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To report the results of a 2020 international survey of the most commonly used materials and techniques for the fabrication of extraoral maxillofacial prosthetics and to assess the use of 3D technology.A 43-question survey was administered via Qualtrics to the members of the American Academy of Maxillofacial Prosthetics, the International Anaplastology Association, and the International Society of Maxillofacial Rehabilitation. The use of current 3D technology in the fabrication of maxillofacial prostheses, as well as barriers to care such as patient cost and insurance coverage, were also assessed.A total of 134 respondents (13%) completed the survey; 96 (73%) reported that they were currently fabricating maxillofacial prostheses and were thus included in the survey. The majority of respondents reported currently using Silastic MDX4-4210 BioMedical Grade Elastomer (DuPont) with either Silastic Medical Adhesive Silicone Type A or Silastic MDX4-4210 crosslinker. Incorporating the use of current CAD/CAM technology was reported by a majority of respondents (58%; 45/77); however, a small cohort (33%, 15/45) reported they were "still experimenting how best to use technology." A total of 39 clinicians (49%) reported that facial prosthetics were most often paid for by the patient (fee for service), with the fee ranging from $10 to $5,500 USD.The results of this survey indicate that current CAD/CAM technology has been adopted and incorporated into the design and fabrication of maxillofacial prostheses. More research is needed to advance CAD/CAM technology as well as the physical and mechanical properties of materials in maxillofacial prosthetics and anaplastology clinical practice.

The rehabilitation of a patient with a total glossectomy with a prosthetic device is challenging and depends on the individual patient. Ablation of a tongue tumor leaves defects that can be either surgically reconstructed or replaced by a prosthesis to help recreate normalcy and balance in the oral cavity. This clinical report describes a prosthetic design to rehabilitate a patient after a total glossectomy. This approach successfully recreated the glossal surface with a soft, hollow, depressible structure that emulates the tongue during speech and a solid structure to facilitate swallowing. The components were joined by magnets.

This report describes the treatment of a 68-year-old man with basosquamous cell carcinoma of the left auricular area. His oncologic treatment resulted in the loss of his left ear and much of the left temporal bone. The loss of a significant portion of the temporal bone precluded the use of extraoral implants. Owing to the lack of anatomic landmarks after his surgical treatment, positioning his auricular prosthesis proved challenging. The fabrication of his prosthesis and a custom positioning aid are described.

Background Skin cancers requiring nasal resection may be surgically reconstructed and/or prosthetically reconstructed. Singular surgical reconstruction may be ideal for smaller defects in which the nasal bone and cartilaginous portions of the nose are maintained, but surgical reconstruction falls short of providing acceptable aesthetic results for more extensive nasal defects. Prosthetic rehabilitation, or a combination of surgical and prosthetic rehabilitation, is more appropriate for larger defects, but prosthesis retention can be challenging when adhesives are required on adjacent mobile and secreting skin. Methods We report 2 cases of patients with extensive nasal defects who were successfully rehabilitated with nasal prostheses. The nasal defects were surgically optimized with immediate preparation of the surgical margins, placement of a split-thickness skin graft (STSG) within the nasal cavities and exposed maxillary sinuses, and immediate placement of osseointegrated implants. Results Excellent prosthetic retention can be achieved without the need for adhesives. A skin graft-lined defect has minimal secretions and allows for improved defect cleansing. Conclusion The success of a nasal prosthesis depends on appropriate surgical management of the defect, and, thus, collaboration between the various surgical and prosthetic teams is essential. © 2016 Wiley Periodicals, Inc. Head Neck, 2016

The complete or partial loss of an ear can have a negative impact on self-esteem, and physical disfigurement can impair social integration. An auricular prosthesis can replace the absent or partially absent ear resulting from tumor ablation, infection, congenital defect, or trauma. This chapter briefly describes considerations in fabricating an auricular prosthesis as well as case presentations to support the benefit of a prosthetic ear compared to soft tissue reconstruction.

Obtaining the correct orientation of the stone cast in the fabrication of a nasal prosthesis is a challenging task. The current technique involves repeated trials of the waxed nasal prosthesis on the patient's face to establish its correct position. This article proposes a simplified technique to aid in establishing the proper orientation of the stone cast in an effort to decrease the number of error corrections related to midline discrepancies during the wax sculpting stage.

