Maxillectomy Patients Research Articles

A Titanium Cast Hollow Definitive Obturator Prosthesis for a Maxillectomy Patient

ABSTRACT Oral cancer necessitates the surgical removal of all or part of the maxilla. The extent of surgical resection is dependent on the size, location, and potential behavior of the tumor. The maxillectomy procedure leaves the patient with a defect that compromises of the integrity and function of the oral cavity, leading to hypernasal speech, fluid regurgitation into the nasal cavity, and impaired masticatory function. Rehabilitation of subtotal and total bilateral maxillectomy surgical defects is a complex challenge to the prosthodontist. Prosthetic rehabilitation of the surgical defect with the help of obturator is very important, because the resulting functional deficiencies have a detrimental effect on the quality of life and self-esteem of the patient. How to cite this article Fernandez T, Rodrigues SV, Vijayanand KR. A Titanium Cast Hollow Definitive Obturator Prosthesis for a Maxillectomy Patient. Int J Prosthodont Restor Dent 2016;6(3):69-72.

Evaluation of quality of life of maxillectomy patients after prosthetic obturator rehabilitation

Evaluation of quality of life of maxillectomy patients after prosthetic obturator rehabilitation

Creating a digitized database of maxillofacial prostheses (obturators): A pilot study.

PURPOSEThis study aimed to create a digitized database of fabricated obturators to be kept for patients' potential emergency needs.MATERIALS AND METHODSA chairside intraoral scanner was used to scan the surfaces of an acrylic resin obturator. The scanned data was recorded and saved as a single standard tessellation language file using a three-dimensional modeling software. A simulated obturator model was manufactured using fused deposition modeling technique in a three-dimensional printer.RESULTSThe entire obturator was successfully scanned regardless of its structural complexity, modeled as three-dimensional data, and stored in the digital system of our clinic at a relatively small size (19.6 MB). A simulated obturator model was then accurately manufactured from these data.CONCLUSIONThis study provides a proof-of-concept for the use of digital technology to create a digitized database of obturators for edentulous maxillectomy patients.

Prosthetic Rehabilitation of Maxillectomy Patient with Post-Surgical Obturator: A Case Report

Case description: A 60 year old female patient presented to Department of Prosthodontics, CODS, BPKIHS, Dharan with a chief complain of loose obturator. History revealed that patient had undergone partial maxillectomy for squamous cell carcinoma 7 years back. The patient also has been wearing obturator which was loose when the patient reported to the department. On examination, the site of surgery was the maxillary right buccal sulcus area and a part of the hard palate including teeth number 11, 12, 13, 14, 15, 16, 17. The presented defect situation corresponded to a Class I situation (resection performed along the palatalmidline) according to the Aramany classification of defects. The surgical site showed complete healing. A hollow-bulb obturator was fabricated for rehabilitation of the defect.Conclusion: The extensive surgical procedures necessary to eradicate cancer of the head and neck and to prevent local recurrence or regional metastasis often leave extremely large physical defects which present almost insurmountable surgical difficulties in restoring acceptable function or esthetics. The prosthesis rehabilitated the patient in terms of function by providing better masticatory efficiency, phonetics by adding resonance to the voice, hence improving the clarity of speech and also improved the esthetics of the patient.JCMS Nepal 2014; 10(4):32-36

The influence of obturators on the respiration of patients with maxillary defects: a clinical study.

The study evaluated the effects of obturators on respiratory function by analyzing the changes in nasal anatomic structures and physiologic function in maxillectomy patients with and without obturators. Twenty-six patients who underwent maxillectomy were chosen and rehabilitated with obturators by a single maxillofacial prosthodontist. The geometric shape of the nasal cavity, the nasal airway resistance, and the ratio of residual volume to total lung capacity (RV/TLC) were evaluated using acoustic rhinometry, rhinomanometry, and a pulmonary function test apparatus, respectively. All patients were tested twice, with and without their obturators. The results were statistically analyzed with a paired t-test. The nasal cavities (0–7 cm to the anterior nostril) of the patients with obturators had a significantly smaller volume ([-8.92, -0.60], P = 0.027), smaller effective nasal cross-sectional area MCA2 ([-3.80, -1,81], P<0.0001), increased airflow in the nasal cavity ([17.76, 147.39], P = 0.015), reduced nasal airway resistance ([-0.11, -0.02], P = 0.009), and reduced RV/TLC ([-5.32, -1.30], P = 0.004) compared with the patients without obturators. According to the results of this study, obturators can improve respiratory function by effectively decreasing the volume of enlarged nasal cavities as well as the nasal air resistance and volume of anatomical dead space after maxillectomy.Trial RegistrationChiCTR.org ChiCTR-PRNRC-14005136

