Midfacial Defects

M. M., Watts, D.C., and Vallittu, P.K. (2008) A fiber-reinforced composite prosthesis restoring a lateral midfacial defect a clinical report. J. Prosthet. 

Some cancer surgery may cause facial defects integrated with an intraoral maxillary defect. Such defects are named midfacial defects, which occur in the horizontal plane of the middle third of the face and include two main categories midline and lateral. Midline defects refer to the complete or partial involvement of the nose, and/or upper lip, along with intraoral maxillary defects [7,8]. A lateral defect may include complete or partial contents of the cheek and or orbit, and may embrace an intraoral defect of the maxilla [9, 10]. Midfacial defects usually require a facial prosthesis to restore function and appearance, and also, an intraoral prosthesis such as an obturator to restore speech... 

Toljanic et al. [32] reported the survival rates of the facial implants in a retrospective study. Implant failure rate in the orbital region was found to be 23% after 5 years and 42% after 10 years. Charpiot et al. [30] found the ossointegra-tion rate of 142 implants used for 51 facial prostheses was 95.7%. Leonard et al. [19] reported that implant failure was observed for 2 of the 3 implants placed to support a nasal epithesis in a patient with hepatitis C virus who also had serious periodontal disease and had experienced a post-infective necrosis of the nose after a liver transplantation. An implant failure was also observed in a diabetic patient with an extensive midfacial defect due to a mycotic infection, but it did not compromise the retention of the prosthesis. 

Skin adhesives are used for this purpose. Hatamleh et al. [21] reported that adhesives commonly retained orbital (48%) and nasal (45%) prostheses. Contrarily, they are not advised for large defects, especially for intraoral integrated midfacials [10]. 

Surgical retention is provided by surgically created retention elements such as skin-penetrating osseointegrated implants [1] (Figure 21.1). Numerous studies were found in the literature about facial implants [3, 4, 14, 15, 19, 20, 27-32]. Burn defects may also be rehabilitated with the facial prostheses anchored with osseointegrated implants [2]. Leonard et al. [19] reported 111 implants that have been positioned to retain 35 facial prostheses. They were placed to support 21 auricular (bilateral in 2 cases), 4 orbital, 8 nasal, and 2 complex midfacial prostheses. Charpiot et al. [30] reported 142 implants that have been placed for 51 facial prostheses. Hatamleh et al. [21] performed a questionnaire study to observe the preferences of maxillofacial prosthetists and technologists (MPTs) and showed that implant-retained bars are commonly preferred to retain auricular prostheses (70%). Karakoca et al. [20] evaluated 32 auricular, 25 orbital, and 13 nasal prostheses supported with implants. 

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