Purpose: The purpose of this survey was to review the extraoral maxillofacial materials currently used as well as the advantages and disadvantages of the materials in the fabrication of facial prostheses. Results of this survey will enhance scientific knowledge, generate research study ideas, and possibly lead to production of alternative or new maxillofacial materials. Material and Methods: A 47-question survey was delivered via e-mail to all members (combined total of 260 members) of the American Anaplastology Association (AAA) and American Academy of Maxillofacial Prosthetics (AAMP) for evaluation of personal preference involving maxillofacial prosthetic materials (intrinsic/extrinsic silicone elastomers and pigments/colorants used, polymerization/curing process, advantages and disadvantages of the most often used materials, most important characteristic of material/technique used). Results: The views of 43 (16%) respondents indicated that the majority surveyed were using room temperature-vulcanized (RTV) silicone products. Silicone pigments for intrinsic and silicone pastes for extrinsic coloring were favored over artist's oil colors and dry earth pigments. The polymerization process and/or curing times and temperatures for the same silicone material varied between users. The top five advantages of most often used materials were good esthetics, ease of coloring, easy manipulation, thin margins possible, and adhesive compatibility. The top five disadvantages were discoloration over time, technique-sensitivity, lack of repairability, extrinsic colors peel/fade, and lack of longevity. Nontoxic/nonallergenic materials with high edge strength and color stability were the most important features when choosing a maxillofacial prosthetic material/technique. Conclusions: The responses to this survey indicate that the majority of AAA and AAMP members are using or have used a variety of RTV silicones, pigments, and colorants in the quest to provide the best possible facial prosthetic service. Further research is needed to further refine and improve extraoral maxillofacial materials/techniques based on the results of this study.

Few published reports have addressed the issues related to upper lip reconstruction. The present clinical report describes the maxillofacial rehabilitation of an edentulous patient who had been diagnosed with squamous cell carcinoma of the nasal septum and contiguous structures. The patient underwent total rhinectomy, anterior maxillectomy, and maxillary lip resection. Her maxillary lip was reconstructed with a bilateral cheek advancement flap, which allowed primary closure of the lip and aided in maintaining function of the orbicularis oris muscle. Microstomia was anticipated and was a consequence of this procedure. During primary resection, and before chemoradiotherapy, dental implants were successfully placed in the maxilla. These implants helped to retain a maxillary obturator prosthesis, which, in turn, helped to retain a silicone nasal prosthesis that restored the nasal defect. An intranasal acrylic resin framework with magnets aided in connecting the extraoral prosthesis with the intraoral prosthesis. The surgical and prosthodontic advantages of a cheek advancement flap and the treatment challenges in a microstomic patient are discussed.

A retrospective clinical follow-up was done of 14 children with cerebral palsy between 14-59 months after selective posterior rhizotomy (SPR). Three children had regressed and two had made minimal, seven moderate, and two good progress in functional mobility skills. Hypesthesia, paresthesia, and muscle spasms were present in more then 50% of the cases. Four children had bladder problems and three had developed orthopedic complications. Clinical outcomes are discussed in relation to conflicting viewpoints on the rationale for SPR and functionally relevant methods are proposed for prospective assessment of children with cerebral palsy before and after SPR.

Several ocular and orbital disorders require surgical intervention that may result in ocular defects. The associated psychological effect of these defects on the patient requires immediate management and rehabilitation intervention by a team of specialists. The role of the maxillofacial prosthodontist in fabricating an ocular prosthesis with acceptable esthetics to restore facial symmetry and normal appearance for the anophthalmic patient becomes essential. This article presents a technique for fabricating ocular prostheses using the advantages of digital photography.

Physical therapists employed in public schools may be responsible for the evaluation and treatment of not only physically handicapped children, but also children who have moderate to severe motor disabilities secondary to mental retardation. The purpose of this article is to suggest appropriate assessment and treatment techniques for these children. General principles of intervention based on neurophysiologic treatment approaches, particularly sensory integration, are described. Examples of specific assessment and treatment strategies are given for visual, auditory, tactile, olfactory-gustatory, proprioceptive-kinesthetic, and vestibular functions. In addition, self-stimulatory behaviors, tests of motor and reflex development, problems in muscle tone and strength, and variations in gait patterns are discussed.

