MAXILLOFACIAL PROSTHETICS DEPARTMENTS SCHOOLS AND MEDICAL CENTERS

IN DENTAL

V. TCHALIAN, D.D.S.," D.M. AND J. B. DRANE, D.D.S."""

Indiana University University,

CUNNINGHAM,

D.D.S.,M.S.D.**
Ind., and

School of Dentistry,

Indianapolis, Texas

of Texas, Dental Branch,

Houston,

HE PROSTHETIC RESTORATION of intraoral, extraoral, and paraoral defects resulting from surgical intervention, trauma, developmental, or congenital malformation dates back in history. Artificial eyes, noses, and ears have been found in Egyptian mummies. The Chinese also made facial restorations with the use of wax and resin. These were made by physicians with the assistance of sculptors and painters.ls2 Since the early part of the 20th century and especially during and after World War I, prosthetic restorations were made in collaboration with dentists and plastic and oral surgeons. Now, almost all patients with oral or facial defects are referred to dentists for the construction of maxillofacial prostheses. The reason for this ,is that within the profession of dentistry lie the knowledge, artistic skills, materials, and techniques for the prosthetic repair of these defects. Maxillofacial prosthetics is the art and science of anatomic, functional, or cosmetic reconstruction, by means of nonliving substitutes, of those regions in the maxillae, mandible, and face that are missing or defective because of surgical intervention, trauma, developmental, or congenital malformations.+ MAXILLOFACIAL DEFECTS

There are three types of maxillofacial defects : (1) congenital, such as cleft palate, and cleft lip, (2) developmental, such as prognathism, and (3) acquired, such as postsurgical defects, pathologic defects, and traumatic defects.
MAXILLIOFACIAL PROSTHETIC DEPARTMENT IN DENTAL SCHOOLS

Many patients who are treated by the maxillofacial prosthodontist have defects which are closely connected with dentistry. Among these are : (1) cleft palate (obturator, speech appliance, superimposed denture), (2) resected maxilla (obturator), (3) resected mandible (resection appliance), and (4) facial fracture (splint).
Presented at the meeting of the American Academy of Maxlllofacial Prosthetics, City, N. J. *Director of Maxlllofacial Prosthetics Division, Department of Oral Rehabilitation. **Associate Professor and Chairman, Department of Oral Rehabilitation. ***Professor of Restorative Dentistry and Maxillofacial Prosthetics. +Bulbulian, A. H.: Personal Communication. 570 Atlantic

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Since all of these defects are in the mouth and are directly or indirectly related to the function of teeth, it is important that a course in maxillofacial prosthetics be oaered in dental schools. Some dental schools have added a special course in maxillofacial prosthetics to their curricula. In the near future, we believe all dental schools will institute such a course. The question arises : Is it possible to have a separate department of maxillofacial prosthetics, or should it be a subdepartment under prosthetics, or oral rehabilitation? If a school has the physical facilities and trained personnel, there should be a separate department of maxillofacial prosthetics. But, if the above facilities do not exist, the maxillofacial prosthodontist will fit in either the prosthetics or the oral rehabilitation department since his work is closely related to theirs.
MAXILLOFACIAL PROSTHETIC DEPARTMENT IN MEDICAL CENTERS

Maxillofacial prosthetics has an important role in restoring oral and paraoral congenital, developmental, postsurgical, pathologic, and traumatic defects. This brings the dentist to hospitals and medical centers and makes him a valuable member of the hospital staff. For this reason, we find hospital routines, such as the filling out and interpretation of charts, consultations, and medical rounds as part of the maxillofacial prosthodontists training. Accordingly, residency training in maxilIofacia1 prosthetics would appear to be essential in making the maxillofacial prosthodontist an effective member of the hospital team. Under what services should the maxillofacial prosthetics department function? If the medical center has the facilities, there should be a subdepartment under the existing separate dental department. If there is no separate dental department, it could function effectively under the general surgery, tumor surgery, head and neck surgery, or maxillofacial surgery department.
OBJECTIVES OF MAXILLOFACIAL PROSTHETICS

The most important objectives of maxillofacial prosthetics include: (1) The restoration of esthetics or cosmetic appearance of the patient. The prosthetic replacement of the nose, an eye, or ear, and the restoration of facial contour with a maxillary obturator, mandibular implant or cranial prosthesis are representative examples. (2) The restoration of function. Prosthetic closure of the palate made necessary because of congenital or acquired defects for the correction of speech, deglutition, and mastication. (3) Protection of the tissues. Many prosthetic devices serve to protect tissues. For example, the radium protective shield, skin graft stent, and cranial implants. (4) Therapeutic or healing effect. Several prosthetic devices have at least as one of their functions the promotion of healing ; for example, splints, stents, and radium needle carriers. (5) Psychologic therapy. Prosthetic repair that restores esthetics and functions as well as aids in healing adds substantially to the patients morale.
PHYSICAL FACILITIES

