Palatal Obturator Research Articles

Limits of prosthetic rehabilitation of cocaine-induced midline destructive lesions: Time to change the paradigm

The steady rise in cocaine consumption, particularly in its snorted form, has led to the increased incidence of cocaine-induced midline destructive lesions (CIMDLs), a severe condition resulting from chronic cocaine use that leads to significant tissue destruction in the nasal and palatal regions. Four patients with CIMDLs are presented, all characterized by nasopalatine perforation. Each patient reported a spontaneous onset of tissue loss in the hard palate near the midline, with the affected area ranging from 2.3 to 5.1 cm². All patients had a history of psychiatric conditions, including depressive episodes but without other significant medical conditions, which contributed to an average delay of 9 months before seeking initial medical consultation. Treatment, which included the use of palatal obturators to improve quality of life, remains nonstandardized and, combined with the patients' continued cocaine use and refusal of addiction care, led to poor follow-up and persistent tissue damage. This clinical report underscores the need for a paradigm shift in managing CIMDLs, emphasizing the integration of addiction treatment and psychological support with prosthetic rehabilitation to optimize long-term outcomes and prevent relapse.

REHABILITATION WITH OBTURATOR PROSTHESES IN PATIENTS AFTER MAXILLECTOMY: An integrative literature review

Maxillectomy is used for the removal of neoplastic tissues in the maxilla and adjacent regions. Defects in the maxilla resulting from this surgical approach generally lead to physical dysfunctions and compromise oral function, including problems with chewing, swallowing, and speech, as well as aesthetic impairments. To minimize the sequelae of maxillectomized patients, the fabrication of obturator prostheses is advocated to block communication between the oral and nasal cavities, enabling functional and aesthetic recovery. This study aims to present an integrative literature review on rehabilitation with obturator prostheses after maxillectomy. The literature search included PubMed, Medical Literature Analysis and Retrieval System Online, ScienceDirect, and the Scientific Electronic Library Online, using a combination of the MeSH terms "Palatal Obturators," "Oral Cancer," and "Oral Rehabilitation." Studies suggest that the greater the tissue destruction, the worse the prognosis, due to greater difficulty in sealing and retaining obturator prostheses, as well as aesthetically unfavorable outcomes. Modified prostheses have superior results in terms of retention, stability, and sealing compared to conventional ones. The use of obturator prostheses is considered an effective treatment option for patients undergoing maxillectomy, as it can restore chewing and speech functions, as well as acceptable aesthetics, contributing to an improvement in quality of life. The importance of the appropriate professional approach from the beginning of treatment is emphasized, considering long-term planning and follow-up ideally.

Fabrication of a definitive obturator for a patient with partial maxillectomy defect following post-covid mucormycosis: A case report

Mucormycosis was a rapidly progressing and life-threatening fungal infection. After surgery, we should anticipate seeing more individuals with orofacial abnormalities given the total number of cases and the orofacial region's primary involvement in the previous COVID-19 pandemic. Thus, in order to improve the quality of life for individuals suffering from mucormycosis, maxillofacial prosthetic rehabilitation is of paramount importance. Postoperative maxillary defects can be rehabilitated through surgical and prosthetic procedures. An obturator was utilized as a part of prosthetic management to facilitate efficient deglutition and articulation. It also provides support for the facial soft tissue to restore the midfacial contour in cases of palatal defects. This case report describes about the fabrication of a definitive palatal obturator for a patient with postsurgical maxillary defect wearing interim obturator made of polymethyl methacrylate (PMMA). Food impaction and irritation of the fitting surface over the tissue defect, resulting in erythema to the tissue surface and discomfort of using interim obturator. With the remaining teeth and tissues serving as support, the definitive obturator made of cobalt and chromium was made. With no degradation in the prosthesis, the follow-up showed satisfactory outcomes.

