Maxillectomy Patients Research Articles

Prospective Clinical Pilot Study to Evaluate the Effect of Prosthodontic Rehabilitation on Psychological Status and Quality of Life in Maxillectomy Patients: An Indian Experience.

The purpose of the study was to assess psychological status (PS) and quality of life (QOL) before surgical resection of maxilla (T0), 2weeks after resection (T1), 2weeks after use of intermediate obturator (T2), before (T3) and 12weeks after use of definitive obturator (T4). 20 participants, planned for resection of maxilla and subsequent prosthodontic rehabilitation were enrolled. Assessment was done using Hospital Anxiety and Depression Scale (HADS) (HADS-A: anxiety and HADS-D: depression) for PS, World Health Organization Quality of Life BREF (WHOQOL-BREF) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire- Head and Neck Module (EORTC QLQ- H&N35) for QOL, and obturator functioning scale (OFS) for obturator functioning. Six cases were dropped out. Highest HADS-A score was observed presurgically (18.7 ± 1.1) and highest HADS-D score at T1 (18.5 ± 1.8). After rehabilitation, HADS-A and HADS-D decreased significantly (P < 001). Least WHOQOL-BREF score was observed at T1, followed by a consistent, significant rise after rehabilitation at all time intervals (P < 001). Highest EORTC QLQ-H&N 35 score was observed at T1, with significant reduction (P < 0.001) after rehabilitation for all questions, except those related to sexual wellness (P = 1). Highest OFS were observed at T2 (3.1 ± 10.3) and least at T4 (1.9 ± 0.2). QOL and PS decline after maxillectomy. Patient education and rehabilitation with obturator leads to improvement in QOL and PS probably due to restored oral functions, and improved health of soft tissue. Both parameters improved with enhanced obturator quality and time. Reg. No. CTRI/2018/04/013164 http://ctri.nic.in/Clinicaltrials/regtrial.php?modid=1&compid=19&EncHid=67729.89030.

Rehablitation of a maxillectomy patient with hollow bulb obturator: A case report

God has given beautiful face and smile to human being. It is right of every individual to look good. If an individual lost his/her facial part due to certain cause, it has to be restored immediately. Patient will face severe mental trauma and functional disability after maxillofacial structure loss. Post-surgical maxillary defects pre-dispose the patient to hypernasal speech, fluid leakage into the nasal cavity, and impaired masticatory function. Such defects need special prosthesis to establish oro-nasal seal and rehabilitate the patient. After maxillectomy, the prosthodontist treats the defect with obturator. The obturator takes the retention from remaining teeth, undercut areas and scar bands around the defect. In this article, a technique for creating an interim maxillary hollow bulb obturator that engages the remaining teeth, undercut areas and scar band around the defect is described. Keywords: Maxillectomy, Obturator, Oroantral communication, Interim obturator, Pre-maxilla defect.

Clinician’s Choice of Health Related Quality of Life Index in Maxillectomy Patients with Obturator Prostheses: A Systematic Review

Clinician’s Choice of Health Related Quality of Life Index in Maxillectomy Patients with Obturator Prostheses: A Systematic Review

Comparison of Data Acquisition for Maxillectomy Patients Using Two Different Intraoral Scanners

Comparison of Data Acquisition for Maxillectomy Patients Using Two Different Intraoral Scanners

Oral rehabilitation with an implant-retained obturator prosthesis for a maxillectomy patient: A case report

Oral rehabilitation with an implant-retained obturator prosthesis for a maxillectomy patient: A case report

Validation of masticatory function and related factors in maxillectomy patients based on the concept of "oral hypofunction": A retrospective cross-sectional study.

