Dental Tribune U.S. Edition

Clinical DENTAL TRIBUNE | February 20118A Galveston, Texas, where a special maxillofacial prosthesis was fabri- cated. Composed of a silicone rubber, a facemask with one glass eye, eye- brow, cheek and nose was designed for him by a medical sculptor. This was in addition to a maxillary obtura- tor prosthesis restoring the roof of his mouth. Once the maxillofacial prosthesis was shaped, hand painted and dyed to visually match his face shape and skin color, it was given to him and he returned to Israel. Shortly after, despite his somewhat unusual looking face and slurred speech, he regained his strength and returned to the prac- tice dentistry. Although his silicone maxillofacial prosthesis was custom made, it had limited retention. As mentioned ear- lier, back in the ’70s the success of the majority of these large facial prosthe- ses depended on retention primarily derived from mechanical undercuts and medical grade skin adhesives. Due to the size, extent and weight of his prosthesis, these forms of reten- tion were insufficient. After wearing the extraoral pros- thesis for some time, Eskenazi finally refused to wear the prosthesis. Appar- ently, one day while working in his dental office, due to the combination of the weight, size and high tempera- ture, the prosthesis dislodged. Sur- prised and horrified at the sight, his patient jumped out of the dental chair while pointing at his face. As a result, from that time forward and most likely due to insecurity, Eskenazi no longer wore his maxil- lofacial prosthesis. Instead, he care- fully packed the defect in his face with gauze pads and then covered it externally with a large piece of gauze, a ritual, he repeated each morning AD Fig. 1: a) Following radical head and facial surgeries in 1975 and 1977, Dr. Eskenazi ended up with a large gaping defect in his face. His tongue and throat could be seen through the defect. b) To his satis- faction, the surgeons left a sliver of his upper right side of his lip and mustache, concealing somewhat the bottom section of the defect below the gauze. (Photos/Provided by Dr. Almog) was closed with a skin graft, taken primarily from his thighs and shoul- ders regions. Each surgical procedure also left permanent scars at the donor sites. In 1975, he was diagnosed again with clinical evidence of recurrence of basal cell carcinoma in the deep portion of the facial defect. According to his medical records, this recur- rence infiltrated his sinuses near the margins of the existing skin grafts. At this point, the Organization of Disabled IDF Veterans decided to seek international expertise, and sent him to the head and neck service at Memorial Sloan-Kettering Cancer Center in New York City. In July 1975, Eskenazi was oper- ated on at Memorial Sloan-Kettering. According to his medical records, the disease was indeed evident bilater- ally in the posterior sphenoid sinuses. While most of the diseased tissue was removed, there were no satisfactory margins that were completely clean of the disease. Surgeons further extended the resection to include the midface and the entire maxilla. The surgical site extended from above his right eye- brow onto his forehead, crossed the midline and included a large segment of the nose and a total maxillectomy, thus significantly increasing the size of the defect (Fig. 1a). Craniofacial prosthesis incident Before returning to Israel, Eskenazi was referred to the Burn Institute in a b f DT page 7A