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Maxillofacial Prosthetics (MFP) : Section Four
Maxillofacial Prosthetics (MFP) : Section Four
Maxillofacial
Prosthetics
(MFP) • Introduction to Maxillofacial
Prosthodontics
Types of Maxillofacial Defects
Types of Maxillofacial Prosthesis
Materials Used in
Maxillofacial Prosthetics
Chapter 35
Introduction to
Maxillofacial Prosthodontics
Introduction
Classification of
Maxillofacial Prosthesis
Introduction to Maxillofacial
Prosthodontics
MAXILLARY DEFECTS Cleft lip and cleft palate Cleft lip occurs due to
improper fusion between the fronto-nasal and
In the following section we shall discuss about the maxillary process. If this occurs on one side it leads
types of maxillary defects, prosthetic impli-cations to a unilateral cleft. If it occurs on both sides, it leads
of their surgical management and the restoration of to a bilateral cleft. In Mohr’s syndrome, a median
these defects with modified partial or complete (midline) cleft lip is seen (Fig. 36.1).
dentures.
Patients with maxillary defects will have diffi-
culties in mastication, speech and deglutition. The
aim of a maxillofacial prosthesis should be to restore
the normal physiological function in these patients.
The fabrication of various prosthesis used in the
management of these defects are described in the
next chapter.
Figs 36.1a and b: (a) Bilateral cleft lip
Types of Maxillary Defects (b) Single median cleft lip
Maxillary defects can be broadly classified as Aetiology includes infections, drugs (pheny-toin,
follows: ethanol and barbiturates), poor diet, and hormonal
— Congenital imbalance in the first trimester and genetic factors
– Cleft lip (13 trisomy Ptau’s syndrome).
– Cleft palate Cleft lip with or without cleft plate occurs in a
— Acquired ratio of 1:1000. It is twice as common in males when
– Total maxillectomy compared to females. It can either be unilateral or
– Partial maxillectomy bilateral. Unilateral cleft lip is more common on the
In the following section, we shall discuss about left side.
the clinical considerations of common maxillary
defects in detail. Classification of Clefts
Classification based on the extent of the defect:
Congenital Maxillary Defects
Clefts can be classified into three types under this
The most common congenital maxillary defects category,
include cleft lip and cleft palate. Other defects like Class I : Cleft lip with cleft alveolus (primary
sub-mucous cleft palate, Pierre Robin syn-drome, palate) (Fig. 36.2).
hemifacial microsomia are treated using the same Class II : Cleft of hard and soft palate (secondary
basic principles followed in the management of cleft palate) (Fig. 36.3).
lip/palate cases. Class III: Combination of I and II (Fig. 36.4)
fig 36.2 fig 36.5
Fig 36.3
Fig 36.6
Fig 36.4
Fig 36.7
Veau’s Classification of Cleft Palate
Veau (1922) classified cleft palate into four
types mainly,
Class I: Cleft involving the soft palate. It can
also be a sub-mucous cleft, which appears
normal (Fig. 36.5).
Class II: A midline cleft involving the bone,
present only on the posterior part of the palate
(Fig. 36.6).
Class III: A unilateral cleft extending along the
Fig 36.8
mid-palatine suture and a suture between pre-
maxilla and palatine shelf (Fig. 36.7).
Class IV: A unilateral cleft extending along the between pre-maxilla and palatine shelf (Fig.
mid-palatine suture and both the sutures 36.8).
Anterior cleft is associated with defective development of the primary palate. It occurs due to
mesenchymal deficiency. Posterior cleft occurs due to defective development of the secondary palate
(due to improper fusion of the palatine shelves).
For young patients, a permanent prosthesis should not be provided. Instead, a well fitting interim
prosthesis should be provided. This interim prosthesis is replaced with a permanent one at around 25
years of age. A removable interim partial denture is preferred over a fixed prosthesis because it is
more aesthetic in repro-ducing gingival contour, and it also helps to cover an unaesthetic residual
alveolar cleft. The most
important concern in the restoration of these cases is establishment of aesthetics.
One should remember that most of these patients would have had complete surgical management
of the defect before they report to a prosthodontist. Patients treated with bone grafts to fill the alveolar
clefts are easy to manage compared to patients with open clefts (Fig. 36.9).
Figs 36.9a and b: (a) Alveolar cleft repaired with a bone graft (b) Open or ungrafted alveolar cleft
Posterior cleft palate cases are usually treated using speech bulbs and palatal lift prosthesis. These
maxillofacial prosthetic appliances are usually combined to the conventional prosthesis (RPD, CD,
FPD) that may be required for the patient.
Design Considerations in the Placement of Implants for a Cleft Lip, Cleft Palate Patient
Usually the permanent maxillary lateral incisor will be absent in such cases. The missing tooth (lateral
incisor) can be restored using a fixed par-tial denture, a removable partial denture, Mary-land bridge
or an implant supported single tooth replacement. Implants have the following advantages:
No abutment tooth preparation is required.
It helps to avoid excessive load on the natural teeth.
It helps to transfer the forces to the grafted bone. (This helps to reduce the resorption of
the graft).
Most acquired maxillary defects occur due to surgical resection of tumours. Benign lesions
require a smaller resection and are easy to res-tore. Whereas malignant tumours require
exten-sive resection, which are very difficult to restore.
Common tumours of this region are epidermoid carcinoma (mostly arising from the
maxillary sinus), salivary gland tumours (pleomorphic adenoma, adenoid cystic carcinoma,
mucoepi-dermoid carcinoma and adenocarcinoma), malig-nant mesenchymal tumours
(lymphosarcoma, rhabdomyosarcoma, chondrosarcoma, neuro-fibrosarcoma, angiosarcoma
and osteosarcoma) and benign mesenchymal tumours (fibroma, hemangioma,
angioleomyoma, angioblastoma, fibrolipoma and myxoma) . Tumours of dental origin can
also occur in the palate.
Other non-neoplastic lesions like midline granuloma, Wegener’s granulomatosis, Mucor-
mycosis, and aspergillosis may also require surgical resection in the course of treatment.
One other major cause for an acquired maxillary defect is trauma. Since one cannot predict
the nature and extent of the defect produced by trauma it has been discussed separately.
• Class II: It is a unilateral defect involving one • Class V: It is a bilateral posterior defect (teeth
side of the arch posterior to the canine (teeth anterior to the second premolar are present)
posterior to the canine are absent) (Fig. 36.11). (Fig. 36.14).
• Class III: It is a defect involving the centre of • Class VI: It is a bilateral anterior defect ((teeth
the palatine shelves (all the teeth are present) anterior to the second premolar are absent).
(Fig. 36.12). (Fig. 36.15).