Orofacial anomalies can affect speech, chewing, swallowing, breathing, and facial appearance. Resulting from congenital defects, injuries, infections, or tumor removal, they greatly impact functionality and quality of life, necessitating thorough rehabilitation to recover function, aesthetics, and psychological health [1,2]. Rehabilitating acquired maxillary defects is a fulfilling aspect of prosthodontics, allowing most patients to attain nearly normal function and aesthetics. Maxillofacial prosthetics offer a conservative and efficient treatment solution, enhancing speech, chewing, appearance, and overall life quality [3,4].

Improvements in materials, retention techniques, and clinical approaches have enhanced maxillofacial prosthetics. Osseointegrated craniofacial implants offer enhanced retention, stability, appearance, and patient satisfaction in comparison to traditional adhesive-retained prosthetics [5]. The effectiveness of maxillofacial prosthetic rehabilitation is assessed by enhancements in function, retention of the prosthesis, appearance, and overall quality of life. Successful rehabilitation also improves psychological health, boosts self-esteem, fosters social reintegration, and increases overall patient satisfaction [6]. Regardless of these improvements, rehabilitation results rely on the nature of the defects, retention of the prosthesis, adherence from the patient, oral cleanliness, and collaborative care. Timely prosthetic intervention and consistent monitoring enhance functional recovery and long-term treatment outcomes [4].

Research has consistently shown that maxillofacial prosthetic rehabilitation greatly enhances both functional and psychosocial results. Prostheses supported by implants improve retention, stability, oral function, facial appearance, patient satisfaction, and psychological well-being. In the same way, properly crafted obturator prostheses enhance speech, chewing, swallowing, social adjustment, and overall life quality. Comparative evidence further suggests that obturator prostheses yield functional and quality-of-life results similar to those of palatomaxillary reconstruction, reinforcing prosthetic rehabilitation as a viable alternative to surgical reconstruction [7-9].

Data on the clinical results of maxillofacial prosthetic rehabilitation in Bangladesh is scarce. This study seeks to assess the clinical results of maxillofacial prosthetic rehabilitation in patients with orofacial defects at a tertiary care hospital in Bangladesh to furnish local evidence for enhancing patient care.

This prospective observational study was conducted in the Department of Prosthodontics, Faculty of Dentistry, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka, Bangladesh, over a one-year period from March 2007 to February 2008. The study aimed to evaluate the clinical characteristics of patients with congenital and acquired maxillofacial defects and to assess the functional, esthetic, and patient-reported outcomes following maxillofacial prosthetic rehabilitation. The study included patients of all age groups and both sexes who attended the Department of Prosthodontics and required maxillofacial prosthetic rehabilitation. Patients with congenital defects, such as cleft lip and palate, and acquired defects resulting from tumor resection, trauma, infection, or other causes were eligible for inclusion. Patients who completed prosthetic rehabilitation and provided written informed consent (or whose parents or legal guardians provided consent in the case of pediatric patients) were enrolled consecutively during the study period. Patients who declined participation, discontinued treatment before prosthesis delivery, or failed to attend the scheduled follow-up visits were excluded. A total of 22 consecutive patients were included in the study. Demographic and clinical data, including age, sex, nature and etiology of the defect, anatomical site of the defect, and type of maxillofacial prosthesis, were collected using a structured data collection form. Based on the clinical indication, feeding obturators, speech aid prostheses, obturator prostheses, mandibular guidance prostheses, and nasal prostheses were fabricated according to standard clinical and laboratory procedures practiced in the department. Patients were assessed before prosthetic rehabilitation and at follow-up after prosthesis delivery. Functional outcomes, including feeding ability, speech, mastication, swallowing, and facial appearance, were evaluated using clinician-administered 10-point numerical rating scales, with higher scores indicating better functional performance. Overall quality of life was assessed using a 100-point visual analogue scale. Patient satisfaction with the prosthetic rehabilitation was evaluated using a four-point Likert scale (very satisfied, satisfied, neutral, and dissatisfied). For inferential analysis, patient satisfaction was further categorized as satisfied (very satisfied and satisfied) and not satisfied (neutral and dissatisfied). Prosthesis-related complications, including discomfort, retention problems, and mucosal irritation, were also recorded during follow-up. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 16.0 (SPSS Inc., Chicago, IL, USA). Continuous variables were expressed as mean ± standard deviation (SD), while categorical variables were summarized as frequencies and percentages. Pre- and post-rehabilitation functional scores were compared using the paired t-test. Associations between patient satisfaction and selected demographic and clinical variables were analyzed using the Chi-square test or Fisher's exact test, as appropriate. A p-value of <0.05 was considered statistically significant. Ethical approval for the study was obtained from the Institutional Review Board (IRB) of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. Written informed consent was obtained from all adult participants and from the parents or legal guardians of pediatric participants prior to enrollment. Confidentiality of participant information was maintained throughout the study, and all procedures were conducted in accordance with the ethical principles of the Declaration of Helsinki.