Understandability of Speech Predicts Quality of Life Among Maxillectomy Patients Restored With Obturator Prosthesis

Maxillary malignant tumor resection by maxillectomy might lead to defects that can be repaired by prosthetic obturation. The aim of this study was to associate quality of life (QoL) and the Obturator Functioning Scale (OFS) with functional performance and salivary flow rate in Brazilian patients rehabilitated with an obturator prosthesis. This retrospective cross-sectional study included patients who underwent surgical resection with or without radiotherapy or without chemotherapy and the rehabilitation with an obturator prosthesis at the Fundação Oncocentro de São Paulo (São Paulo, Brazil). The predictor variables were Performance Status Scale for Head and Neck Cancer Patients (PSS-HN) domains and clinical evaluation of salivary flow rate. The outcome variables were overall scores obtained by the University of Washington QoL Scale (UWQOL) and the OFS. Sociodemographics (gender and age) and clinical characteristics (postoperative radiotherapy, tumor stage, classification of maxillary defect, tooth in maxilla, and type of obturator) also were evaluated. Univariate and multivariate analyses were performed to determinate whether PSS-HN domains and salivary flow were predictors of overall QoL and overall OFS. The sample was composed of 73 patients with a mean age of 62years and 51% were men. According to the PSS-HN domains, some patients (5%) always ate alone, 87% reported that speech is usually or always understandable, and 56% had no dietary restrictions. Sixty-one patients (65%) reported some degree of hyposalivation. The mean overall QoL score was 76.5 (standard deviation, 5.3). Patients with compromised PSS-HN domains had significantly worse overall UWQOL scores (P= .001, P < .001, and P= .006, respectively). In multiple regression analyses, understandability of speech was the only predictor of overall QoL scores. The results of this study showed that understandability of speech was the only predictor of overall QoL scores.

Rehabilitation of a complete maxillectomy patient: A case report of osteomyelitis of maxilla

Osteomyelitis of the jaws is osteomyelitis (which is inflammation of the bone marrow, sometimes abbreviated to OM) which occurs in the bones of the jaws (i.e. maxilla or the mandible). Historically, osteomyelitis of the jaws was a common complication of odontogenic infection (infections of the teeth). Before the antibiotic era, it was frequently a fatal condition. Today osteomyelitis of facial bones is a rare condition. Maxillary osteomyelitis is rare compared to mandible osteomyelitis because extensive blood supply & strut like bone of the maxilla make it less prone to chronic infection. We report a rare case of Osteomyelitis involving whole of the Maxilla in a 63 year old male patient, diabetic and hypertensive for the past 2 years. He presented to us with anpalatally exposed bone with offensive odour from the nose. Examination revealed a necrotic maxilla involving whole hard palate. A computerized tomography scan confirmed Osteomyelitis of whole Maxilla. Patient underwent complete surgical excision with prosthesis reconstruction. Prosthetic rehabilitation of patients with acquired defects of the maxilla present a challenging task because of inadequate retention and stability of prosthesis and these goals are even more challenging in a complete maxillectomy case. This case report describes the fabrication of prosthesis utilizing soft tissue undercuts for retention using soft liners as one technique and fabrication of a two piece prosthesis utilizing magnets to meet the goals.

Retrieval of residual alginate impression material from a small oral-nasal communication defect in a maxillectomy patient

Maxillectomy surgery can often result in oral-antral and oral-nasal communication defects that range from small isolated defects to large defects that are bilateral and extend to the orbit.1 These defects can occur in individuals who are dentate, partially edentulous, or completely edentulous.1 Many patients with these types of defects require prosthetic rehabilitation to improve phonation and deglutition.

