A comfortable silicone bulb obturator with or without dentures

Abstract

M axillectomy patients who have lost a portion of the hard palate and some of the maxillary ridge can be made more comfortable with a separate silicone sinus bulb that will lend full support to a complete upper denture. An acrylic resin obturator fastened solidly to a denture creates problems in the sinus region. Movement of the hard acrylic resin obturator in the palatal opening causes an irritation of the edges of the hard palate and turbinate bones. Hard acrylic resin limits the use of the undercuts that may be made available for retention of denture obturators. A stable soft silicone bulb and insert can be used to fill the undercuts of the open sinus in order to provide more retention and less irritation than the usual hard acrylic resin obturators fastened to dentures. The removal of a part of the exposed sinus and turbinate bones during the original operation for cancer benefits both the patient and the maxillofacial prosthodontist. It allows space for the obturator bulb and creates more retention than if the turbinate bones are left in place. The reason given for retaining the turbinate bones is to warm the air and prevent the crusting of mucous secretions. With an accuratefitting bulb, 50 per cent or more of the turbinate bones can be removed, and the result is very little or no crusting in that region. Most of the mucus is brought out with the bulb and can be readily washed away. Some unsuccessful obturators have been made successful by removing some of the turbinate bones. We make our prosthesis in two parts (Fig. 1) . First a silicone bulb is constructed to fit into as many of the undercuts of the sinus region as possible. A denture is then constructed to fit the remaining part of the maxillary arch and the bulb. An insert is incorporated in the denture for retention.