Rehabilitation of maxillectomy defect with obturator prosthesis

Abstract

The acquired defects of the palate are created commonly surgical intervention of benign or malignant neoplasms. The size and location of the defect influence the level of difficulty in prosthetic rehabilitation. Surgical intervention creates anatomic defect which forms communication among the oral cavity, nasal cavity and maxillary sinus. The goal of prosthodontist is to rehabilitate missing oral and extra oral structures with restoration of normal anatomic and physiologic function. Prosthetic rehabilitation with obturator restores the oral structures and also acts as barriers between communications among the cavities. Acquired maxillary defects of the palate are seen in patients suffering from benign and malignant neoplasms, trauma, pathologic changes, radiation therapy and surgical intervention. Ablative surgical therapy is frequently adopted for the control of malignancies and other abnormal growths. This results in anatomic defect that allows the oral cavity maxillary sinus and nasal cavity to become one compartment, abrupt alteration of physiologic functions such as speech, mastication, deglutition and salivary control. Prosthodontics rehabilitation for an acquired maxillary defect begins immediately at the time of surgical resection. Prosthetic rehabilitation begins with a surgical obturator, which is inserted at the time of surgery to help retain the packing, prevent oral contamination of the surgical wound and skin graft, and to allow the patient to speak and swallow during the initial post operative period. The surgical obturator is commonly converted into an interim obturator with the addition of resilient lining material to adapt to the defect. Definitive obturator is initiated approximately 3 to 4 months after surgery when healing is complete. The impression for definitive obturator prosthesis should include the skin graft mucosal junction, lateral aspect of the orbital floor, and the dynamic physiology of the velopharyngeal mechanism during speech and swallowing. The obturator bulb must also be contoured to prevent obstruction of nasal breathing and to maintain nasal resonance during speech. The degree of extension into the defect varies depending upon the configuration of the defect, character of its lining tissue, and functional requirement for retention, stability and support of the prosthesis. This article describes a case report of a patient who had undergone partial maxillectomy secondary to squamous cell carcinoma and rehabilitated with definitive obturator.