Rehabilitation using combined oral and maxillofacial prostheses: a case report

This case report describes maxillofacial and palatal obturator rehabilitation after resection of head and neck cancer. A 71-year-old man sought prosthetic restoration of an extensive surgical defect that involved the right orbital floor, maxilla, and palate. The treatment plan involved fabrication of maxillofacial and palatal obturator prostheses that would be connected by magnets as well as a conventional total mandibular prosthesis. Intraoral and extraoral impressions were made with irreversible hydrocolloid, and stone casts were prepared. Test bases and wax rollers were made on the arch casts, which were adjusted and mounted on an articulator. Artificial teeth were selected and mounted on the test bases. After clinical and functional testing of the waxed-up prostheses and selection of the resin colors, the prostheses were processed in heat-activated acrylic resin. Waxing was performed on the maxillofacial cast, and the wax pattern was tested on the patient's face. To determine the location of the magnets, zinc oxide paste was applied to the inner surface of the wax pattern, and both the obturator prosthesis and wax pattern were positioned on the patient. A hole was opened in the bulb of the obturator at the location demarcated by the paste when the surfaces of the extraoral and intraoral prostheses made contact. A magnet was bonded inside the hole with chemically activated acrylic resin. An acrylic capsule was fabricated to house another magnet and positioned at the corresponding location on the inner surface of the wax pattern. The wax pattern was placed in a muffle furnace to generate a mold for compression of intrinsically pigmented silicone, which had been selected to match the patient's skin color. After polymerization, the prosthesis underwent finishing and extrinsic pigmentation to better the capture the nuances of the patient's skin tone. A pair of eyeglasses was bonded to the maxillofacial prosthesis to increase stability. The combined prostheses restored esthetics and function to the patient, fostering his social reintegration.