Hollow Bulb Research Articles

A Comprehensive Prosthodontic Management of Subtotal Maxillectomy

ABSTRACT Patient A 21-year-old female patient was diagnosed with intraosseous mucoepidermoid carcinoma on the left side of maxilla, which was planned for subtotal maxillectomy involving the left maxillary sinus. Discussion Prosthodontic rehabilitation of patients with maxillectomy is a challenge as it involves restoring speech, deglutition, mastication and respiration. This clinical report describes a comprehensive prosthodontic management of a young girl treated for a subtotal maxillectomy due to intraosseous mucoepidermoid carcinoma. The prosthodontic manage- ment that was carried out right from the surgical obturator to a definitive prosthesis with a two-piece closed hollow bulb, magnet-retained obturator shows the ease and simplicity in the management of a case with subtotal maxillectomy. Conclusion Subtotal maxillectomy defects represent a complex challenge for the maxillofacial prosthodontist. The comprehensive technique described in this clinical report can be employed in any similar case. How to cite this article Sundar MK, Kumar GPS, Lakhanpal S. A Comprehensive Prosthodontic Management of Subtotal Maxillectomy. Int J Prosthodont Restor Dent 2014;4(4):120-126.

Prosthetic Rehabilitation of Maxillectomy Defect with Cast Metal Framework and an Acrylic Hollow Bulb -A Case Report

Prosthetic Rehabilitation of Maxillectomy Defect with Cast Metal Framework and an Acrylic Hollow Bulb -A Case Report

Techniques for fabricating hollow obturator: Two case reports

The most commonly seen intraoral defect is the one affecting the maxilla, through an opening into the nasopharynx. These defects can either be congenital or acquired. These are usually large openings in the palate and/or the surrounding structures. Obturators are used to close or seal these defects to restore proper mastication, speech, deglutition, and esthetics. This article presents case reports describing two different techniques for fabricating hollow bulb oburator.

Rehabilitation of a partial maxillary defect with magnet retained two-piece hollow bulb obturator

A restricted mouth opening in hemimaxillectomy patients can create a significant problem with insertion and removal of the obturator prosthesis. A two-piece obturator is an alternative management for such patients. The treatment of a patient with a hemimaxillectomy due to squamous cell carcinoma is presented in this clinical report. A sectional obturator prosthesis retained by magnets was fabricated to deal with trismus, fibrosis, and microstomia. The patient's esthetic and functional expectations were satisfied. The new generation of magnets with improved technology provides sufficient denture retention for clinical application. However, further follow-up may be necessary to ascertain the long-term usefulness of the magnet-retained obturator prosthesis, because of corrosion and further loss of magnetism.

Rehabilitation of a partially dentate patient with closed hollow bulb obturator: A case report

The palatal defects are usually created due to palatal clefts or surgical removal of tumors or trauma. Patients with this defect are confronted with problems in speech, deglutation, mastication and appearance. The fear of food and drink entering the oronasal and/or oroantral cavities are prevented by the obturator prosthesis. This article is a description of a clinical case that was treated successfully by using a closed hollow bulb obturator.

Prosthetic Rehabilitation of an Edentulous Veau's Class II - A Case Report

Patients with acquired defects or congenital malformations of the palate exhibit disturbances in speech including hypernasality, nasal emission and decreased intelligibility of speech. Maxillofacial prosthesis is an art and science which not only replaces the lost structure but also sometimes restores the function.obturator is a prosthesis which closes the palate and pharyngeal defects and improving the speech and other function. This article presents a case report of a completely edentulous patient with palatal insufficiency rehabilitated prosthodontically with a hollow bulb obturator and a procedure for fabrication of closed hollow bulb obturator prosthesis. DOI: http://dx.doi.org/10.3329/bjms.v12i4.16665 Bangladesh Journal of Medical Science Vol. 12 No. 04 October ’13 Page 435-438

One step polymerizing technique for fabricating a hollow obturator

PurposeAlthough a closed hollow obturator is often applied to post maxillectomy patients, it has a few problems such as complexity of fabrication and water leakage to inside. A one step curing technique to fabricate a closed hollow obturator by constructing a small hollow bulb made by two thermoplastic resin sheets is described in the present report. MethodsIn the one step curing technique, after dewaxing the wax denture fabricated conventionally, one size smaller hollow body was fabricated with two thermoplastic resin sheets and set into the investment mold as a core. Then the circumferential part of obturator was cured by the pour type resin.This technique was used to fabricate an obturator prosthesis in a 60-year-old post-maxillectomy patient. The weight of this obturator was well controlled and the definitive prosthesis weighed 22g. At a one year follow-up, the obturator fared well without any water leakage or breakage. ConclusionsThis technique allows the fabricator to control the thickness and weight of the obturator by the amount of relief provided by the hollow bulb. It also rectifies the disadvantages of the closed hollow obturator such as water leakage and complexity of fabrication.