KISMİ MAKSİLLEKTOMİ YAPILMIŞ HASTALARIN BUKKAL UZANTILI OBTURATÖR İLE PROTETİK REHABİLİTASYONU: VAKA RAPORU

Patients who underwent maxillectomy operation are faced with many problems like aesthetic, phonetic, functional, psychological. The treatment of patients is quite difficult and troublesome. Different treatment alternatives are available for maxillectomy patients. There are advantages and disadvantages of each treatments. The primarily aim of prosthetic rehabilitation is to cover the maxillary defect and eliminate the problems. The best treatment option is obturator when surgical techniques are not sufficient. Clinical findings etiology and prognosis of the case must be evaluated completely for exact treatment and suitable technique must be apply for treatment. In this article, rehabilitation with obturator prosthesis was explained for two patients subjected to maxillary resection at the end of tumoral reason

Scapular Tip Free Flap for Head and Neck Reconstruction.

ObjectivesHead and neck reconstruction is still challenging in terms of esthetic and functional outcomes. This study investigated the feasibility of the angular branch-based scapular tip free flap (STFF).MethodsThis was a retrospective study of 17 patients undergoing maxillectomy and mandibulectomy and either primary or secondary reconstruction by STFF. This study included surgical, esthetic, and functional outcomes, and detailed data are presented regarding the flap, such as pedicle length, size of the harvested bone, and failure rate. Medical photographs were used to estimate the esthetic outcome, and computed tomography was used to check the flap status postoperatively.ResultsThe data were collected from April 2013 to April 2014. Eight patients underwent maxillary reconstruction, and nine underwent mandibular reconstruction. Maxillary defects usually included unilateral alveolar structures and the palate; mandibular defects were usually those involving mandibular angle and short segment. Vein grafting was not required in any of the patients. Flap failure occurred in one of the 17 patients (5.9%) with successful reconstruction after revision. Of the eight maxillectomy patients, orbital revisions for diplopia after maxillary reconstruction were performed in two patients (25%), and oroantral fistula repair was performed in one patient (12.5%).ConclusionThis study demonstrated the reconstructive advantages of the angular branch-based STFF, long pedicle, low flap failure, 3-dimensional nature of bone and soft tissues (chimeric flap), and small rate of donor site morbidity with free ambulation. This flap is an excellent option for use in complex three-dimensional head and neck reconstruction.

Delayed obturator for irradiated maxillectomy patients: Case report of two patients

Functional rehabilitation is the sequel to tumor ablation and consequent cancer-free status in most patients. Unfortunately, a plethora of reasons may play a stellar role in delayed rehabilitation. These may range from unsuitability of the remnant tissue bed for prosthesis, prolonged tissue inflammation, postirradiation unfavorable tissue changes, and secondary bacterial or fungal infection in the recipient tissue bed. In some situations, the economic status of the patient may grossly restrict the patient's effort to seek prosthetic service. These unwarranted and undesirable obstacles would lead to gross facial disfigurement and a progressive tissue shrinkage which might render the recipient site nonamenable to the seating of the prosthesis. CLINICAL RELEVANCE TO INTERDISCIPLINARY DENTISTRY When prosthodontic therapy is not conjoint with surgery, the succeeding tissue contracture, and soft tissue collapse can lead to irreversible unesthetic, and contorted facial contours Components of prosthesis function assessed were esthetics, speech, mastication, all of which were restored to satisfactory levels by the interim obturators. Thus, optimal restoration of esthetics and function is achievable despite a time lag in prosthodontic therapy after surgery.

Prosthetic rehabilitation of the dentate maxillectomy patient from a delayed surgical to an interim obturator: A clinical case report

The surgical management of maxillary pathosis results in direct communication between the oral and nasal cavity, imposing problems such as nasal regurgitation, unintelligent speech, difficulty in deglutition and compromised esthetics. A restoration of these defects is not always possible surgically, but prosthetic rehabilitation is an established treatment modality. Early rehabilitation can improve the quality of life and reduce the psychological trauma caused by surgical excision. Surgical and interim obturators placed during the initial phase can improve the outcome of the definitive prosthesis. This article presents a case report of a patient with partial maxillectomy who has been rehabilitated with a delayed surgical and an interim obturator.

