Facial reconstruction following radical surgery

The patient case history so far: This patient had advanced cancer of the face/sinus, for which he received life-saving surgery with loss of his left eye, cheek, and jawbone and much of his skull. He could not have a surgical reconstruction due to his medical history, as well as the extraordinary size of the defect, the radical radiotherapy, and the chemotherapy treatment he received, all limiting his capacity to heal. For 4 years, the patient has endured life with a gauze dressing covering a defect extending from the forehead down the left side of the face and through into the mouth. Plastic surgery was not an option. Our approach was therefore to work with a silicone facial prosthesis and an oral prosthesis. Because of the considerable size and bulk, these prostheses needed to be anchored by implants – which is tricky as much of the bone has been removed from this side of the face. We used 3D imaging and printing technologies to plan the novel treatment used in this case. Implants had been placed into the rim of the eye socket (orbital implants) at the time of tumor resection, and three zygomatic implants were placed in an unusual configuration, extending across from the remaining right cheekbone, through the remaining right part of the jaw, to the missing left side, for anchorage of the facial prosthesis. The implants retain a framework which extends through the face to provide retention for an oral prosthesis, to seal the defect, and a silicon prosthesis which provides a much-improved appearance. The next steps will include a prosthesis for the lower jaw, to restore an occlusion, and to upgrade the prostheses.