A two-step (altered cast) impression technique in the prosthetic rehabilitation of a patient after a maxillectomy: A clinical report

This clinical report describes the prosthetic rehabilitation complicated by trismus (as a consequence of surgery and radiation therapy) of a patient with an acquired maxillary defect, after surgical removal of the right maxillary sinus tumor. The patient was restored with a partial removable dental prosthesis with a hollow bulb obturator to obtain orofacial rehabilitation and defect obturation. Precise obturation requires an accurate impression of the resection defect. A 2-step impression was performed because of trismus. A primary maxillary impression was made with an irreversible hydrocolloid, while a secondary (altered cast) impression was made with a silicone material by using the obturator cast framework as a tray. In that way an altered cast was produced. Subsequently, an obturator prosthesis was processed with a conventional technique.

Effect of varying bulb height on articulation and nasalance in maxillectomy patients with hollow bulb obturator

PurposeTo evaluate the effect of bulb height of hollow bulb obturator prosthesis on articulation and nasalance. MethodA total of 10 patients, who were to undergo maxillectomy falling under Aramany class-I and II, with normal speech and hearing pattern were selected for the study. They were provided 2 maxillary obturators, one extending full height of the defect and other with bulb height approximately up to inferior nasal concha. The patients were asked to wear each obturator for 6 weeks and the speech analysis was done to measure changes in articulation and nasalance at 6 different stages of treatment i.e. preoperative, postoperative (after complete healing), 24h and 6 weeks after providing full bulb height obturator and reduced bulb height obturator. Articulation was measured objectively for distortion, addition, substitution and omission by speech pathologist and nasalance was measured by Dr. SPEECH software. ResultComparison between full and reduced bulb height for nasalance and articulation, showed that there was no statistical significant difference (P>0.05) between the two for both the parametres. ConclusionArticulation and nasality improves after providing obturator. Articulation and nasalance both are independent of bulb height.

Closed Hollow Bulb Obturator—One‐Step Fabrication: A Clinical Report

A method is described for the fabrication of a closed hollow bulb obturator prosthesis using a hard thermoforming splint material and heat-cured acrylic resin. The technique allowed the thickness of the thermoformed bulb to be optimized for weight reduction, while the autopolymerized seal area was covered in heat-cured acrylic resin, thus eliminating potential leakage and discoloration. This technique permits the obturator prosthesis to be processed to completion from the wax trial denture without additional laboratory investing, flasking, and processing.

Fabricating a hollow bulb obturator

Obturators are generally used in the rehabilitation of the maxillectomy defects. Ideally, obturators should be light, properly fit and construction should be made easily. By decreasing the weight of the prosthesis, the retention and stability may be optimized to allow the obturator for function comfortably during mastication, phonation, and deglutition. In this case, a 65-year-old male patient underwent surgical removal of left part of the maxilla due to the squamous cell carcinoma. In this technique fabrication of a hollow bulb obturator prosthesis as a single unit in heat-cured acrylic resin using a single-step flasking procedure was described. The patient’s functional and esthetic expectations were satisfied.

A Direct Investment Method of Closed Two-Piece Hollow Bulb Obturator

Maxillary defects occur due to surgical treatment of benign and malignant tumors, congenital malformation, and trauma. Prosthetic rehabilitation in such patients is influenced by the size and location of the defect. The most common of all intraoral defects are seen in the maxilla, in the form of an opening into the maxillary sinus and nasopharynx. These defects create disabilities in speech, deglutition, and mastication. The prosthesis which closes such an opening and recreates the functional separation of the oral cavity and sinus and nasal cavities is referred to as an obturator. Numerous techniques of hollow bulb fabrication have been mentioned in the literature from time to time. But there are only a few methods for bulb fabrication in two-piece obturator. This technique describes a direct investment method of waxed-up closed hollow bulb two-piece obturator.

Oromaxillary Prosthetic Rehabilitation of a Maxillectomy Patient Using a Magnet Retained Two-Piece Hollow Bulb Definitive Obturator; A Clinical Report

Resection of a malignant lesion involving the maxilla produces severe oromaxillary defect that can seriously jeopardize the normal phonetics of the patient. These defects are effectively managed by well-designed and fabricated obturator. This paper discusses the oromaxillary prosthetic rehabilitation of a maxillectomy patient using a magnet retained two-piece hollow bulb definitive obturator.

Effectiveness of a Custom-Made Temporary Obturator after Bilateral Total Maxillectomy

Large oro-antral communication, associated with total maxillectomy, may lead speech and/or swallowing dysfunction. These surgical defects are packed with obuturator or prosthesis following surgery; however, achieving retention and stability is dependent on anatomical conditions. A 68-year-old Japanese female with large oro-antral communication arising because of bilateral total maxillectomy was referred for evaluating application of obturator. The temporary obturator was constructed as underlying 3 mm thick and covereing 1.5 - 2 mm thick ethylene vinyl acetate sheet (EVA). These two sheets formed the flexible hollow bulb portion, which aided retention and stability by engaging the undercut portion of the surgical defect. For the patients who have difficulty anatomical features for conventional prosthesis, this type of temporary obturator made with EVA sheets could be an effective solution in the early postoperative period.

