Maxillofacial prosthetics is defined as the art and science of anatomic, functional or cosmetic reconstruction by means of a nonliving substitute of regions in the maxilla, mandible and face that are missing or defective due to surgical intervention, trauma, pathology, developmental malformation or congenital malformation. It is a difficult dental field dealing with disorders of speech, mastication, deglutition and esthetics, adding to this radiotherapy or even chemotherapy, that can complicate the prosthetic rehabilitation in tumor origin cases. The placement of an immediate, semi-immediate, or temporary palatine plate after the surgery will help ensure comfort during breathing and partially improve facial aesthetics. After complete healing, the fabrication of a maxillofacial prosthesis to replace missing teeth and fill in maxillary bone loss will provide satisfactory speech and chewing function, as well as acceptable aesthetics.

For information, the consent was obtained from the patient to report this case.

Mr. H. H., a 46-year-old man, presented for a consultation in the maxillofacial surgery department due to a localized mass in the maxillary arch ( Figure 1 ).

The interview revealed nocturnal pain and difficulty in chewing, swallowing, and speech.

The clinical examination ( Figure 1 and Figure 2 ), noted a movable excrescence compared to the adjacent bone that bled upon contact. The mass occupied the hard palate with an extension into the soft palate.

An anatomical-pathological examination was conducted and confirmed a malignant tumor of the adenoid cystic carcinoma type.

Radiological examination showed significant bone lysis in the anterior maxilla ( Figure 3 ), proximity to the right and left sinuses, and persistence of a root of tooth 45 that was impacted ( Figure 4 ).

Post-surgical maxillary bone loss due to malignant tumors causes severe defects, leading to difficulties in chewing, swallowing, speech, olfaction, and taste, as well as nasal secretions leaking into the oral cavity and aesthetic and psychological issues [1] [2] . Treatment with a semi-immediate (temporary) obturator, followed later by a definitive obturator, can correct these defects, allowing for comfortable breathing, good chewing [3] , correct speech, and satisfactory aesthetics, ultimately resulting in patient satisfaction [4] .

For therapeutic purposes, several authors have classified these maxillary bone losses [5] . Devauchelle’s classification is the most interesting:

Type I: Bone loss affecting the hard palate while preserving the alveolar dental arch:

(a): Anterior location;

(b): Posterior location.

Type II: Bone loss involving the alveolar dental arch:

(a): At the incisor-canine block;

(b): Laterally.

Type III: Bone loss of one hemi-palate.

Type IV: Total bone loss.

Several types of obturators are available [6] :

The immediate obturator, created before surgery and placed right after the resective surgery, which helps the healing of the tissues surrounding the maxillary substance loss, and reduces the psychological impact [7] ;

The temporary obturator, which allows the patient to restore proper eating and speech during the fabrication of their definitive prosthesis [8] - [10] ;

The definitive obturator, which is better suited to the extent of the bone loss and the remaining maxillary structures.

These obturators can be full or hollow, with the choice depending on the clinical situation.

The hollow obturators are indicated to help ensure retention in the maxilla in case of heavy prosthesis.

The full obturators are indicated in small maxilla bone loss [11] .

The maxillofacial prosthetic rehabilitation is a challenge due to the specific anatomical characteristics of the remaining bones and mucous tissues. The treatment is individual [11] .

The therapeutic prognosis will depend on several parameters:

Digital technologies “computer aid design and manufacturing CAD-CAM” can improve maxillofacial prosthesis with:

Camera’s scanning the maxilla defects with a precision (resolution 30 microns) [13] ;

3D camara’s and software’s (modjaw) helping in the acquisition and reconducting the static and dynamic occlusion;

Print software’s and 3D printers to produce the prosthetic pieces.

Digital technologies can highly improve the making of orthosis if the maxilla defects touch the face with:

Perfect symmetric facial structures reconducted;

A large panel of silicone colors and shades.

After loss of the maxilla following tumor surgery, a maxillofacial prosthesis will allow patients to maintain their facial aesthetics, self-esteem, and comfort during functions such as eating and speaking correctly. Currently, there is a notable contribution from implantology through the development of prosthetic retention methods, implants, the advancement of digital imaging providing a very high level of prosthetic precision, and the introduction of new materials like silicones that offer colors and textures very close to that of the skin.