Aesthetic rehabilitation of a patient with an anterior maxillectomy defect, using an innovative single-step, single unit, plastic-based hollow obturator

What could be better than improving the comfort and quality of life of a patient with a life-threatening disease? Maxillectomy, the partial or total removal of the maxilla in patients suffering from benign or malignant neoplasms, creates a challenging defect for the maxillofacial prosthodontist when attempting to provide an effective obturator. Although previous methods have been described for rehabilitation of such patients, our goal should be to devise one stage techniques that will allow the patient an improved quality of life as soon as possible. The present report describes the aesthetic rehabilitation of a maxillectomy patient by use of a hollow obturator. The obturator is fabricated through a processing technique which is a variation of other well-known techniques, consisting of the use of a single-step flasking procedure to fabricate a single-unit hollow obturator using the lost salt technique. As our aim is to aesthetically and functionally rehabilitate the patient as soon as possible, the present method of restoring the maxillectomy defect is cost-effective, time-saving and beneficial for the patient.

Prosthodontic management of maxillectomy patients with dental implants in residual zygomatic bone: a preliminary report.

This report describes the 3-year follow-up of clinical and radiographic evaluation of soft and hard tissue outcomes for dental implants placed in residual zygoma in patients with surgical resections. Obturator retention and support, together with a questionnaire evaluation of the patients' satisfaction before and after insertion of implants, also were carried out. A novel approach to the palatomaxillary reconstruction of eight maxillectomy patients (mean age: 40 years) using dental implants inserted into the remaining zygomatic bone on the affected side and left unloaded for 3 months is described. Ball (O-ring) abutments were used with acrylic resin soft tissue conformers after surgical soft tissue thinning above the implants. All patients were radiographically evaluated and clinically documented at regular follow-up appointments. The 3-year follow-up period showed no implant failures, stable peri-implant soft tissue level, and an increase in all of the patients' satisfaction with their implant-supported obturators. Osseointegrated implants in residual zygomas are an integral part of oral rehabilitation strategies, with minimal cost and complications, for maxillectomy patients. This short-term record underscores both the potential of such management interventions and the importance of even longer-term clinical outcome documentation.

Novel method of fabricating individual trays for maxillectomy patients by computer-aided design and rapid prototyping.

Making impressions for maxillectomy patients is an essential but difficult task. This study developed a novel method to fabricate individual trays by computer-aided design (CAD) and rapid prototyping (RP) to simplify the process and enhance patient safety. Five unilateral maxillectomy patients were recruited for this study. For each patient, a computed tomography (CT) scan was taken. Based on the 3D surface reconstruction of the target area, an individual tray was manufactured by CAD/RP. With a conventional custom tray as control, two final impressions were made using the different types of tray for each patient. The trays were sectioned, and in each section the thickness of the material was measured at six evenly distributed points. Descriptive statistics and paired t-test were used to examine the difference of the impression thickness. SAS 9.3 was applied in the statistical analysis. Afterwards, all casts were then optically 3D scanned and compared digitally to evaluate the feasibility of this method. Impressions of all five maxillectomy patients were successfully made with individual trays fabricated by CAD/RP and traditional trays. The descriptive statistics of impression thickness measurement showed slightly more uneven results in the traditional trays, but no statistical significance was shown. A 3D digital comparison showed acceptable discrepancies within 1 mm in the majority of cast areas. The largest difference of 3 mm was observed in the buccal wall of the defective areas. Moderate deviations of 1 to 2 mm were detected in the buccal and labial vestibular groove areas. This study confirmed the feasibility of a novel method of fabricating individual trays by CAD/RP. Impressions made by individual trays manufactured using CAD/RP had a uniform thickness, with an acceptable level of accuracy compared to those made through conventional processes.

