excision of a midfacial tumor. Plastic and reconstructive surgery is one therapy option for patients with facial deformities, but for larger flaws with severe anatomical loss, where surgery is not a viable option, prosthetic rehabilitation is the best alternative.[1],[5] Numerous surgical reconstructive attempts had failed in this case, so the prosthetic alternative was used.

The numerous maxillofacial impression procedures employed and reported in the literature are dependent on the materials available and the operator's dexterity, making extraoral facial prosthesis creation more of an art than science.[4] Conventionally, irreversible hydrocolloid material reinforced with Type II gypsum is used to make maxillofacial impressions.

In this case, the final impression was made with light-body polyvinyl siloxane impression material, which has high flowability and helps to record the fine details of the defect during various functional movements of the face. Polymethyl methacrylate, polyvinyl chloride, polyurethane, and silicone are among the different biomaterials used as maxillofacial prosthetic materials.[6] Acrylic resin and silicones are the most frequently used materials. Although acrylic prostheses are inexpensive, they are rigid and have esthetic restrictions. Acrylic biomaterial was not used in this case because repeated movements during insertion and removal of the prosthesis from the undercut area can easily traumatize the mucosa. Silicone was used in the fabrication of maxillofacial prostheses due to its flexibility, life-like appearance,[7] lightweight, translucency, incorporation of intrinsic and extrinsic coloration, dimensional stability, and lack of allergic reactions.

The patient's ability to use and accept the facial prosthesis is highly dependent on the retention of the prosthesis. Anatomical undercuts, spectacles, bioadhesives, implants, or double-sided tape can all be used to keep the prosthetic in place.[1] Retention is achieved in this situation using two methods:

  1. The utilization of beneficial retentive undercuts that were present on the defect's inferior wall
  2. The usage of spectacles.


For shade matching, the trial and error method was used as it is simple and inexpensive. Intrinsic pigments are utilized because they have greater color permanence and produce superior esthetic outcomes.[7] Shade guides, pigment dispersion systems, and color measurements with a colorimeter or spectrophotometer are some more of the advanced methodologies and approaches for shade matching. Despite advances in technology and material sciences, the trial and error method of color replication is still frequently used,[8] as spectrophotometers are not easily available. Furthermore, using a spectrophotometer or colorimeter on a layered structure like skin does not allow for the replication of translucency and surface roughness.

Although silicone is regarded as an ideal maxillofacial prosthetic material, it has its own set of limitations. The drawbacks include that some adhesives do not function well with silicones, high polishing difficulty, low tear strength, and can promote microbial development.[9] Several trials have been carried out to improve the quality of various accessible maxillofacial biomaterials, but there is still no ideal material that precisely resembles human skin.

Recent digital technologies such as computer-aided design and manufacturing, rapid prototyping,[10] and computed tomography scanners can be used to reduce the number of manual steps required to fabricate a prosthesis. The fundamental benefit of these systems is that all modifications can be performed directly on the computer screen, thus reducing the possibility of error.


  Conclusion Top


This clinical report outlines a simple, straightforward, noninvasive, and cost-effective procedure for fabricating a lateral midfacial prosthesis that provides the patient with adequate esthetics and comfort. By meticulously recording all the borders and undercut areas, optimal marginal integrity and stability were achieved.

Acknowledgments

The authors are grateful to Dr. Mandeep Kaur MDS Prosthodontics and Crown and Bridge at Apex Dental Care, Patiala, for the providing material used in the described case.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published, and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Aggarwal V, Datta K, Kaur S. Rehabilitation of post-traumatic total nasal defect using silicone and acrylic resin. J Indian Prosthodont Soc 2016;16:87-90.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Patil PG. Modified technique to fabricate a hollow light-weight facial prosthesis for lateral midfacial defect: A clinical report. J Adv Prosthodont 2010;2:65-70.  Back to cited text no. 2
    
3.
The glossary of prosthodontic terms: Ninth edition. J Prosthet Dent 2017;117:e1-105.  Back to cited text no. 3
    
4.
Shetty S, Mohammed F, Kamath J, Shenoy KK. Nasal reconstruction with silicone using customised impression technique. J Indian Prosthodont Soc 2018;18:68-71.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Ejlali M, Moghadam L. Prosthetic rehabilitation of nasal defect: A case report. J Dent Sch 2016;34:99-101.  Back to cited text no. 5
    
6.
Anantharaju A, Kamath G, Mody P, Nooji D. Prosthetic rehabilitation of Oro-nasal defect. J Indian Prosthodont Soc 2011;11:242-5.  Back to cited text no. 6
    
7.
Taylor TD. Clinical Maxillofacial Prosthetics. Chicago: Quintessence Publ Co; 2000. p. 233-44.  Back to cited text no. 7
    
8.
Anitha KV, Behanam M, Ahila SC, Jei JB. A custom made intrinsic silicone shade guide for Indian population. J Clin Diagn Res 2016;10:C27-30.  Back to cited text no. 8
    
9.
Beumer J, Curtis TA, Marunick MT. Maxillofacial Rehabilitation Prosthodontic and Surgical Consideration. 1st ed. St Louis: Ishiyaku Euroamerica; 1996. p. 387-99.  Back to cited text no. 9
    
10.
Al Mardini M, Ercoli C, Graser GN. A technique to produce a mirror-image wax pattern of an ear using rapid prototyping technology. J Prosthet Dent 2005;94:195-8.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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