19 Facial Prosthesis

The use of facial prostheses such as wax ears has been reported in ancient Egypt. The first historically documented evidence comes from sixteenth century, when the French surgeon Ambroise Paré describes the first nose prostheses from gold, silver and “papier mâché”, which were held to the face by a string tied around the head. In late 19th century Claude Martin conceived an idea of an immediate prosthesis using tissue excised from the maxilla and mandible as a template for fabricating complex appliances. In 20th century, while the quality of lifelike craniofacial prostheses was considerably improved with introducing of silicone materials, the problem of their retention, which is important for aesthetics, function, and comfort, was not entirely solved. With increasing aesthetic requirements conventional fixation tools such as skin adhesives, skin pockets, skin loops, and glasses became unsuitable. It was Brånemark, who first placed a modified extraoral implant for a boneanchored hearing aid in 1977 and for a bone-anchored auricular prosthesis in 1979. These events changed concepts of prosthetic maxillofacial reconstruction. Since then, osseointegrated extraoral implants are widely used for retention of orbital, ear, and nose prostheses. Their usage diminishes adhesive related problems like discoloration and deterioration of the prosthetic material. The skin and mucosal surfaces are less subject to mechanical and chemical irritation from intrinsic mechanical retention, adhesives, or adhesive solvents. Maintenance of fine feathered margins and simple positioning of an implant-retained craniofacial prosthesis greatly increased their aesthetic qualities. Lot of scientific and clinical studies confirm the success of their practical application and improvement of patient’s quality of life. Acquired facial defects, especially after radical surgical operations very often result in huge functional, cosmetic and psychological handicap in patients. A complex rehabilitation is necessary to be carried out by maxillofacial surgeons and prosthodontists. Plastic surgical reconstruction of these defects is frequently limited due to unfavorable conditions, such as vascular compromise of the surgical bed due to radiotherapy, insufficient residual soft and hard tissues. In such cases, rehabilitation of patients with large maxillofacial defects is done using craniofacial prostheses, which can offer an acceptable aesthetic solution. Facial prostheses are constructed by maxillofacial surgeon, implantologists, prosthodonticts and technician, as an alternative treatment when facial defects cannot be surgically fulfilled. Facial prosthesis using dental implants and ball attachments, bars or magnetic abutments