Functional anatomical reconstruction in an oculofacial prosthesis.

Abstract

The exenterated, maxillectomy, and/or palatectomy patient is ideally referred prior to surgery for two primary reasons: (1) to reassure the patient of an attempt to restore appearance and function to nearly the same as before ablative surgery, and (2) to make an entire face alginate impression for post surgical replication. The sixth week postoperatively, a second full-face alginate impression is made of existing wound and remaining anatomy. Photographs are taken for comparative sculpting. The prosthesis is designed to redirect airflow to a normal pattern in order to avoid "blow out" of the prosthesis from a sneeze or cough. Bone-like acrylic sinus replication provides normal speech resonance, a bonding surface for Silastic "skin" and a hollow socket for an impression-fitted prosthetic eye. The prosthetic eye, intrinsic pigmentation and extrinsic pigmentation, eye lashes and brows are incorporated into completed prosthesis. A combination of aesthetic and functional elements into a single three- or four-piece prosthesis provides restoration of natural appearance, improved functions of facial anatomy, and improved breathing, sinus drainage, speech articulation and resonance.