MAXILLOFACIAL PROSTHETICS

INTRODUCTION

It is the art and science of functional or cosmetic

reconstruction by means of non - living
substitutes for those regions in the maxillae,
mandible and face that are missing because of
surgical intervention, trauma, pathology,
developmental or congenital malformation.
 CLASSIFICATION OF ORAL &
MAXILLOFACIAL DEFECTS
Based on the Etiology of Defects
CONGENTIAL
Cleft lip & Palate.

ACQUIRED
Oral cancers
Benign tumours
Trauma
Gunshot wounds
 CLASSIFICATION OF ORAL &
MAXILLOFACIAL DEFECTS
Based on location of defects
EXTRA ORAL
Ocular defects
Nasal defects
Facial defects
Auricular defects
 CLASSIFICATION OF ORAL &
MAXILLOFACIAL DEFECTS
Based on location of defects
INTRAORAL
Defects of hard palate
Defects of soft palate
Defects of mandible
Defects of tongue
Restoration of cleft lip & palate
patients
 INTRODUCTION

“An opening in the hard and soft

palate due to improper union of the
maxillary process and the median
nasal process during the second
month of intrauterine life”
GPT 2005
 INTRODUCTION

• Clefts of the lip, alveolus and palate are

the most common congenital
malformations of the head and neck.

• Second most common congenital

• malformation of the entire body.
Bailey BJ et al. TEXT BOOK OF GENERAL SURGERY 3rd ed 
 INCIDENCE & PREVALANCE
IN PAKISTAN

• More than 200,000 reported cases

at present

• 1: 570 live births

• 4th country with largest population

of cleft lip and palate babies.

WHO.2008
ETIOLOGY
MULTIFACTORIAL
 GENETIC CAUSES

MORE THAN 150

SYNDROMES
ENVIRONMENTAL CAUSES OF CLEFT LIP &
PALATE

Anti-Epileptic drugs
Retinoic acid
Cigarettes & Alcohol
Diabetes
Hyperthermia
Steroids
Methotrexate
Inhibition of folate metabolism
 CLASSIFICATION

• Veau Classification – 1931

– Veau Class I: isolated soft palate cleft

– Veau Class II: isolated hard and soft palate
– Veau Class III: unilateral CLAP
– Veau Class IV: bilateral CLAP
VEAU CLASS1 : Cleft of soft palate
VEAU CLASS 2: Cleft of hard palate and soft palate
VEAU CLASS 3: Unilateral cleft lip and entire palate.
VAEAU CLASS 4:Bilateral cleft lip and alveolus

.
MORPHOLOGICAL PROBLEMS

FACIAL DISFIGUREMENT
 MORPHOLOGICAL PROBLEMS
COLLAPSE OF DENTAL ARCHES.
MORPHOLOGICAL PROBLEMS
MISSING TEETH
MORPHOLOGICAL PROBLEMS
GROWTH
RETARDATION
Functional problems in cleft lip & palate
S
Oro nasal communication P
E
E
Decreased negative pressure C
H

Nasal regurgitation P
R
Feeding time is prolonged O
B
Weight loss L
E
Excessive air intake M
S
Choking
 PSYCHOLOGICAL PROBLEMS
Lowered self esteem

Low self confidence

Decreased academic performance

Lowered IQ

SOCIAL ISOLATION
 TEAM OF CONSULTANTS
• Obstetrician and Gynecologist
• Pediatrician and Neonatologist
• Psychiatrist
• Prosthodontist
• Plastic Surgeon
• Orthodontist
• Speech therapist
• Medical social worker
MANAGEMENT CONTINUES
THROUGHOUT
LIFE.
•FEEDING •Cleft lip
•Midface
•Orthodo advancement
repair:5-6 •Alveolar
AIDS ntics bone
months grafting •Rhinoplasty
•Naso •Orthodontics
alveolar •Interim
•Cleft •orthodontic •Speech appliance
molding obturator
palate s
•Replacement of
repair:1yr
missing teeth
SURGICAL REPAIR
CLEFT LIP & PALATE INVOLVES MORE THAN A
SINGLE SURGERY
 SURGICAL REPAIR
LIP ADHESION: 2 WEEKS

CLEFT LIP REPAIR 10 WEEKS

CLEFT PALATE REPAIR: 6- 18 MONTH

ALVEOLAR BONE GRAFTING: 12 YEARS

MID FACIAL ADVANCEMENT: 18 YEARS

RHINOPLASTY: 20 YEARS.
 ROLE OF PROSTHODONTIST

A prosthodontist provides the final active

treatment for the patient with a cleft.

