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The rehabilitation of a combined mid-facial defect using a magnetretained intra- and extra-oral prosthesis: a case report Hollie Hawrot Rachael Y Jablonski Zaid Ali Dental Update 2024 51:7, 707-709.
There are several treatment options available to restore function and appearance in patients with combined mid-facial defects. Owing to the size of the defect and the associated size and weight of the prostheses, adequate retention can be challenging to achieve. Retention of a facial prosthesis can be improved using several techniques, such as medical grade adhesives, attachments, or osseo-integrated implants. For patients with a history of radiotherapy, surgical rehabilitation may be less favourable than non-surgical approaches owing to the risk of osteoradionecrosis and a reduced blood supply in the surgical fields. This clinical case report highlights the conservative rehabilitation of a combined mid-facial defect using a magnet-retained intra-oral and extra-oral prosthesis.
CPD/Clinical Relevance:
A thorough medical and clinical assessment will highlight factors that will influence the treatment planning process when managing a combined mid-facial defect.
Article
Malignant tumours that arise from the paranasal sinuses, salivary glands and upper aerodigestive tract are classified as head and neck cancers (HNC).1,2 In 2008, there were over 500,000 cases of HNC worldwide, of which, around 6000 of these cases occurred in the United Kingdom.2 Current data show an upward trend in HNC and, as the eighth most common type of cancer currently in the UK, the treatment and rehabilitation of HNC will become more common practice.3 The primary treatment modalities for HNC are surgery, radiotherapy, chemoradiotherapy, or a combination treatment.4 In cases where surgical intervention is required and the tumour resection is large, a mid-facial defect may be a consequence.4
Mid-facial defects are classified as defects that are confined to the middle third of the face in the horizontal plane and communicate with intra-oral maxillary defects.5 Inevitable consequences of mid-facial defects include functional difficulty and significant disfigurement.6 Some confusion exists over the classification of mid-facial defects owing to the presence of multiple classification systems and the amalgamation of mid-facial defects with maxillectomy defects. Furthermore, a standardized approach to apply to the reconstruction of mid-facial defects is lacking.7 However, local classifications do exist, such as the classification made by the Memorial Sloan–Kettering Cancer Center, which describes four broad types of facial defects based upon the extent of resection of the maxillary walls, palate, and orbital contents.7
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