Sequential custom facial prostheses developed through analog and digital workflows: A 5-year clinical report

Acquired facial defects can profoundly impair function, appearance, and psychosocial well-being. During the early phases of reconstruction, rapid tissue changes often limit definitive prosthetic rehabilitation, creating a therapeutic gap in patient care. This clinical report describes the sequential development of custom facial prostheses over a 5-year period for a 35-year-old man who developed a severe midfacial defect secondary to idiopathic purpura fulminans. Initial treatment focused on edema control, protection of healing tissues, and support of speech therapy through a custom compression mask, commissure splints, and intraoral prosthetic support. As the patient underwent multiple reconstructive procedures, repeated stereophotogrammetric acquisitions, digital superimposition, additive manufacturing, and analog sculpting techniques were used to fabricate successive prostheses that accommodated continual anatomical changes. Progressive incorporation of patient-specific digital data, including preinjury photographs and video-derived facial reconstructions, facilitated the development of increasingly realistic facial contours. The prostheses evolved from purely therapeutic devices into patient-centered restorations that addressed functional requirements (especially by promoting lymphatic draining and protecting the healing tissue from the external environment), surgical planning, and esthetic concerns. This clinical report demonstrates how iterative facial compression prostheses fabricated through combined digital and analog workflows can provide continuous functional and psychosocial support during prolonged multidisciplinary reconstruction. The described approach may offer a practical framework for rehabilitation of patients with complex facial defects undergoing staged surgical treatment.