He must anticipate and decide upon the

prosthodontic procedures in collaboration with
the plastic surgeon and/or the orthodontist
during the period of their interventions
 Role of a Prosthodontist
PRESURGICAL PHASE POST SURGICAL PHASE
INTERIM
OBTURATOR
FEEDING PLATES
PALTAL
OBTURATOR

DENTAL
PALATAL IMPLANTS
OBTURATOR

SPEECH AID
PROSTHSIS

REPLACEMENT
OF TEETH
IMPRESSION PROCEDURE IN
INFANTS
 Patient Positioning
 FACE DOWN

 UPRIGHT

INVERTED UPSIDE DOWN

&
HORIZONTAL RAISED WHEN IMPRESSION SETS
 IMPRESSION MATERIALS
• ALGINATE

• LOW FUSING IMPRESSION COMPOUND

• SILICONE BASED HEAVY BODY( PUTTY

MATERIAL).
 IMPRESSION MATERIALS
• ALGINATE

• LOW FUSING IMPRESSION COMPOUND

• SILICONE BASED HEAVY BODY( PUTTY

MATERIAL).
 PROTOCOAL OF TAKING INFANTS
IMPRESSION.
• Neonatal intensive care unit in the presence of
surgeon.

• High volume suction.

• Not to feed the child 2 hours before

• No premadication ,or anaesthesia.

• parent should sit on adjustble stool height.

 COMPLICATIONS WHILE TAKING IMPRESSIONS.

• TEARING OF IMPRESSION MATERIAL.

• ASPHYXIATION.
• CHOKING.
• SCALDING OR BURNING.
• INCREASED RESPIRATORY DIFFICULTY.
• DEVELOPMENT OF CYNOSIS.
• LOSS OF CONSIOUSNESS.
 MANAGEMENT OF COMPLICATIONS.
MANAEUVERS TO REMOVE FOREIGN BODY.

• BACK BLOWS
• CHEST THRUSTS
• FINGER SWEEPS.
 MANAGEMENT OF COMPLICATIONS
ADJUNCTS FOR AIRWAYS COMPLICATIONS

OXYGEN DELIVERY DEVICES.

SUCTION DEVICES.

BAG VALVE SYSTENS

CRICOTHYRODOTOMY.
 Feeding Aids

 Specially designed teats with enlarged

openings

 Specially designed feeding bottles

 Orogastic and nasogastric tubes

 Feeding obturators
 Feeding obturator

“An ancillary prosthesis constructed for a child

with cleft palate to permit normal sucking and
feeding.”

GPT-2005
 PURPOSE
 Rigid platform to assist neonate suckling
 Facilitates feeding
 Reduces nasal regurgitation
 Reduces choking
 Shortens the time of feeding
 Prevents the tongue from entering the defect
 Contributes to speech development
 Reduces the incidence of nasopharyngeal infection
 Relieving the anxiety of parents
FEEDING OBTURATORS FOR
A NEONATES
CASE No. 1
CASE No.2
A young patient with repaired cleft lip with
intra oral defect
Failed tongue graft for closure of the defect
 A prosthodontic option

Impression compound Primary impression

DIAGNOSTIC CAST CUSTOM TRAY
Cast & custom tray Custom tray
Final impression Master cast
Feeding obturator

Tissue surface

Polished surface
Pre operative Post operative with an obturator
 Prosthodontic Management of
adult cleft lip & palate patient

Removable partial dentures can be given to restore the

missing teeth
 PROSTHODONTIC CONSIDERATION

OVERLAY DENTURE OR PARTIAL

OVERDENTURES
PROSTHODONTIC CONSIDERATION
SPEECH APPLIANCE
JPD 2006,92:392-6
VELOPHARANGEAL INSUFFICIENCY
VPI
PALATAL LIFT PROSTHESIS
DEFINITIVE PALATAL LIFT
PROSTGESIS