The rehabilitation of patients with tumor resective surgery involving the facial area creates numerous chal- lenges for both the surgical and maxillofacial prosthet- ic teams. 1,2 Although immediately reconstructing the tissue defect with autogenous tissues plays a major role in maxillofacial reconstruction, 3 sculpting the autoge- nous tissue into intricate anatomy for larger nasal defects is difficult. A midfacial surgical defect may influence the patient’s self-esteem as well as his or her body image. 4-9 The sooner the surgical defect is rehabilitated, the ear- lier the patient will be able to return to normal daily activities, with the realization that ablative surgery does not result in a permanent handicap. 10,11 This clinical report describes the clinical and labora- tory procedures for fabricating a facial prosthesis using a custom-made metallic substructure over a necrotic frontal bone flap. CLINICAL REPORT A 77-year-old white man was referred to the Dental Oncology Group of the Ontario Cancer Institute- Princess Margaret Hospital for a postsurgical maxillofa- cial prosthetic assessment. His medical record revealed a history of ethmoid sinus squamous cell carcinoma dis- placing his dura below the frontal lobe. A partial rhinectomy involving the superior two-thirds of his nose and resection of the ethmoid sinus were per- formed. Access to the ethmoid sinus was gained through a midsegmental frontal bone flap. Immediate- ly after the tumor resection, the frontal bone flap was repositioned and covered with local soft tissue. Postop- eratively, 6000 cGy of external beam radiation therapy was delivered to the affected area. The soft tissue overlying the midsegmental frontal bone flap became necrotic approximately 10 months after the initial tumor resection surgery. A rectus abdominal free-flap was harvested to re-cover the exposed frontal bone flap. The rectus abdominal free- flap became nonvital as a result of secondary infection and was removed. The patient was closely followed for daily local debridement with saline irrigation. Although a bone scan revealed loss of vitality in the exposed frontal bone flap, there were no symptoms (Fig. 1). Sequestration of the frontal bone flap was anticipated and surgical removal of the necrotic bone was delayed. Metallic cranial implants have been proposed for reconstructing cranial bony defects 12,13 but they have not been widely accepted because of their high thermal and electrical conductivity, which may precipitate headaches and adversely affect the accuracy of elec- troencephalograms. 14-16 The immediate maxillofacial prosthodontic treatment goal was to return the patient Maxillofacial prosthodontic management of a facial defect complicated by a necrotic frontal bone flap: A clinical report Ansgar C. Cheng, BDS, MS, a David Morrison, CDT, b Alvin G. Wee, BDS, MS, c Walter G. Maxymiw, DDS, d and Daphne Archibald b Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Ontario, Canada a Head of Maxillofacial Prosthetics. b Anaplastologist. c Assistant Professor, Section of Restorative Dentistry, Prosthodontics and Endodontics, College of Dentistry, The Ohio State Universi- ty, Columbus, Ohio. d Chief of Department of Dentistry. J Prosthet Dent 1999;82:3-7. JULY 1999 THE JOURNAL OF PROSTHETIC DENTISTRY 3 1998 JUDSON C. HICKEY SCIENTIFIC WRITING AWARD Fig. 1. Frontal view of patient with facial defect and exposed necrotic frontal bone flap.