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The formation and persistence of an orocutaneous fistula as a sequela of major head and neck surgery followed by microvascular reconstructive surgery and adjuvant radiation therapy is a common and frustrating challenge to address. When reconstructive surgical options are exhausted, limited, or with high risk for failure, the fabrication of an oral appliance can provide a temporary to long-term treatment option for the patient. In this case report, an oral appliance was fabricated to decrease salivary incontinence, improve intelligibility, and deglutition in a 60-year-old patient who underwent a subtotal glossectomy with radical mandibulectomy followed by reconstruction with an osteocutaneous radial forearm free flap who developed a chronic orocutaneous fistula following completion of radiation therapy.

Midface defects can be life-changing, both functionally and psychologically, for the affected patient. Additionally, restoration of form, function, and aesthetics can be challenging for the reconstructive surgeon. For defects affecting facial subunits such as the nose and orbit, a maxillofacial prosthetic can both obturate the defect and achieve aesthetically pleasing outcomes. Osseointegrated implants placed into sound bone at the defect site allows the maxillofacial prosthodontist to optimize prosthesis retention without the need for adhesive or a mechanical device. In this article, we will share our multidisciplinary treatment protocol and outcome for addressing large midface defects using osseointegrated implant-retained maxillofacial prosthetics. Finally, we will also share our experience and challenges in the incorporation of digital technology in the prosthetic processes of the treatment plan. In the evolving digital age, rapid prototyping technologies have provided the reconstructive surgeon and maxillofacial prosthodontist the ability to accurately plan and execute predictable and reproducible results for a complex array of maxillofacial defects.