Purpose Although oral functions have been evaluated by various methods in maxillectomy patients, there exists substantial difficulty in the assessment procedures. The purpose of this study was to evaluate masticatory function, maximum occlusal force (MOF), and maximum tongue pressure (MTP) in maxillectomy patients objectively as per the "oral hypofunction" criteria, and examine the factors that correlate with masticatory function.Methods This retrospective cross-sectional study included 50 maxillectomy patients with maxillofacial prostheses (23 males and 27 females, median age, 72 years; interquartile range (IQR), 63.75-77). The records of masticatory function, MOF, and MTP as per the "oral hypofunction" criteria and their profiles (age, number of occlusal supports, and maxillary defect configuration) were reviewed. The number of patients who exceeded a threshold value of "oral hypofunction" and the effects of occlusal support and defect configuration on masticatory function and MOF were calculated. Multiple regression analysis was performed to assess the associations between masticatory function and other variables.Results The median value of masticatory function (114 mg/dL, IQR: 73-167.5) exceeded a threshold value, but not MOF (229.2 N, IQR: 110.2-419.6) and MTP (25.9 kPa, IQR: 21.4-29.0). The number of patients who exceeded each threshold value was 27 (masticatory function), 8 (MOF), and 12 (MTP), respectively. The influence of the number of occlusal supports, but not the defect configuration, was statistically significant. Multiple regression analysis revealed that MOF was independently related to masticatory function (P=0.042).Conclusions Within the limitations of this study, the median value of masticatory function in maxillectomy patients could exceed a threshold and MOF might be an independent predictor of masticatory function.

A novel technique to maximise retention in the rehabilitation of maxillectomy patients with three piece hollow bulb obturator – A case report

A novel technique to maximise retention in the rehabilitation of maxillectomy patients with three piece hollow bulb obturator – A case report - APRD- Print ISSN No: - 2581-4796 Online ISSN No:- 2581-480X Article DOI No:- 10.18231/j.aprd.2020.047, IP Annals of Prosthodontics and Restorative Dentistry-IP Ann Prosthodon

Spring retained surgical obturator followed by closed hollow definitive obturator using lost wax bolus technique in a total maxillectomy patient- a case report

Total maxillectomy is referred to as bilateral resection of maxillae in patients suffering from a benign, malignant neoplasm or chronic infections like osteomyelitis, etc. It causes communication between the oral and antral cavity extending to the nasopharynx. A complete bilateral maxillectomy defect presents a considerably reconstructive challenge for the prosthodontist because of the absence of normal hard and soft tissues for the support of prosthesis. The surgical obturator was retained via spring which develops the seal between the acrylic plate and the dorsum of the tongue during deglutition, thus helping the patient to take a soft diet orally during the healing period. The definitive conventional closed bulb hollow obturator fabricated using the “lost wax bolus” technique, is a reliable and feasible treatment option to restore the total maxillectomy defect, thus improving and enhancing the quality of patient’s life and livelihood.

Nutrition assessment of an elderly patient with recurrent advanced carcinoma of the maxilla: A case report

Maxillectomy patients require a maxillofacial prosthesis for improving quality of life from the preoperative period to the stage of palliative care. This case report describes maxillofacial prosthetic treatment from the aspect of nutrition by following the condition of a 69-year-old woman who received surgery for a right-side carcinoma of the maxilla. After the initial treatment, metastatic disease was found, and her nutritional status worsened steadily. Although the prognosis may be poor, maxillofacial prosthodontic treatment should be given in order to maintain nutritional status and quality of life and to achieve optimal function for the patient as palliative care. (Int J Maxillofac Prosthetics 2020;3:28-31)

Aesthetic outcome following prosthetic rehabilitation after ablative maxillary surgery. A Preliminary Study

Objective: Psychological impact of poor dento-facial aesthetics constitutes a major part of the low quality of life in maxillectomy patients. The purpose of this study was to present the aesthetic outcome following prosthetic rehabilitation after ablative maxillary surgery.Method: All consecutive patients that had surgery for tumours affecting the upper jaw and gave their consent were included in the study. Classification of maxillectomy was based on the Brown's classification. Facial attractiveness after final prosthetic rehabilitation was graded by two independent observers with a modified Liekert scale into four grades. For the purpose of comparison of facial attractiveness, the patients were divided into 2 groups: those below 2A and those above 2A.Result: Seventeen patients with tumours affecting the upper jaw were operated. Ten (58.8%) were females and 7 (41.2%) were males. The age range was 6-65 years, mean (SD), 37.6 (18.5) years. Two (11.8%) cases were children. There were 3 (17.6%) cases in the level 1, one case was 1A, two cases were 1B; 11 (64.7%) cases in level 2, 8 (47.1%) cases were 2A, 3 (17.6%) cases were 2B and 3 (17.6%) cases in level 3. Two (11.8%) patients, both in the level 2B had moderately attractive appearances and also, 2(11.8%) patients in the levels 2B and 3B respectively had least attractive appearances.Conclusion: Majority of our patients had resections at levels 2A and below and there was no obvious difference between the two groups, immediate prosthetic obturation may have minimized collapse of midface in those above 2A.&#x0D;