Rehabilitation of apartial maxillectomy patient with silicone relined hollow bulb obturator – Case report

Maxillary resection results in a discontinuity of the oral nasal and maxillary sinus cavities. Defect of any extent results in significant disabilities experienced by the patient. This may be manifested as difficulties in speech, mastication and esthetics.Prosthetic rehabilitation in the form of a palatal obturator is usually required to cover the defect and restore normal functions. In the cases of edentulous patients application of anobturator becomes even more cumbersome as the mechanism of retention is compromised.Achieving peripheral seal is questionable. In the present case, palatal defect is rehabilitated with silicone relined hollow bulb obturator. The portrayed obturator reduces the redundant load on the supporting tissue and provides a functional solution to the compromised state of the patient.

Modified snap-on attachment with ′O-ring′ for two piece hollow bulb obturator

Restoration of near normal functions in patients who have been treated with hemimaxillectomy is generally difficult, in view of the restriction in mouth opening following healing of large surgical wound. Further, the extent and nature of the surgical defect differ from patient to patient. Thus, design of an obturator needs to be patient oriented. In this report, we describe a novel snap-on attachment with O-ring in a conventional two piece hollow bulb obturator for a 70-year-old male treated for carcinoma of the left maxilla and sinus.

Prosthetic rehabilitation of maxillofacial defect with magnetically retained maxillary interim obturator – Case report

Acquired diseases like carcinomas can cause tremendous effects on human being like psychological, functional and surgical. The Prosthodontic rehabilitation of the extensive maxillofacial defects with restoration of the function, speech and esthetics is a challenging task.Prosthodontic prognosis is affected by volume and location of the post surgical bony anatomy, availability and prognosis of the abutment teeth, size of the defect, quality of mucosa, history of radiation therapy, patient's experience with dental prosthesis and neuromuscular control of the patient.This case report describes the prosthetic rehabilitation with magnetically retained hollow bulb maxillary interim obturator for a patient with large maxillofacial defect with Naso Cutaneous Fistula.

Rehabilitation of a Maxillectomy Case with Telescopic Crowns: A Case Report

Prosthodontic rehabilitation of acquired defects of the maxilla is a challenge in terms of reestablishing oronasal separation. Most of the times these goals are met by means of obturator prosthesis. Preservation of the remaining hard and soft tissues in such patients is very much essential in order to have a good retention, stability and support for the prosthesis. It is very much imperative to fabricate a prosthesis to provide proper function to the patient. Various techniques have been developed to enhance the retention and stability of the prosthesis, some of them being extension of the obturator bulb into the undercuts within the defect, use of magnets, implants etc. Telescopic crowns have been an adjunctive utility to prosthetic dentistry since a very long time. The biomechanics of telescopic crowns aid in providing a good retention and stability to the prosthesis. In the following clinical report a patient with a status of Subtotal Hemi Maxillectomy is presented in whom telescopic copings were incorporated into the cast hollow bulb obturator to enhance the retention and stability of the prosthesis.

PROSTHODONTIC REHABILITATION OF A PATIENT WITH HOLLOW BULB OBTURATOR : A CASE REPORT

AbstractA prosthesis used to close a palatal defect in dentulous or partially edentulous mouth is correctly referred to as an obturator. An obturator serves to restore speech, mastication, deglutition and esthetics. A light weight hollow obturator optimises retention and stability as well as patient comfort.This case report describes the fabrication of an hollow bulb obturator for a completely edentulous patient who has undergone wide excision and partial alveolar resection squeal of management of pleomorphic adenoma of the palate.

Speech rehabilitation of maxillectomy patients with hollow bulb obturator

Aim:To evaluate the effect of hollow bulb obturator prosthesis on articulation and nasalance in maxillectomy patients.Materials and Methods:A total of 10 patients, who were to undergo maxillectomy, falling under Aramany classes I and II, with normal speech and hearing pattern were selected for the study. They were provided with definitive maxillary obturators after complete healing of the defect. The patients were asked to wear the obturator for six weeks and speech analysis was done to measure changes in articulation and nasalance at four different stages of treatment, namely, preoperative, postoperative (after complete healing, that is, 3-4 months after surgery), after 24 hours, and after six weeks of providing the obturators. Articulation was measured objectively for distortion, addition, substitution, and omission by a speech pathologist, and nasalance was measured by Dr. Speech software.Results:The statistical comparison of preoperative and six weeks post rehabilitation levels showed insignificance in articulation and nasalance. Comparison of post surgery complete healing with six weeks after rehabilitation showed significant differences in both nasalance and articulation.Conclusion:Providing an obturator improves the speech closer to presurgical levels of articulation and there is improvement in nasality also.