**Abstract**

Maxillofacial defects arising due to developmental anomalies, trauma or ablative cancer surgeries pose a challenge to an individual due to alteration in form, function and esthetics. Face is considered to be a reflection of one's personality and existence. Any alteration in facial structures or symmetry alters the esthetics of an individual. This may have a deep psychological impact on the patient affecting self-confidence, self-worth and ability to interact among peers. Maxillofacial Prosthodontics is a specialty that deals with rehabilitation of missing or deformed structures of orofacial region to achieve normalcy as much as practically feasible. A multidisciplinary approach is required to evaluate the psychological status, understand the impact of defect altering esthetics and mental make-up of the patient and follow an organized approach to alleviate the impact of maxillofacial defects in overall life of an individual. This chapter highlights the impact of maxillofacial defect on esthetics of an individual and psychological impact of the same.

**Keywords:** Psychological evaluation, maxillofacial defect, esthetics

## **1. Introduction**

*"It is the God given right of every human being to appear human" [1].*

Beauty is the quality or an aggregate of qualities in a person/ thing that gives pleasure to the senses or pleasurable exalts to the mind or spirit. Esthetics is the branch of philosophy dealing with beauty. Body image is considered as "the lifelong anchor for self-awareness" as it is closely related to sense of adequacy and competence [2]. A symmetrical, proportionate facial appearance with equal horizontal thirds and vertical fifths, gives an appearance of esthetically beautiful face. Various proportions like golden proportion exist in nature which gives a perception of dynamic symmetry. Lombardi proposed various principles for esthetics based on laws of nature [3].

Mouth is the most dynamic component of face which provides a unity with variety. **According to Sigmund Freud's theory 'Oral phase" as earliest expressions of "self ". Since very early age, mouth is considered as an area of gratification and security. Orofacial region is the reflection of personality, image and primary mode of self- expression for growing young adults and a gateway for proper diet and nutrition in elderly.**

Any defect in the maxillofacial region leads to loss of form, function and esthetics. It compromises the integrity of craniofacial region and thus poses a deeper impact on an individual altering his personal and social acceptability to a major extent. Rehabilitation of these defects surgically or Prosthodontically restores the function, esthetics to near normalcy and elevates the sense of 'incomplete' to an extent but deep seated insecurities and psychological impact needs to be dealt with, to ensure complete rehabilitation of patient and acceptance in society.

Defects in the maxillofacial region may be intraoral including maxillary defect, mandibular defect affecting continuity of mandible, velopharyngeal defects or defects of soft palate and extraoral defects like residual ocular, auricular, orbital, cranial, nasal or combination defects.

Due to variations in the site and size of defect, the impact of defect on various spheres of an individual's life, the psychological make-up and ability to cope up, esthetic expectations titrated with the realistic rehabilitation options makes maxillofacial rehabilitation a challenging task.

### **2. Discussion**

#### **2.1 Loss and grief in maxillofacial defect**

Loss is defined as 'a state of being deprived of or being without something one has had and valued' [4]. According to Peretz, loss may be in form of loss of significant person, Loss of a part of the self, Loss of material object or Developmental loss. Loss of part of human body especially in the esthetic regions like craniofacial region, puts a deep psychological stress on an individual. From the diagnosis of pathology itself to the surgical trauma, followed by healing phase, rehabilitation and finally maintenance and follow up puts individual into a progressive cycle of grief at different stages. The reaction to grief is an adaptive function 'to assure group cohesiveness in species where a social form of existence is necessary for survival' [4]. It follows a pattern of shock and denial characterized by signs of depression and suicidal tendencies in some patients. This is followed by a phase of guilt, anger and a search to find ways to discharge emotional pain. Eventually, adjustment, acceptance and growth takes over where the patient acceptance to loss, tries to make healthy adjustments and formulates new life patterns [4]. A cycle of loss, grief and reintegration must be completed by the patient and understood by the prosthodontist. The role of a specialist is to empathize with the patient and evaluate the need for referral to a psychotherapist.

### **3. Esthetic impact of maxillofacial defect**

Face is the individuality of a person, it is a medium of conveying various emotions, expressions and governs the personality of an individual. Based on age, gender, occupation, social interactions and interpersonal relations, different individuals weigh their appearance differently. But a disfigured, asymmetric face grabs first attention. **Prior to involving the orofacial region, though affected but its integrity is maintained. Post maxillofacial surgery, the resected site leads to loss of continuity and causes an altered disfigured appearance. This is one of the major factors contributing to distress, shame and psychosocial burden for the patient.** Post-surgical depression, hampers healing and makes patient prone to infections [5]. Surgical reconstruction or Prosthodontic rehabilitation attempts to restore the function and esthetics to as near natural as possible with its own limitations and constraints. **The constraints includes anatomical limitations which may limit the extension of the prosthesis, material based on area of application i.e. intraoral or extraoral, patients mental state and ability to accept.**