Contemporary treatment modalities for definitive rehabilitation of acquired maxillary defects – A review

Various techniques have been described to restore acquired maxillary defects. The aim of this paper is to review the contemporary treatment modalities that have been explored to rehabilitate and reconstruct partial or complete maxillectomy in dentulous and edentulous patients. MEDLINE/PUBMED search was conducted for dental literature published from January 2000 to December 2018. Literature study revealed various methods and materials used to treat patients with acquired maxillary defects. These include modifications in method and materials used for the fabrication of conventional obturators (using precision and semi-precision attachments, telescopic copings, magnets, silicone based materials, titanium and its alloys, PEEK, thermoplastic resin); implant-supported obturators supported on conventional, zygomatic and pterygoid implants using different attachments (ERA, magnet, bar attachment, locator, ball attachment); use of CAD/CAM technology for presurgical planning and fabrication of obturator prosthesis; surgical reconstruction with microvascular free tissue flaps; and bone engineering. Significant attention has been devoted to refining current methods and developing better methods to successfully rehabilitate maxillectomy patients. The use of osseointegrated implants, newer prosthesis materials, advanced laboratory procedures, inclusion of CAD/CAM technology, advances in surgical reconstructive techniques and tissue engineering has revolutionized the traditional treatment options. Keywords: Maxillectomy, Implants in maxillectomy, Microvascular free flap, Bone tissue engineering.

Mastication in maxillectomy patients: A comparison between reconstructed maxillae and implant supported obturators: A cross-sectional study.

ObjectiveThe aim of this study was to compare masticatory performance and patient reported eating ability of maxillectomy patients with implant‐supported obturators and patients with surgically reconstructed maxillae.MethodsThis cross‐sectional study was conducted at the University of Alberta, Edmonton, Canada and at Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. Eleven surgically reconstructed maxillectomy patients have been included at University of Alberta and nine implant‐supported obturator patients at MUMC+. The mixing ability test (MAT) was used to measure masticatory performance. In addition, the oral health related quality of life (OHRQoL) was measured with shortened versions of the oral health impact profile (OHIP) questionnaire. Values of the implant‐supported obturator group versus the surgical reconstruction group were compared with independent t‐tests in case of normal distribution, otherwise the Mann‐Whitney U test was applied.ResultsPatients with reconstructed maxillae and patients with implant‐supported obturator prostheses had similar mean mixing ability indices (18.20 ± 2.38 resp. 18.66 ± 1.37; P = .614). The seven OHRQoL questions also showed no differences in masticatory ability between the two groups.ConclusionWith caution, the results of this study seem to confirm earlier results that implant‐supported obturation is a good alternative to surgical reconstruction for all Class II maxillary defects. With both techniques, the masticatory performance is sufficiently restored, with careful planning being highly desirable.

Three Assessments of Food-mixing Ability and Their Association with Food-comminuting and Perceived Chewing Ability in Maxillectomy Patients

Three Assessments of Food-mixing Ability and Their Association with Food-comminuting and Perceived Chewing Ability in Maxillectomy Patients

Obturators to facilitate speech and swallowing in a maxillectomy patient with dementia and cerebral infarction

The purpose of dental treatments normally includes the recovery from the functional impairments and aesthetic problems. This case report describes the rehabilitation of a maxillectomy patient with dementia and cerebral infarction, using obturators made of different materials to facilitate speech and swallowing. The patient had difficulty inserting the original prosthesis by himself and would sometimes bite down on the obturator to position it in his mouth instead of using his hands. As a result, the obturator caused irritation and bleeding, especially in the sensitive maxillectomy area. Ultimately, a new obturator with a base made of heat-cured acrylic resin and a bulb made of silicone was delivered. In this article, we describe the case and discuss the use of the obturator to recover swallowing and speech function in this patient. (Int J Maxillofac Prosthetics 2019;1:33-35)

Masticatory performance and oral health-related quality of life in edentulous maxillectomy patients: A cross-sectional study to compare implant-supported obturators and conventional obturators.

