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Dental Tribune U.S. Edition

DENTAL TRIBUNE | February 2011 Clinical 7A originally practiced dentistry in Bucharest, the largest city and capi- tal of Romania. Shortly after he was discharged from the IDF, he re-estab- lished a dental office and resumed his career as a dentist. Unfortunately, the basal cell car- cinoma turned out to be a “rodent ulcer” type, a persistent basal cell carcinoma condition. As a result, the affected site increased in size fol- Craniofacial reconstruction has been recorded throughout recorded history. Human beings have found the need to reconstruct missing or defec- tive maxillofacial parts — such as eyes, ears, noses, maxilla, mandible and teeth — with artificial substitutes. These maxillofacial deformities may be due to congenital defects such as cleft palates, acquired disfigure- ments of the face from accidents, war trauma, cancer or other diseases. Evidence of the making of such pros- theses has been found in archeologi- cal digs dating back to the Egyptian Dynasty (pre-2500 B.C.).1 Maxillofacial defects can cause not only functional difficulties, but also some serious psychological struggles that could cause the individual to avoid social contact all together. In view of the significance placed upon facial appearance, especially in today’s society, accolades should be given to those creative profession- als involved in the development and improvement of various facial and ocular prosthetic restorations, materi- als and treatment modalities.2–5 There are several synthetic poly- meric materials, such as rubber, sili- cone or acrylic, that are currently used for facial prostheses. These require color and texture blending and matching with that of the patient to achieve a realistic and seamless appearance. Long-term success of these facial prostheses depends mainly on their material stability, strength and facial retention. For many years, retention of the synthetic polymeric craniofacial prosthetic restoration was obtained by inferior mechanical factors, such as tissue undercuts or skin adhesives. The retentive abilities were some- what proven to be unpredictable, with the potential of prompting some very delicate psychological circumstanc- es.3–5 It was only after the introduction of extraoral osseointegrated implants, with retention bars, clips, magnets and other attachment mechanisms for anchoring the prostheses, that the area of maxillofacial reconstruction gained the needed support, securi- ty and the anchorage that patients required for confidence in the treat- ment of their complex reconstructive prostheses.2,6,7 One exception to this was patients who have received radiation therapy. Those should be selected cautiously because overall success rates in this category were found to be low.8 Case report In 1950, Dr. V. Eskenazi, the subject of this case report — a general dentist who served his mandatory term in the Israeli Defense Force (IDF) — sus- tained a shattering facial injury. In addition, the location of the inju- ry involved a facial birthmark that was compounded by basal cell carci- noma. As a result, for the following 10 years, he ended up having numerous surgical and radiation procedures. Interestingly enough, Eskenazi AD lowing each surgical excision. Ulti- mately, about 10 years after his injury, his right eye and surrounding socket were removed as well. His medical records defined this procedure as an “orbital exentera- tion and radical maxillary resection.” The defect encompassed the right orbit, midface and right maxilla. It By Dov M. Almog, DMD, Stephen F. Bergen, DDS, and Giselle Yap, DMD Maxillofacial prosthesis: it can happen to anyone g DT page 8A