Maxillofacial Prosthetics In Dental Practice
Maxillofacial Prosthetics may be defined as the art and science of dental practice which involves the functional and esthetic rehabilitation by artificial means of intraoral and paraoral structure. The structures may be missing or mutilated as a result of surgery, trauma, or congenital defects. The primary form of treatment for such patients may involve head and neck surgery, maxillofacial surgery, or reconstructive plastic surgery. Maxillofacial prosthetics is used as an adjunct to or a replacement for plastic surgery. Surgery of course is always the treatment of choice except in situations in which (1) examination of the defect area is desired for a long period of time, (2) the blood supply around the defect area has been impaired by irradiation, making repair by tube pedicles impractical, (3) the defect area is too large to be repaired with the patients own tissue, (4) the age of the patient would not warrant repeated plastic surgery procedures, (5) the patient is a surgical risk, and (6) the patient has inadequate financial resources to undergo several major surgical procedures.
For a number of years the medical profession has been perflexed by the difficulty of treating certain patients with facial deformities. Until recently these problem patients have been either totally neglected or just partially treated. But the trend is changing, because it is recognized that adequate diagnosis and treatment for this type of patient is dependent upon a team of highly qualified medical and dental specialists working together toward the common goal of treating and rehabilitating the patient.
A team effort is essential to the effective and efficient treatment of patients with maxillofacial problems. Members of such a team might include a head and neck surgeon, oral surgeon, radiation therapist, plastic surgeon, maxillofacial prosthodontist, physiatrist (Phisycal medicine), speech therapist, nurse, and social worker. Not all the team members listed are usually involved with every patient, however, none should be overlooked if his services can be utilized.
In any successful team effort it is necessary that one member of the team assume responsibility for the patient. The team member having the most involvement with the patient should assume responsibility for the management of the patient, whether it be the plastic surgeon, radiotherapist, head and neck surgeon, or oral surgeon. The prosthodontist rarely assumes responsibility for patient management. The prosthodontist should assume the responsibility for those aspects of treatment related to prosthodontics, but not for the medical and surgical management of the patient. Certainly the prosthodontist should be able to recognize tumor recurrence at the operative site.
The dentist has assumed a major role in maxillofacial prosthetics because of this knowledge of anatomy, physiology, and phatology as well as this skill and experience in using materials that are compatible with the patients remaining tissues,. However, much research needs to be accomplished before dentistry can render satisfactory treatment to all patients requiring their care in maxillofacial prosthodontics.
Source :
Arthur O. Rahn and Louis J. Boucher, 1970, Maxillofacial Prosthetics Principal and Concepts, W.B. Saunders Company, Philadelphia London Toronto.p.1-2.