English

Benign or malignant tumors of mouth and oropharyngeal region often result in the maxillofacial defects. The acquired maxillectomy defects results in the impairment of speech, mastication, swallowing and facial esthetics. The Prosthodontist plays a significant role in the rehabilitation of the acquired maxillectomy defects with the special emphasis to the reduction of the weight of the prosthesis and thereby enhancing the retention and stability. The weight of the obturator can cause a dislodging force. It must therefore be as light as possible. A suitable technique of fabrication should be selected to achieve this. This case report describes the fabrication of a hollow bulb obturator for a hemi- maxillectomy patient (Aramany's class 1 defect) who had undergone wide excision and alveolar resection squeal of management of adenoid cystic carcinoma of the right palate. This article describes the step by step clinical and laboratory procedure involved in the rehabilitation of a hemimaxillectoy dentate patients using obturator lined with soft liner to restore the functions such as esthetics, mastication, deglutition and speech.

Rehabilitation of Disfigurement Associated with Maxillectomy by a Cheek Plumper Prosthesis

Patients having undergone maxillectomy as a result of carcinoma in the region or facial trauma are left with severe facial disfigurement that is associated with long term psychosocial effects. As one side of the face loses the crucial support from the maxilla, innovative customized treatment options become the choice of rehabilitation. Ideally, such treatment should be preceded by consultation with a prosthodontist which unfortunately most of the times is not the case. Rehabilitation of maxillectomy patients is not possible without incorporating the dynamics of facial expression. This article discusses a patient having undergone maxillectomy who was successfully rehabilitated with an obturator that had an additional lip/cheek plumper incorporated in its design.

Measurement of Voice Onset Time in Maxillectomy Patients

Objective speech evaluation using acoustic measurement is needed for the proper rehabilitation of maxillectomy patients. For digital evaluation of consonants, measurement of voice onset time is one option. However, voice onset time has not been measured in maxillectomy patients as their consonant sound spectra exhibit unique characteristics that make the measurement of voice onset time challenging. In this study, we established criteria for measuring voice onset time in maxillectomy patients for objective speech evaluation. We examined voice onset time for /ka/ and /ta/ in 13 maxillectomy patients by calculating the number of valid measurements of voice onset time out of three trials for each syllable. Wilcoxon's signed rank test showed that voice onset time measurements were more successful for /ka/ and /ta/ when a prosthesis was used (Z = −2.232, P = 0.026 and Z = −2.401, P = 0.016, resp.) than when a prosthesis was not used. These results indicate a prosthesis affected voice onset measurement in these patients. Although more research in this area is needed, measurement of voice onset time has the potential to be used to evaluate consonant production in maxillectomy patients wearing a prosthesis.

Prosthetic rehabilitation of maxillectomy patient with telescopic cast partial denture

Surgical management of Benign or Malignant neoplasm, congenital malformations, maxillofacial trauma or neuromuscular disease would result in maxillofacial defects. The size and location of these defects influence the degree of impairment and difficulty in prosthetic rehabilitation. Lack of support, retention, and stability of the prosthesis are some of the common problems in maxillectomy patients. Apart from these, social integration also becomes difficult as the quality of their lives is altered. Retention of partial denture prosthesis in rehabilitation of maxillectomy patient has been an enigma for prosthodontist. However, a well-planned prosthesis fabricated in accordance to the designing principles, reinforced by knowledge and skill of the prosthodontist would result in prosthesis with improved retention and stability. This case report presents management of a female patient with hemimaxillectomy using a telescopic cast partial denture treatment modality that resulted in enhanced quality of life with optimal aesthetics and functional adequacy.

Prosthodontic Rehabilitatative Therapy through Surgical Obturator for Maxillectomy Patients: A Review

The maxillofacial patient experiences a unique alteration in the normal oral/craniofacial environment and functions, which are the results of congenital, traumatic or surgical insults. Maxillofacial Prosthetics aimed to attain the optimal functions, such as speech and swallowing, and normalcy of surrounding structure. The provision of surgical obturator is one step in achieving normalcy, as it allows covering the deficiencies/defects to regain optimal/suboptimal functions immediately after surgical resection. This paper provides an overview on the designing principles, goals and role of surgical obturator in rehabilitating maxillectomy cases.