Prosthetic rehabilitation of a hemifacial defect using hybrid digital-conventional workflow

The choice of appropriate treatment aids holds paramount significance in achieving optimum treatment outcomes. Rehabilitation of large craniofacial defects following conventional workflow is challenging and is influenced by the required material properties, operator's expertise and anatomical complexity. A woman in her early 30s was referred for the prosthetic rehabilitation of an extensive facial defect following traumatic avulsion from a fodder-cutting machine. The defect involved the frontal bone, orbit, cheek and upper lip on the right side, including complete nose. Analogue impressions were unsuccessful in recording the tissue bed accurately and in a resting state.A predominantly digital workflow was employed for prosthesis fabrication. Facial scanning using structured light technology obtained a precise and detailed three-dimensional (3D) model of the entire face including the defect. A computer-aided design software programme was used to duplicate and mirror the normal side of the face on the defect side. A hollow shim and three-part mould were digitally designed and 3D printed. The final prosthesis was processed conventionally using silicone and characterised with extrinsic staining. Eyebrows and eyelashes were sewn in the prosthesis using patient's hair. A combination of medical-grade adhesive and a customised hair wig was employed to achieve both aesthetic integration and functional stability.At 6 months, the prosthesis showed a stable fit and colour, with notable progress in the patient's confidence and social reintegration. The outcome achieved makes a strong case for integrating digital workflow not only for the rehabilitation of extensive facial defects but also in routine clinical practice.