The purpose of this study was to examine the effect of arousal on the nystagmus response of normal children to vestibular stimulation. Arousal level was manipulated by verbal instruction in 12 subjects (six boys and six girls) during a standard set of sinusoidal angular acceleration stimulation. Electronystagemographic data reflecting the nystagmus response differed significantly during “aroused” and “relaxed” conditions. Implications for the use of nystagmus as a measure of vestibular responsively are discussed.

Three groups of trainable mentally retarded children participated in three different motor programs for an eight-month period. Children receiving sensory integrative therapy showed the greatest gains on test batteries for reflex integration and gross and fine motor skills. Children in a developmental physical education program demonstrated greater improvement on the same test batteries than a third group of children who participated in a recreational, adaptive physical education program and an "arts and crafts" oriented therapy program. Results of data analysis indicate that neuromotor development may be enhanced more effectively by activities which facilitate improved postural responses rather than by practice of specific motor skills.

In order to formulate a hypothesis regarding the etiology of toe walking, the sensory processing abilities of 17 mentally retarded children who toe walk were examined. A galvanic skin response was used to compare reactions of the mentally retarded children and a group of normal children to a variety of sensory stimuli. Galvanic skin response testing did not reveal significant differences between the two groups in processing sensory input. Scores of the mentally retarded children from a postrotary nystagmus test were compared to values for normal children of the same age, and the results indicated that vestibular dysfunction was present in all of the subjects. We hypothesize that children may toe walk to increase somatosensory input to the lateral vestibular nucleus (Deiter's) and the lateral vestibulospinal tract to facilitate support tone in the lower extremities during walking.

The purpose of this study was to determine the effect of state on nystagmus duration following administration of the Southern California Postrotary Nystagmus Test (SCPNT). Twenty-four normal children, 12 first-graders and 12 fourth-graders, were administered the SCPNT under three conditions: aroused, relaxed, and alert (standard instructions). Six boys and six girls in each grade participated. First-grade boys and fourth-grade girls demonstrated a statistically significant response decline in the aroused condition, and a further decline in the relaxed condition as compared to the alert condition. Further analyses demonstrated that the first-grade boys accounted for most of the variance. Possible reasons for the results obtained are discussed, and suggestions are made for future research.

The purposes of this article are 1) to compare the similarities and differences between norm-referenced and criterion-referenced tests and 2) to summarize how each should be used in the assessment of developmental performance in children. Specific developmental assessments, the populations they address, and the information they provide are described briefly. The need for additional criterion-referenced tests in physical therapy is discussed, and an example of how task analysis can be applied to movement or motor skills in the development of a criterion-referenced test is provided. Physical therapists can enhance the credibility of their assessments by appropriate use of norm-referenced and criterion-referenced tests.

The effect of sensory input on the performance of a geographical orientation task of children at two different ages (kindergartners and fourth graders) and adults was determined. I investigated the ability of subjects to point accurately to the starting position after experiencing identical routes under three sensory conditions. In Condition 1, subjects were led walking through routes and could see the walls and ceiling of the test room (visual, somatosensory, and vestibular information). In Condition 2, subjects were led walking with vision occluded (somatosensory and vestibular information). In Condition 3, subjects were pushed in a wheelchair with vision occluded (primarily vestibular information). As more sensory information was available, subjects maintained their orientation better to their starting position, and accuracy improved with age. This quantitative analysis of geographical orientation may be appropriate for future clinical studies of neurologically impaired adults and children.

Proper positioning of children with neuromotor handicaps is important to achieve maximum function and to minimize abnormal movements. Positioning devices are also necessary, in some instances, to prevent undesirable postures that may lead to secondary deformities. Physical therapists are often responsible for evaluating the positioning needs of infants and young children and for providing families with suggestions regarding specialized adaptive devices. In our experience, a commercially available seating insert has met the need of many handicapped infants and young children for proper upright positioning in a highchair, stroller, or similar furniture designed for sitting. The seating insert is called a Baby Safe Sit* and was designed for use with healthy infants from 3 months to 2 years of age. It consists of a seat back and bottom with tie down cords for each leg of the chair and a support flap that is positioned between the child's legs and brought up around his trunk and buckled in back of the chair (Fig. 1).…