Facial Prosthetics Case 1

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A 68 years old, male patient was referred for facial rehabilitation after surgical excision of left maxilla including orbit along with its contents, zygoma & soft tissues including half of the nose, cheeks, upper lip of the ipsilateral side due to an underlying severe fungal infection mucormycosis. Decision for prosthetic rehabilitation was undertaken after ruling out surgical reconstruction owing to financial constraints.

Treatment :
Due to large midfacial defect magnet retained combined acrylic resin intraoral-extraoral prosthesis framework and an overlying silicone facial prosthesis was given. The whole assembly was then suspended with the eyeglass frame.
“The patient couldn’t believe his face could ever be restored like that without surgery. He was unable to express his happiness when people could understand his speech after giving prosthesis.”(see video)
He was given hygiene instructions for cleaning the prosthesis and was recalled every six months. During these visits, prosthesis was thoroughly cleaned with a disinfectant.

Customized Digital Iris technique:
Replacement of the lost eye as soon as possible after healing from eye removal is necessary to promote physical and psychological healing of the patient and to improve social acceptance. Artificial eyes have been in existence since the very early times. Several techniques have been used in fitting and fabricating artificial eyes.[6] Unlike glass eyes, the acrylic resin eyes are solid, lightweight, easy to fit and adjust, unbreakable, translucent, easily fabricated, had intrinsic and extrinsic coloring capabilities, and inert to the socket secretions.[7] Empirically fitting a stock eye, modifying a stock eye by making an impression of the ocular defect, and the custom eye technique are the most commonly used techniques.[6,7,8]
However custom eye technique is found to be most acceptable. As compared to stock eyes, custom made prosthetic eyes have several advantages (Table 1).

Custom made Prosthesis Stock Eye
Fabricated according to patient's socket Pre fabricated
Made of medical grade acrylic Made of low grade plastic
Good symmetry with other eye Poor symmetry with other eye
Better eye movements Limited eye movements
Modifications are possible in same prosthesis with growth of eye socket No modifications are possible in same prosthesis
Retains the size and shape of the socket Causes disfigurement of socket, as are not fabricated according to individual and are usually round or oval
Can be easily cleaned and are practically unbreakable. Require frequent polishing and is fragile
No potential stagnation spaces at the prosthesis-tissue interface Non uniform contact with tissues causing infection prone dead spaces

We are fabricating artificial eyes using Digital image of the iris of the adjacent normal eye to give better esthetics in a fraction of time and with much enhanced color stability as compared to that required for painting the iris which require lot of skill and often initial color stability of few paints is doubtful. Digital image also gives a more similar look to the lost eye. Digital photograph of the patient’s iris using a digital camera is taken. Laser print of image is taken and is attached to the ocular disk and is used for fabrication of artificial eye.

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