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DR.CIGU ANDOR TONI
WHAT IS A MAXILLOFACIAL PROSTHETIST
IMPT Registrar.
In the UK we are referred to as Maxillofacial Prosthetists. In other countries they also use terms such as Anaplastologist (USA and Europe) and
Epithetist (Europe).
The field of Maxillofacial Prosthetics in the UK provides a wide variety of prostheses and medical devices. A list of some of the work undertaken
includes:
Prostheses

Facial and Body prostheses

Eye prostheses and cosmetic shells
Breast and nipple prostheses
Custom made body implants
Polands syndrome, Pectus Excavatum
Titanium skull implants
Eyelid weights
Other Non Prosthetic clinical procedures

Micro-pigmentation (medical tattooing)

Skin camouflage
Custom made splinting devices
Burns splints
Keloid scar splints
Surgical planning
Jaw surgery (Osteotomy) and Facial or Craniofacial surgical planning
Cleft lip and palate
Medical Modelling
Surgical Simulation modelling
Surgical appliances to help after trauma
Custom made medical device manufacture
TMJ appliances
Tracheal oesophageal valve modifications
Sleep apnoea devices
Oral obturators (specialist dentures)
Nasal septum obturators
Intra-oral prosthetics
Maxillofacial Prosthetists are registered with theGDC and are able to provide a wide variety of custom made dental devices.
WHAT IS A PROSTHESIS? WHO MAY BENEFIT FROM ONE?

Facial prostheses usually encompass the ears, nose, cheeks and lips and the area
including the eye and eyelids. If the eye and the eyelids have been removed this is
usually called an ‘orbital prosthesis’. If the eyeball has been removed and the eyelids
are still in place the prosthesis to replace the eyeball is called an ‘indwelling’ eye or
ocular prosthesis.
Body prostheses, sometimes called Somato prostheses, usually include everything else
apart from the face. This could be the nipple, breast, the hands or fingers and also
missing skin on the legs or arm.

WHAT ARE THEY MADE FROM?

This really depends on where the site of the defect is. If it is a skin defect then it will
usually be made of a soft material called medical silicone. This is a very skin like
material that is soft to touch and can be coloured to match the surrounding skin.
Eye prostheses are made from a material called acrylic (plastic). They are hard and can
be highly polished to copy the other eye.
If the prosthesis is an implant to replace bone or muscle and skin it can be made from a
silicone (soft for muscle or skin) or a metal such as Titanium (to replace bone)
CUSTOM MADE SPLINTING DEVICES
What is a keloid splint? Who may benefit from it? A keloid is a type of scar. It is a result of an overgrowth of granulation
tissue at the site of a healed skin injury. Keloids are firm, rubbery lesions or shiny, fibrous nodules. Keloids should not be
confused with hypertrophic scars, which are raised scars that do not grow beyond the boundaries of the original wound.
A keloid splint is a device made usually in acrylic (plastic) or some other type of thermoplastic material which applies
controlled pressure on the keloid to stop it growing and help to reduce it or flatten it.

A KELOID SPLINT WHAT IS A BURNS SPLINT? WHO

MAY BENEFIT FROM IT?
A custom made burn splint is designed to provide direct pressure over the burned area to help prevent unwanted build up of
scar tissue. It also controls the affected area from unwanted skin contraction when the wound is healing. It may also provide
a physical barrier to protect the burn from any contact with the environment to avoid infection.

A burns splint
the Surgeon.
These models will also be used to make custom made surgical guides so that the surgery is carried out exactly as
planned.
This is usually carried out where patients are having procedures such as:
•Jaw surgery (Osteotomy) and facial or craniofacial surgical planning
•Oral or facial cancer removal
•Cleft lip and palate repair
•Implants placed in the jaws for teeth or for facial prostheses

                                                                                                                           

  Plan to remove a lower jaw

cancer
Plan to remove facial cancers

                                                                             
Implant placement plan for a
prosthesis
CUSTOM MADE MEDICAL DEVICES
Maxillofacial Prosthetists provide many different types of custom made
devices.
These will sometimes be for common conditions such a those to control
jaw pain (TMJ devices), devices to prevent sleep apnoea and reduce
snoring (Mandibular Advancement Devices) and devices to help after
surgery of the mouth to protect the surgical site (a cover-plate).

Specialist dentures called Obturators are made to fill holes in peoples

mouths made after the removal of cancers, surgical defects after
removal of teeth or from defects in the jaws from birth such as a cleft
palate.

This cavity can interfere with speaking, swallowing and chewing if left
open. They are usually held in place by the remaining teeth, dental
implants or as an extension to an existing denture.
INTRA-ORAL PROSTHETICS
Maxillofacial Prosthetists are registered with the GDC
(hyperlink to the GDC) and are able to provide a wide
variety of custom made dental devices including dental
prosthetics, orthodontics, crown and bridge prosthetics
and other specialist devices.
Maxillofacial prosthetists and technologists design and
construct facial and body prostheses, as well as custom-made
surgical appliances.
These may be from prescription or direct referrals from
consultants and include:
facial prostheses contour defect prostheses breast and nipple
prostheses digital prostheses keloid splints obturators trauma
and surgical splints. 

Dental technicians construct fixed and removable intra-oral

prostheses, orthodontics appliances and intra-oral splints from
prescription, which may include:
fixed and removable dentures  crowns and bridges  fixed and
removable orthodontics appliances 
intra-oral splints. 
Oral and maxillo-facial surgery (OMFS)
The team supports patients with oral and maxillo-facial problems, including restorative
dentistry. We provide clinics for our patients in the outpatients departments at the Lister and New
QEII hospitals, with any operations are carried out in the day surgery units at the Lister.
Maxillofacial laboratory – what do we do?

The maxillo-facial laboratory fabricates custom-made medical devices, appliances and prostheses
to prescription. The technologists also plan, construct and provide prostheses directly to referred
patients.
Why do we do it?
The devices, appliances and prostheses aid the treatment, rehabilitation, aesthetic appearance,
and function to patients who have congenital abnormalities, facial or body deformities, resulting
from traumatic injuries, malignancy, disease or surgery.
What do we make?

Facial and body silicone prostheses

Removable, fixed and functional orthodontic appliances
Cast, wrought, pressure formed and methyl methacrylate trauma splints
Sleep apnoea devices
Splints, wafers and planning models for orthognathic surgery
Occlusal splints and devices for treatment of TMJ disorders
Obturators for cleft palate and maxillectomy patients
Implant retained prostheses and dentures for compromised patients
Computerised orthognathic treatment planning
Prosthetic eyes
Maxillofacial laboratory
(Fig. 1) 3D CT scan Imported
into MIMICS (A),
modelling (B) and
slicingpossibilities (C) and
production of the working
template (D) in Z PRINT
Software.
(Fig. 2) Steps followed
in constructing the
titanium plate. The 3D
model produced (A&B),
defect wax up(C), stone
duplication (D), titanium
plate swaging(E) and
final titanium plate prior
to sterilization (F).