Fabrication of an interim buccal-retaining flange obturator for a patient undergoing partial maxillectomy

Abstract Prosthodontic treatment of palatal defects focuses on closing oronasal communication and improving masticatory function, speech, esthetics, and comfort. The most difficult aspect of rehabilitating patients with hemimaxillectomy is ensuring the prosthesis has enough retention and stability. During healing, a simpler design and effective retention should adequately meet the patient’s functional requirements. This case report presents the fabrication of an interim cost-effective and retentive buccal flange palatal obturator for a 65-year-old male patient who had an acquired maxillary defect resulting in mastication and deglutition difficulties. In this report, the retention of the obturator was achieved by utilizing the remaining teeth and employing a flexible thermoplastic buccal flange, with a wrought-wire U-shaped loop, on the buccal surfaces of the left canine, premolars, and molars. A complete palatal acrylic palate was designed to achieve optimal distribution of load to the surrounding tissues. To enhance patient comfort, the obturator featured a closed hollow bulb, reducing its overall bulk and making it lightweight. This interim prosthesis successfully rehabilitated the patient, resulting in improved masticatory efficiency, enhanced speech clarity, and an overall improvement in the patient’s quality of life.

3D Printing for the Development of Palatal Defect Prosthetics.

Three-dimensional (3D) printing has emerged as a promising new technology for the development of surgical prosthetics. Research in orthopedic surgery has demonstrated that using 3D printed customized prosthetics results in more precise implant placements and better patient outcomes. However, there has been little research on implementing customized 3D printed prosthetics in otolaryngology. The program sought to determine whether computed tomography (CT) serves as feasible templates to construct 3D printed palatal obturator prosthetics for defects in patients who have been treated for head and neck cancers. A retrospective review of patients with palatal defects was conducted and identified 1 patient with high quality CTs compatible with 3D modeling. CTs of the patient's craniofacial anatomy were used to develop a 3D model and a Formlabs 3B+ printer printed the palatal prosthetic. We successfully developed and produced an individualized prosthetic using CTs from a veteran with head and neck deformities caused by cancer treatment who was previously treated at the Veterans Affairs Palo Alto Health Care System. This project was successful in printing patient-specific implants using CT reproductions of the patient's craniofacial anatomy, particularly of the palate. The program was a proof of concept and the implant we created was not used on the patient. Customized 3D printed implants may allow otolaryngologists to enhance the performance and efficiency of surgeries and better rehabilitate and reconstruct craniofacial deformities to restore appearance and function to patients. Additional research will strive to enhance the therapeutic potential of these prosthetics to serve as low-cost, patient-specific implants.

Image Guided Palatal Obturator Design and Fabrication for Maxillectomy Defect in the Case of Acute Invasive Fungal Sinusitis

Acute invasive fungal sinusitis requires a high clinical suspicion and rapid diagnosis for initiation of surgical and medical treatment. Due to necessity of expedited surgical treatment, evaluation and impression making by a maxillofacial prosthodontist is rarely possible prior to debridement. Surgical debridement often results in maxillary defects, which can negatively impact speech, deglutition, and respiration. A surgical obturator occludes the palatal defect resulting in improved speech, swallowing and prevention of wound contamination with food particulate. This article focuses on utilizing medical imaging, usually acquired for diagnosis and surgical planning, to fabricate a well-fitting surgical obturator without conventional or digital intraoral dental impression making.

Recommendations for post-rehabilitation care of maxillofacial prostheses

Aim: This study aimed to review the scientific literature to describe the main care and hygiene protocols for different types of maxillofacial prostheses (MFP). Methods: A bibliographic search on the PubMed / Medline database using the following keywords: [“maxillofacial prosthesis” OR “ocular prostheses” OR “palatal obturators”] AND [“Cleaning” OR “disinfection”] AND [“care”] AND [“color stability”] OR [“denture cleansers” OR “cleansing agents”]. Articles addressing materials, cleaning and disinfection protocols, and care related to MFP were included. The following exclusion criteria were applied: no adequate methodology, incompatibility with the area of interest, and unavailability for reading in full. Results: The papers were grouped into the following topics: facial prostheses, ocular prostheses, maxillofacial intraoral prostheses, and retention systems. Conclusion: Despite the MFP changes over time, its degradation decreases upon following the recommendations and post-adaptation care. The guidelines for cleaning and disinfection must be individualized to guarantee the longevity of the prosthesis and the patient health.

