Surgical and prosthetic rehabilitation of cancerous defects of the maxilla: A prosthetic rehabilitation after partial maxillectomy

Objectives: The excision of maxillary tumors causes face mutilation, which leads to a functional and esthetic deficit. Maxillary reconstruction has four objectives: closure of the defect, function retrieval, repair of the shape and symmetry of the face, and of the eye socket if necessary. Methods: The following case illustrates the prosthetic treatment of a palatal defect after the excision of an epidermoid carcinoma. Surgical reconstruction of the defect was not possible in this case. Surgical reconstruction and prosthetic reconstruction were compared in a literature review. Results: The clinical case underlines some of the difficulties encountered during a maxillofacial prosthetic treatment. Rehabilitation after maxillectomy can be surgical or prosthetic. It is also possible to combine both treatments. The tissue loss must be treated as soon as possible, in a functional and esthetic manner, so that the patient can return to a "normal" life. Very few studies compare prosthetic and reconstructive techniques. The choice of the best technique still remains quite subjective, as evidenced by multiple and sometimes contradictory publications. There is no consensus on an "ideal" treatment indication for each anatomic situation. The decision to reconstruct the maxillary defect surgically or to conceive a prosthetic obturator depends on factors such as: the age and medical history of the patient, the size of the maxillary defect, and the experience of the surgeon. Surgical reconstruction and prosthetic rehabilitation both provide advantages and disadvantages. Conclusion: In all cases, teamwork between doctors, and the psychological and social aspects are essential. The treatment must include surveillance of the defect, and an adaptive global rehabilitation. The future reconstructions of maxillary defects seem to evolve towards an alliance of techniques: microvascular surgery, osseous distraction, implantology, and prosthetic rehabilitation by Computer-Aided Design and Computer-Aided Manufacturing (CAD-CAM). Keywords: cancer, maxilla, surgery, maxillofacial prosthesis