Sociodemographic Characteristics

Table 1 shows total of 22 patients who underwent maxillofacial prosthetic rehabilitation at the Department of Prosthodontics, Bangabandhu Sheikh Mujib Medical University (BSMMU), during the study period were included in the analysis. The largest proportion of patients belonged to the 1–10 years age group (36.4%), followed by the 21–30 years age group (18.2%). Male patients slightly outnumbered females, accounting for 54.5% (n=12) of the study population.

Table 1. Sociodemographic characteristics of the study participants (n=22)

Clinical Characteristics of Maxillofacial Defects

Table 2 presents among the study participants, 12 (54.5%) presented with acquired defects, while 10 (45.5%) had congenital defects. Congenital cleft lip and/or palate was the most common congenital anomaly, whereas tumor resection constituted the leading cause of acquired defects. Palatal defects were the most frequently encountered anatomical defects (45.5%), followed by mandibular defects (22.7%), maxillary defects (13.6%), nasal defects (13.6%), and combined defects (4.5%).

Table 2. Clinical characteristics of the patients (n=22)

Distribution of Maxillofacial Prostheses

Figure I show speech aid prostheses were the most frequently fabricated prostheses (27.3%), followed by feeding obturators (22.7%), obturator prostheses (18.2%), mandibular guidance prostheses (18.2%), and nasal prostheses (13.6%).

Figure I: Types of maxillofacial prostheses provided (n=22)

Functional Outcomes Following Prosthetic Rehabilitation

Table 3 shows following prosthetic rehabilitation, marked improvement was observed in functional performance. Improvement in facial appearance was reported by 95.5% of patients, while feeding ability improved in 90.9%. Swallowing function improved in 86.4%, speech in 81.8%, and mastication in 77.3% of the participants.

Table 3. Functional improvement following maxillofacial prosthetic rehabilitation (n=22)

Comparison of Functional Scores Before and After Rehabilitation

Table 4 shows statistically significant improvements were observed in all assessed functional domains after rehabilitation. The mean feeding score increased from 4.1 ± 1.4 before treatment to 8.7 ± 0.9 after treatment (p<0.001). Similarly, speech scores improved from 4.5 ± 1.8 to 8.3 ± 1.1, mastication scores from 4.0 ± 1.6 to 8.1 ± 1.2, and facial appearance satisfaction from 3.4 ± 1.3 to 9.0 ± 0.8 (all p<0.001). The overall quality-of-life score also demonstrated a significant increase from 49.2 ± 10.8 to 82.8 ± 7.9 following rehabilitation.

Table 4. (n=22)

Note: *Paired t-test was used for comparison between pre- and post-rehabilitation scores. A p-value of <0.05 was considered statistically significant.

Patient Satisfaction with Prosthetic Rehabilitation

Figure II presents overall satisfaction with treatment was high. Nearly half of the participants (45.5%) reported being very satisfied, while 40.9% were satisfied with the prosthetic rehabilitation. Only one patient (4.5%) expressed dissatisfaction with the treatment outcome.