Adequate physical facilities are essential for treating patients with maxillofacial defects.4v5 These facilities should include at least a two room maxillofacial

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TCHALIAN,

CUNNINGHAM,

AND DRANE

J. Pros. Den. May-June, 1965

Fig. 1.-A suggested laboratory Impression table, E, Shelves.

set up. A, Oxygen tank. B, Suction device. C, Work table. D,

Fig. 2 .-A suggested examining room arrangement. D, Painting table. E, Shelves. F, Hot plate. G, Light.

A, Mirror.

B, Dry heat oven. C, Chairs.

laboratory equipped as shown in Figs. 1 and 2,O also a completely equipped dental operatory and laboratory. A camera and tape recorder are essential for making preand postoperative records.
CHART FACILITIES

The charts or forms are also very important. They should serve to record vital information gained in-taking a history and making a clinical examination as well as to indicate the progress of treatment (Fig. 3). Diagrams are helpful in indicating the exact location and extent of the intra- or extraoral defect and the prosthetic repair (Figs. 4 and 5).
SUMMARY

1. Maxillofacial prosthetics is a specialized branch of dentistry. 2. The types of maxillofacial defects are listed.

MAXILLOFACIAL

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YAXILLOPACIAL

PROSTHETICS

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PatimtrNmt

ChartNo.

Telqhc

No.

Occupatim

A@-

sex

Pmnt

Ait

Ptittq

Diqnosis

Hospital

Admiaim Disdmrgc

Hapihl

Chut

No. -

Opmtim

Pathology Report

XAy

Report

I, ihe undersigned, wbmtrnd and accept the plan .of treatment as pmmtcd to me md 81 cutlined above. 1 futtk agree to the detaining of my necnury records, including photographs and/or movies for the pup01 d dii tts&~~M planning. teaching or publicatim.

signed: Fig. 3.-A suggested form for recording the patients history.

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TCHALIAN,

CUNNINGHAM,

AND DRANE

J. Pros. Den. May-June, 1965

MAXILLOFACIAL

PROSTHETICS

DEPARTMENT

Fig. 4.-A chart for diagrammatically their prosthetic repair.

recording

the extraoral,

cranial,

and facial defects and

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MAXILLOFACIAL

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DEPARTME NT

Fig. 5-A chart for diagrammatically cleft lip and/or cleft palate patients.

recording

intraoral

defects,

especially

designed

for

576 3. to other 4. 5. gested.

TCHALIAN,

CUNNINGHAM,

AND

DRANE

J. Pros. Den. May-June, 1965

Maxillofacial prosthetics as a separate department and/or its relationship departments in both dental schools and medical centers has been explained. The objectives of maxillofacial prosthetics have been listed. Minimal physical facilities including a system of records have been sug-

CONCLUSION

Maxillofacial prosthetic restorations can be best accomplished by a dentist because of his understanding of the nature of the materials that may be used, the techniques required, and his artistic skills. The treatment of patients with maxillofacial defects should be done through the cooperation of a team of medical, dental, and allied specialists. The maxillofacial prosthodontist should be a member of the hospital staff, with a knowledge of hospital routine. In order to operate efficiently and obtain the best results in a medical center, there should be either a separate maxillofacial prosthetic department or a section functioning under the department of head and neck surgery.
REFERENCES

1. Bulb&an, A. H.: Facial Prosthesis, Philadelphia, 1945, W. B. Saunders Company, p. 5. 2. Kazanjian, V. H., and Converse, J. M.: Surgical Treatment of Facial Injuries, ed. 2, Baltimore, 1959, Williams and Wilkins Company, p. 1041. 3. Bulbulian, A. H. : Facial Prosthesis, Philadelphia, 1945, W. B. Saunders Company, p. iii. 4. Bulbulian, A. H. : Facial Prosthesis, Philadelphia, 1945, W. B. Saunders Company, p. 29. 5. Tchalian, V. : Maxillofacial Prosthesis, Houston, 1960, University of Texas Press, p. 5. 6. Tchalian, V. : Maxillofacial Prosthesis, Houston, 1960, University of Texas Press, p. 6.
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