Palato-Antral Involvement of a Primary Extracranial Sinonasal Meningioma

Primary extracranial sinonasal meningiomas are one of the rarest tumours involving the head and neck region. Very few reports exist with additional involvement of the palato-antral region. This paper describes a case of primary extracranial sinonasal meningioma with palatal involvement and the management of the same. The patient was taken up for surgical excision via intra-oral and endoscopic approaches. Postoperative healing was uneventful with no recurrence noted over 2 years. A palatal obturator was used for rehabilitation. The diagnosis of this pathology needs additional immunohistochemistry testing for confirmation and treatment entails complete surgical excision which assures no recurrence or delayed presentation of residual disease in follow-up.
 Keywords: primary extra cranial meningioma; sinonasal; maxilla ; palate.

Obturator hygiene among patients with maxillary defects at two teaching hospitals in Ghana

Background: An obturator may be defined as the component of a prosthesis that fits into and closes a defect within the oral cavity or other body defects. Cleaning one’s obturator is essential to prevent offensive odour, poor aesthetics, the accumulation of plaques, and damage to both natural and prosthetic teeth due to bacteria contamination in the oral cavity.Aim: The study aimed to determine how palatal obturator wearers practice good obturator cleaning habits.Method: A cross-sectional study design was used for this study. A sample size of 40 palatal obturator wearers was used. Data was collected using a well-structured questionnaire. The questionnaire included demographic data (age, sex, educational level, occupation and years of wearing a prosthesis, obturator cleaning habits, obturator cleaning methods, and obturator wearing habits. The data were summarized using Descriptive statistics with tables and charts and analyzed using a chi-square test from Statistical Package for Social Sciences (SPSS version 22.0) and Microsoft Office Excel 2016 at p-value< 0.05.Results: Sixteen (40%) of the total number were males, and 24(60%) were females giving a male-to-female ratio of 2:3. Twelve (30%) of the participants fell between the ages 31-40 years. Participants with tertiary education have better cleaning habits and knowledge of cleaning agents used. Fifteen (37.5%) participants who had worn a palatal obturator between 1-2 years frequently visited the dental clinic for a check-up; however, this number gradually decreased.Conclusion: The majority of the patients evaluated had good clean habits with their prostheses and the cleaning agents used. However, participants with tertiary education had better prosthesis hygiene and maintenance methods.

Full digital workflow of a 2-piece obturator with polyetherketoneketone in a patient with maxillectomy and trismus: A clinical and laboratory report

The computer-aided design and computer-assisted manufacturing of a 2-piece definitive palatal obturator 3D printed from polyetherketoneketone and 2 acrylic resins with a fully digital workflow are presented for a patient who was diagnosed with adenoid cystic carcinoma and who developed severely limited mouth opening after surgery and radiotherapy. The 18-month follow-up period revealed satisfactory function, tissue compatibility, retention, and esthetics for this patient with a maxillectomy and severe trismus.

Surgical management of mandibular and maxillary central giant cell granuloma

BackgroundCentral giant cell granuloma is a benign intraosseous lesion of bone. It frequently affects the head and neck region, particularly the maxillary and mandibular bones. Despite the availability of various nonsurgical treatment options, surgery is still the most effective treatment option for granulomas that do not respond to medical treatment, cause significant bone deformities, or result in extensive bleeding. In this article, we aimed to show the importance of surgery in certain patients by sharing our experience with five patients who were operated on in our clinic.Case presentationIn this case series, five patients who attended our clinic with central giant cell granuloma disease and underwent surgical treatments were retrospectively evaluated utilizing the hospital database records. Demographic and medical information, symptoms at admission, the results of CT and MRI imaging, pathologic results, previous treatments, and the surgical therapy performed at our clinic were all considered. Surgical procedures were performed in five patients; marginal mandibulectomy in two, segmental mandibulectomy in one, and partial maxillectomy in the other two. The granulation tissues in the cavity were removed using curettage and a diamond burr. Primary suture, secondary healing, palatal obturator repair, and free fibula flap reconstruction techniques were performed.ConclusionsThe objective of surgical therapy for central giant cell granuloma is to remove the mass with appropriate surgery and repair it properly with the least amount of morbidity and risk of recurrence possible.

