Use of a surgical positioner for bone-anchored facial prostheses.

The use of osseointegrated implants to retain facial prostheses in craniofacial rehabilitation is a reliable procedure. Proper location of the implants is critical for fabrication of a prosthesis with ideal shape and contour. The use of a positioner at time of surgery can guide placement of the implants to achieve an optimum result. The positioner is also useful as a guide to the shape of the retentive element and as a quick method for obtaining a wax pattern for the prosthesis. This article describes-the fabrication and applications of a positioner.

Teaching model for closure of oronasal fistula and bone grafting of the maxilla.

Secondary bone grafting of the maxilla and closure of the residual oronasal fistula at the stage of transitional dentition has become a well-accepted treatment modality. This procedure, in conjunction with orthodontic treatment, has been incorporated into the management protocol of many cleft teams around the world in an effort to further improve functional and esthetic habilitation of patients with unilateral or bilateral clefts of the lip, alveolus, and palate.

Hygiene procedures for implant-retained facial prostheses.

Implant-retained facial prostheses offer several advantages over facial prostheses that are retained with conventional skin adhesive. However, implant-retained prostheses also require additional hygiene procedures to maintain them in good condition and to keep the implants and retentive elements free of debris and the surrounding skin healthy. This article describes additional hygiene procedures to maintain the implant-retained prostheses.

Nasal conformer to restore facial contour.

Surgical removal of the nose may have devastating psychologic effects on the patient. This article describes the fabrication and use of a nasal conformer to restore facial contour until a definitive nasal prosthesis can be made.

A history of facial and ocular prosthetics.

This article traces the history of facial and ocular prosthetics. Creative individuals who have made significant contributions are highlighted and the evolution of techniques and materials is presented. In view of the significance placed upon facial beauty in today's society, it becomes incumbent upon us to recognize the ingenuity and skill of those in the past to gain appreciation for the present state of the art and to provide incentive for improving facial and ocular prosthetic restorations in the future.

The use of uniform simulated models in the reconstruction of craniopagus twins.

A unique approach to the planning of the separation and subsequent reconstruction of craniopagus twins is presented. In consultation with medical artists and prosthetists, exact models of our patients were fabricated preoperatively. Models were made of a hard acrylic to simulate bone and silicone rubber to simulate skin. In this fashion, the surgical teams were given an opportunity to preplan the bony separation of the heads, as well as to design the best possible coverage for reconstruction of the resulting defects. Physiological, mechanical, and aesthetic considerations are discussed. Two surgical delay procedures were performed without complication prior to neurosurgical separation. A broad segment of inextricably interconnected cerebellar tissue and a shared sagittal sinus could not be overcome at the time of final separation and proved to be fatal for both twins. Owing to the untimely deaths, we can only postulate that the delayed compound musculocutaneous flaps would have produced the best possible results and physiological protection for the extensive bony defects in both skulls resulting from this separation.

The role of the medical artist in maxillofacial prosthetics.

This paper describes a task analysis methodology for defining the role of medical artists as members of a maxillofacial team. On-the-job performances are identified, functionally analyzed and scaled to determine the level of complexity in relation to three dimensions: data, people, and things. Implications for professional role definition and curriculum development are discussed.