Prosthetic Rehabilitation Following Segmental Maxillectomy Confluent with an Orbital Defect Using a Hollow Orbital Prosthesis Retained Magnetically with an Obturator: A Case Report

Abstract

Loss of a sense organ, such as an eye in situations of orbital involvement, or any other bodily part, such as the maxilla or palate, might make one more dependent on others for care and affect how they perceive themselves in society. The prosthetic rehabilitation of large mid-facial defects is a challenging task due to the varied size and shape of the defect. Confluent maxillary and orbital abnormalities are best restored with prosthetic means by creating a comfortable, aesthetically pleasing prosthesis that allows for the restoration of speech, deglutition, and mastication. The retention of any prosthesis is must for it to be successful. The hollow orbital conformer described in this case presentation aids in reducing the weight of the prosthesis, thereby enhancing the retention of the prosthesis. This clinical case presentation highlights the aesthetic and functional rehabilitation using a combined obturator-orbital prosthesis connected using intraoral magnets.

Keywords: Cast partial denture; conformer; exenteration; mucormycosis; orbital defect; segmental maxillectomy.

Figure 1

(A) Close-up view of orbital socket following exenteration. (B) Segmental maxillectomy of the left side with dressing

Figure 2

(A) Adaptation of interim obturator on the diagnostic cast. (B) Preparation of the impression site. (C) Retrieved impression for the facial moulage. (D) Facial moulage. (E) Adaptation of temporary conformer over the mould. (F) Adaptation of putty index over the conformer

Figure 3

(A) Prepared rest seats on the right molars, premolars and canine. (B) Placement of conformer in the orbital cavity while making the impression for the cast partial framework. (C) Final impression for the framework. (D) Adaptation of dough stage of heat cure acrylic resin over the walls of the dewaxed mould along with placement of the putty index for trial closure. (E) Replacement of putty index with the salt solution, (F) Finished and polished final prosthesis

Figure 4

(A) Arbitrary wax-up and positioning of prefabricated iris. (B) Iris positioning done with the help of millimetre grid attached to spectacles devoid of glasses. (C) Transfer of the distance between the glabella and centre of the iris of the unaffected eye through vernier calliper. (D) The facial mould was modified and acrylic stalk was placed over the iris. (E) Beading and boxing of the modified mould. (F) Adaptation of silicone over the mould

Figure 5

(A) Finished and polished orbital prosthesis. (B) Artificial eyebrows and eyelids were positioned on the prosthesis. (C) Adaptation of cast partial framework on the cast. (D) Final finished and polished intraoral prosthesis in situ. (E) Tripod pattern of magnets picked up using autopolymerising resin on the inferior surface of orbital prosthesis. (F) Magnets picked up using self-cure resin on the superior surface of the obturator

Figure 6

(A) Magnetic assembly of orbital-obturator prosthesis. (B) Post-rehabilitative view. (C) Prosthesis reinforced with elastic strap attached to the spectacles