Maxillofacial defects and trauma is one of the most commonly observed occurrence in dental practice generally as the facial skeleton and soft tissues of the orofacial region are very prone to fractures, tissue damages, facial disfigurement due to neoplasm, bullet wounds, lacerations, perforations in the orofacial complex and so on.
Due to these reasons the facial skeleton and soft tissues require some sort of prosthetic manoeuvre and artificially made gadgets that could amend the disrupted and dismembered orofacial structures in case the use of surgery is contraindicated or it cannot satisfy the needed requirements for better treatment and prognosis overtime or might even compound the trauma.
The main objective of using maxillofacial prostheses such as obturators, head and chin cup in orthodontics, acrylic made cover of perforated palate and so on is to restore the anatomical structure and effective function of the orofacial tissues which have been affected by trauma, disease or any other reason.
At times, an option can be given to a patient of low socioeconomic status to use an maxillofacial obturator temporarily prior to having the bouyancy for surgical reconstruction, if surgical intervention is contraindicated and will not complicate the case on ground at the surgery theatre.
Sometimes the use of obturators can be the choice of a patient, irrespective of whether surgery is contraindicated or not and it would be at the discretion of the dental officer to assess the case based on what will be best for the patient.
On the other hand, the use of obturators can make a patient to have some sort social rejection and unwillingness to mixed together with the society due to use of a prosthetic obturator. In such cases a consistent counselling would be required to be given to such patients to avoid being depressed and even to avoid suicide attempts and so on.
It would be great to know that the orofacial traumas are not only affecting the extra-oral structures of orofacial region, it also affects the intraoral and which dictate the need for obturators depending on the available case as a layman could believe orofacial traumas is only limited to external extra-oral tissues.
Some of the disabilities brought upon by orofacial structures trauma include the following defects listed below;
i- Speech impairments:
This includes nasofacial structures disruption and difficulty in understanding the speech of the patient.
ii- Swallowing difficulty and discomfort:
Nasal regurgitation and abnormal reabsorption of fluids and difficult swallowing of solid foods.
iii- Esthetic impairment and disfigurement:
Esthetic is greatly affected depending on the size of the trauma which can be of great concerns for some patients.
iv- Diplopia, cerebrospinal fluid rhinorrhea, palatal ecchymosis, chemosis and facial edema can all be spotted due to orofacial traumas.
v- Psychological trauma and social stigma:
Orofacial defects could deprive a patient from social interaction and involvement.
The two approaches that are mostly used in clinical settings to amend the dismembered orofacial complex are surgical reconstruction or prosthetic reconstruction.
1- Surgical Reconstruction
Surgical intervention is best form of treatment of orofacial traumas since it involves no use of artificially made appliances although it might be contraindicated at times due to some of the following reasons;
a- If the defect would have future complications for the patient such as compromising the airways, esthetic compromise, anatomic imbalance and so.
That's all as regards the post. More on this topic would discuss in details in other subsequent posts and write-ups. Thanks for the usual support and attention for the post.
Happy Blogging and Reading
Video from Dr Teeth YouTuber