Prosthesis-Related Complications

Table 5 shows most patients (68.2%) experienced no prosthesis-related complications during the follow-up period. Minor discomfort was reported by three patients (13.6%), while mucosal irritation and retention problems were observed in two patients (9.1%) each.

Table 5. Prosthesis-related complications during follow-up (n=22)

Factors Associated with Overall Patient Satisfaction

Table 6 shows patients who did not experience prosthesis-related complications were significantly more likely to report overall satisfaction compared with those who developed complications (100% vs. 57.1%; p=0.018). No statistically significant association was found between overall satisfaction and sex (p=0.61), age group (p=0.47), or the nature of the defect (congenital vs. acquired) (p=0.79).

Table 6. Factors associated with overall patient satisfaction (n=22)

Note: Satisfied includes patients who reported being very satisfied or satisfied with the prosthetic rehabilitation. P-values were calculated using Fisher's exact test.

In this study, the majority of patients were aged ≤10 years, with a minor male predominance. In a similar manner, study found a higher number of male patients and noted that extraoral implant-supported prostheses offered outstanding retention, enhanced aesthetics, and significant patient satisfaction [10].

In the current study, acquired defects were somewhat more prevalent than congenital defects, with cleft lip and/or palate and palatal defects being the most commonly observed results. In the same vein, global study pointed out that cleft lip and palate rank among the most prevalent congenital craniofacial anomalies arising from atypical craniofacial development, necessitating comprehensive rehabilitation to recover function and appearance [11].

In this study, the most commonly produced prostheses were speech aid prostheses, followed by feeding obturators, obturator prostheses, mandibular guidance prostheses, and nasal prostheses. These results indicate the varied rehabilitation requirements of patients with orofacial abnormalities. Earlier research has highlighted that the choice of prosthesis must be tailored to the nature and severity of the defect in order to attain the best possible outcomes for speech, swallowing, chewing, and appearance [12].

The current study demonstrated significant enhancement in facial aesthetics, feeding, swallowing, speech, and chewing after prosthetic treatment. Likewise, earlier research indicated that implant-supported prostheses enhance stability, oral function, facial appearance, and patient satisfaction, leading to improved rehabilitation results [13,14].

This study indicated notable advancements in feeding, speech, chewing, facial aesthetics, and overall quality of life after prosthetic rehabilitation. These results align with earlier research, which recognized enhancement in oral function as a crucial marker of effective maxillofacial prosthetic rehabilitation [15].

In this study demonstrated significant patient satisfaction following prosthetic rehabilitation, with the majority of patients indicating they were satisfied or very satisfied, while very few showed signs of dissatisfaction. Comparable results have been noted in earlier research, showcasing significant satisfaction with facial prosthetics attributed to enhanced functionality, appearance, and psychological health [6].

In the current analysis, the majority of patients experienced no complications related to prosthetics, whereas only a small number mentioned mild discomfort, problems with retention, and mucosal irritation. Comparable research indicates that implant-supported prosthetic rehabilitation typically results in a low complication rate and positive clinical results [16].

Overall patient satisfaction was notably greater in patients without complications related to prostheses, and factors such as age, gender, and defect type showed no significant correlation with satisfaction. These results align with earlier research indicating that patient satisfaction is mainly affected by the function of the prosthesis, comfort, speech results, and lack of complications, rather than demographic factors [6,17].

In summary, maxillofacial prosthetic rehabilitation greatly enhances function, appearance, and quality of life, resulting in high patient satisfaction and few complications, regardless of demographic influences

Maxillofacial prosthetic rehabilitation greatly enhances functional results, quality of life, and patient satisfaction for those with congenital and acquired maxillofacial defects. The therapy is very effective, with the majority of patients showing significant enhancements and few complications. Results are especially positive when prosthesis-related complications are not present, emphasizing the significance of correct manufacturing, upkeep, and ongoing care.

ACKNOWLEDGEMENT

We gratefully acknowledge all the patients and their attendances participated in this study. We would also like to acknowledge the Department of Prosthodontics, BSMMU where the study was carried out. 

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