ObjectiveThe aim of this cross‐sectional study was to compare the masticatory performance and oral health‐related quality of life (OHRQoL) of edentulous maxillectomy patients with and without implant‐supported obturator prostheses.Material and methodsNineteen edentulous maxillectomy patients with completed prosthetic obturator treatment in the upper jaw participated in this study. In nine patients, the obturator prosthesis was supported by implants in the remaining bone of the midface and/or skull base to improve retention. Masticatory performance was measured objectively by the mixing ability test (MAT) and subjectively by three OHRQoL questionnaires: (a) the Oral Health Impact Profile for EDENTulous people (OHIP‐EDENT), (b) the Obturator Function Scale (OFS), and (c) the Dutch Liverpool Oral Rehabilitation Questionnaire version 3 (LORQv3‐NL). The independent t test and the Mann–Whitney U test were used to test for differences in outcomes of patients with and without implant‐retention of their obturator prostheses.ResultsPatients with implant‐supported obturator prostheses had significantly better masticatory and oral function, reported fewer chewing difficulties, and had less discomfort during food intake than did patients with a conventional obturator.ConclusionSupporting prosthetic obturators after maxillectomy with implants improve oral functioning, chewing, and eating comfort. This treatment modality is a viable technique to improve the functionality of prosthetic rehabilitation in patients who have undergone maxillectomy.

Relationship between Intraoral Air Pressure and Sound Pressure during Pronunciation in Maxillectomy Patients with and without Obturator

Relationship between Intraoral Air Pressure and Sound Pressure during Pronunciation in Maxillectomy Patients with and without Obturator

Rehabilitating a maxillectomy patient by interdisciplinary alveolar bone preservation technique using submergence of teeth roots

Retention for edentulous maxillary obturator is always challenging. Although implants offer good retention in edentulous patients, lack of tissue beds, less predictable integration, economic constraints may preclude implantation. Therefore, the preservation of residual alveolar ridge is mandatory to enhance the retention, support, and stability of the removable obturator prosthesis. Retaining roots through “Root submergence technique” maintains the attachment apparatus and aids in decreasing the resorptive pattern, thereby preserving the residual ridge to some extent. Here, we report a case in which nonvital root submergence is carried out in a partial maxillectomy patient to prevent alveolar ridge resorption adhering to DeVan's dictum “Perpetual preservation” of what remains is more important than the meticulous replacement of what is missing.

Are zygomatic implants a simple and reliable technique for the stabilization of obturator prostheses? Case report and review of the literature

Zygomatic implants have been used for several years for the treatment of extremely resorbed maxilla. Indications were extended for oral rehabilitations after maxillectomy in oncologic patients. A 24-year old patient with a triple A syndrome who underwent a left maxillectomy due to a spinocellular tumour was addressed for prosthetic rehabilitation. As his obturator prosthesis failed, surgical closure of the defect combined with 2 zygomatic implants to support the prosthesis was proposed. Despite a small persistent oro-antral fistula, the new obturator prosthesis restored the patient's functions and esthetics and improved his quality of life. The literature reports less than 40 cases of maxillectomy patients rehabilitated with zygomatic implants (with or without flap closure of the defect). Regardless of implant placement, there is no significant difference between reconstructive surgery and obturator prosthesis. Thus, zygomatic implants seem to be a reliable method for the stabilization of obturator prosthesis, without complex surgical procedure. Nonetheless, reservations should be expressed given the lack of data in terms of long-term follow up.

Effect of Direct Retainer Types for a Dento-maxillary Prosthesis on Abutment Teeth of Maxillectomy Patients: In Vitro Study

Effect of Direct Retainer Types for a Dento-maxillary Prosthesis on Abutment Teeth of Maxillectomy Patients: In Vitro Study

Rehabilitation of partially resected maxillectomy patient

"Face is the mirror of the soul." Rehabilitation of the patient with congenital or acquired defect of the hard palate and soft palate is a new era in prosthodontics. Acquired maxillofacial defects due to tumors, surgical intervention, and trauma impair the stomatognathic system and aesthetics. Cancers of the head and neck have the potential for producing obvious disfigurement and dysfunction, which may be only partially compensated for by prosthesis and rehabilitation. Intraoral defects Like maxillectomy, mandibulectomy can be rehabilitated with a conventional removable dental prosthesis (cast partial denture) or newer advancements like implants retained prosthesis. This case report describes the fabrication of definitive prosthesis for an individual who underwent partial maxillectomy.