Rehabilitating a Complex Mid-facial Defect With an Interim, Magnet-Retained, Two-Piece Acrylic Prosthesis: A Case Report

TL;DR

This case report describes the successful use of a magnet-retained, two-piece acrylic prosthesis to rehabilitate a complex mid-facial defect in a patient with a history of cancer.

Contribution

The paper presents a novel, non-invasive, and cost-effective prosthetic solution for complex mid-facial defects with intraoral communication.

Findings

The prosthesis improved facial appearance, swallowing, and prevented nasal regurgitation and oral fluid leakage.

Magnetic retention enhanced the stability and support of the prosthesis despite fibrotic tissue and trismus.

Speech and mastication were partially affected, requiring dietary adjustments and reliance on remaining dentition.

Abstract

Mid-facial defects, which often communicate with intraoral maxillary defects, pose significant challenges for prosthetic rehabilitation. An 80-year-old male reported for orofacial rehabilitation following multiple resections for recurrent adenoid cystic carcinoma. The chief concerns include facial appearance, mastication, speech, swallowing, nasal regurgitation, and oral fluid leakage. Examination revealed a complex left-sided mid-facial defect involving the maxilla, infratemporal fossa, and lateral nasal wall, with an intraoral-external communication. Complications included fibrotic tissue healing, trismus, and mandibular deviation. Surgical reconstruction was contraindicated. An interim, magnet-retained, two-piece acrylic prosthesis was fabricated with a palatal obturator without artificial teeth for the intraoral defect and a cheek prosthesis for the external defect. The cheek prosthesis improved facial appearance, while the palatal obturator sealed the intraoral defect, enhancing swallowing and preventing nasal regurgitation and oral fluid leakage; however, mastication and speech were affected. The patient continued with a semi-solid diet and was able to masticate using the remaining dentition. The palatal obturator slightly improved speech by sealing the defect, although slurring persisted. The combined anatomical support and magnetic retention enhanced the retention, stability, and support of the prosthesis. This non-invasive and cost-effective solution was tailored to meet the patient’s specific needs and limitations.

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