Facial Prosthetics

What is a facial prosthesis?

Prostheses are artificial appliances designed to restore a missing part of the body that cannot be reconstructed or repaired surgically. Maxillofacial prostheses replace anatomy inside the mouth (intra-oral), or a part of the face such as the eye, ear, nose, or cheek (known as extra-oral prostheses). These removable prostheses are usually put on and taken off daily much like a pair of dentures. Other prostheses such as cranial plates that restore a missing part of the skull may be permanently implanted into the body.
 
Where can a facial prosthesis be used?

There are many types of intra, and extra-oral facial prosthesis with each surgery and situation creating a different requirement. Prostheses including teeth and the palate are used to restore functions such eating and speech. External facial prostheses are required to simulate important facial features such as the nose, ear, or eye and lids. In addition to function, these types of prostheses are important tools for restoring social confidence after treatment for illness that results in a major facial difference.
 
Nose

Prosthetic nasal reconstruction involves replacing a whole or part of the nose after it has been removed – commonly as a result of cancer. These types of prostheses are provided when surgical reconstruction is not a possible option. A very realistic looking prosthetic nose can be made out of silicone and is sculpted and colour matched to the surrounding skin – often based on photographs of the patient prior to surgery. Nasal prostheses help humidify the nasal cavity during breathing and like a real nose protect the delicate mucosal tissue that lies below. A nasal prosthesis is removable and attached using spectacles, adhesive, or bone anchored implants. This type of prosthesis is usually provided by a maxillofacial prosthetist or anaplastologist.

Eye

A prosthetic eye known as an ‘ocular’ prosthesis or indwelling eye is provided when the eyeball has been lost. This type of prosthesis is made of a hard material called acrylic and is custom made to fit into an individuals eye socket or as a thin shell over an unseeing cloudy eye. An ocular prosthesis is coloured to match the opposing eye exactly.  A clinician that specialises in the provision and manufacture of ocular prostheses is known as an ocularist.
 
If the eye and surrounding lids and skin are missing, a larger prosthesis called an orbital prosthesis can be supplied. This type of prosthesis includes a prosthetic eye, and also the eyelids and surrounding anatomy. Although these prostheses do not move or blink, they are very realistic and often incorporate lashes and eyebrows. Most often supplied and manufactured by a maxillofacial prosthetist or anaplastologist, this type of prosthesis is attached using a variety of different methods.
  
Ears

Removal of cancer can lead to the loss of a part or whole ear. Ear prosthesis made from silicone, are secure and can be very realistic. They help to keep glasses on and also assists to capture sound by duplicating the lost anatomy of the external ear. An ear prosthesis may be provided by a maxillofacial prosthetist or anaplastologist, and are attached using adhesive or bone anchored implants.
  
Other types of facial prosthesis

Other types of facial prosthesis can include the chin, lips or cheeks or are simply made to fill a large scar divot resulting from surgery. Sometimes a facial prosthesis may be a combination of different types of external prosthesis such as the eye, nose, and cheek (known as a hemi-facial prosthesis). Occasionally a large area of loss will require both intra and extra-oral prostheses that link together to provide camouflage and support.
 
How are prostheses made and fitted?

Prostheses are custom made for each person. Making these types of prostheses involve specialised skills and are provided by a maxillofacial prosthetist, prosthodontist, anaplastologist. or ocularist. Your doctor or surgeon will refer you to the right specialist depending on the type of anatomy missing.

For most facial prostheses your prosthetist will see you to make an assessment and devise a prosthetic treatment plan. This will take into account individual needs, goals, and circumstances and includes communication and collaboration with you and your treating medical team. This appointment is also a great opportunity for your prosthetist to provide information about the prosthetic treatment pathway and answer any questions that you or your family may have.

After initial assessment the prosthesis is made over a series of appointments with you that may involve having impressions taken of the area, sculpture, fitting and colour matching. The number of appointments and length of time taken for a prosthesis to be made will depend on the area being restored and the complexity or detail required.

Prostheses are made out of biocompatible materials that mimic the tissue that has been lost. Extra-oral facial prostheses are commonly made out of medical grade silicone because of the materials durability, life-like feel and ability to be coloured realistically. Prosthetic eyes and teeth are often made with acrylic, a type of plastic that can be coloured and polished. Other intra-oral and cranial prostheses require the use of strong materials such as titanium, or PEEK to give strength and longevity.

What are the advantages and disadvantages of a facial prosthesis?

Prosthetic rehabilitation is a valuable option when further surgery is not possible. Like any procedure there are advantages and disadvantages to consider when deciding if a prosthesis right for you.

Advantages

• After major head and neck surgery a prosthesis can enable a person to go back to normal daily life.
• Offer protection and support to affected areas
• Prostheses are important tools for social and physical rehabilitation following cancer surgery.
• Can be very subtle, and in certain anatomical situations can provide a better aesthetic result than some surgical reconstructive options.
• Can be non-invasive: prostheses don’t require more surgery unless the prosthesis is implanted or attached via bone anchored implants.
• Offers protection for delicate tissues
• Helps to empower people to start living ‘The new normal’.

Disadvantages

• A prosthesis is not living tissue, it does not blink or move or have feeling like a real body part
• A prosthesis may not be a permanent attachment and usually needs to be removed daily for cleaning and hygiene
• A non-implanted prosthesis wears out over time and needs maintenance and replacing periodically in a persons lifetime
• ​Can be costly if no funding is available for the particular type of prosthesis

How is the prosthesis attached?

Most facial prostheses are removable and are attached to the body using a variety of different methods. The type of attachment is prescribed by your prosthetist in collaboration with your other medical team. Your clinician will determine the most suitable attachment type by taking into account different factors such as medical history, skin and bone characteristics, your dexterity and available home support for your prosthesis. Facial prostheses may be attached using spectacles, medical adhesive, by locking into natural support from hollows in the surrounding anatomy, or via bone anchored implants.
 
What are bone anchored implants?

Bone anchored implants are used for attaching both intra and extra-oral prostheses. This process involves titanium implants surgically placed into the bone (osseointegration). This can happen after initial surgery to remove the cancer, or at the time of initial surgery. After a healing period the prosthesis is made to interface with these implants via magnets or clips resulting in a snap-on/snap-off type of prosthesis. This type of retention requires a multidisciplinary team approach involving collaboration between surgeons, prosthetists, and supporting health care staff. 
 
How long will a prosthesis last?

The lifespan of a prosthesis varies greatly depending on prosthesis type, the material it is made from, method of attachment, how it is cared for, and finally how often the prosthesis is worn. A general time frame is 1-3 years with many lasting much longer.

Initial prosthesis provided soon after surgery may have a shorter lifespan as tissues continue to heal and settle down within the first months and up to a year after surgery. Well cared-for subsequent prosthesis will fit well and last for much longer.

How long do I have to wait after surgery or radiation?

For intra-oral obturator prosthesis you may be fitted with a temporary prosthesis at the time of surgery. For external facial prosthesis you can proceed once all swelling has subsided and full healing has occurred. This is very dependent on how your body heals and the type of procedures you may have had. Your medical team will let you know when you are ready.

What does it cost?

The cost of a prosthesis varies greatly depending on size, anatomical location, and how the prosthesis is attached. Public and private patients have different levels of cover, your clinician will discuss this with you at your initial consultation.