Different Manufacturing Techniques Accuracy of Palatal Obturator for Acquired Palatal Defect In Treatment Of Post COVID-19 Associated Mucormycosis (CAM)

Different Manufacturing Techniques Accuracy of Palatal Obturator for Acquired Palatal Defect In Treatment Of Post COVID-19 Associated Mucormycosis (CAM)

HIGH - GRADE OSTEOBLASTIC OSTEOSARCOMA OF THE MAXILLA: DIAGNOSIS, TREATMENT, AND BUCCOMAXILLOFACIAL REHABILITATION

Osteosarcoma is one of the most common malignant bone lesions; however, it comprises only 6%-8% of all osteosarcomas. It is a lesion commonly found between the third and fourth decade of life, in addition to having a similar proportion of appearing between the mandible and maxilla. This study aims to report the case of a 64-year-old Caucasian female patient, affected by a high-grade osteoblastic osteosarcoma. The patient presented an edema in the posterior region of the maxilla, paresthesia, and nasal obstruction. Panoramic radiography and CT scans, along with anatomopathological examination, were performed. Histopathologically, an intense volume of osteoid was found. Left radial maxillectomy was the chosen treatment. The patient was first rehabilitated with a provisional palatal obturator prosthesis in order to improve her nutritional status. Her rehabilitation was planned and accomplished with a mandibular removable partial denture and a maxillary removable partial obturator denture. Osteosarcoma is one of the most common malignant bone lesions; however, it comprises only 6%-8% of all osteosarcomas. It is a lesion commonly found between the third and fourth decade of life, in addition to having a similar proportion of appearing between the mandible and maxilla. This study aims to report the case of a 64-year-old Caucasian female patient, affected by a high-grade osteoblastic osteosarcoma. The patient presented an edema in the posterior region of the maxilla, paresthesia, and nasal obstruction. Panoramic radiography and CT scans, along with anatomopathological examination, were performed. Histopathologically, an intense volume of osteoid was found. Left radial maxillectomy was the chosen treatment. The patient was first rehabilitated with a provisional palatal obturator prosthesis in order to improve her nutritional status. Her rehabilitation was planned and accomplished with a mandibular removable partial denture and a maxillary removable partial obturator denture.

Primary Reconstruction of Total Maxillectomy with Custom-Made Subperiosteal Implant and Temporal Muscle Flap: A Case Report

Recent reports on secondary restorations with subperiosteal implants have demonstrated promising results in terms of esthetic and functional restoration. We report the case of a reconstruction of a total maxillectomy with a custom-made subperiosteal implant associated with a temporal muscle flap in a patient who could not undergo bone reconstruction with a free flap. This technique made it possible to restore the division between the oral cavity and the mouth, providing a solid anchorage to the dental prosthesis and correcting an oroantral communication with a small palatal obturator. The subperiosteal implant also granted proper soft tissue support in the middle-third of the face. Subperiosteal implants can be safe and effective even in primary maxillary reconstructions for patients who cannot undergo free bone flap reconstructions. In these difficult cases, this type of implant can provide support to the soft tissues of the middle-third of the face and a solid anchorage for dental prostheses or palatal obturators, thus improving the quality of life for patients.

Retention and Quality of life of Different manufacturing techniques of palatal obturator for acquired palatal defect in treatment of post COVID-19 Associated Mucormycosis (CAM)

Retention and Quality of life of Different manufacturing techniques of palatal obturator for acquired palatal defect in treatment of post COVID-19 Associated Mucormycosis (CAM)

Reabilitação oral após maxilectomia parcial para remoção de adenoma pleomórfico: relato de caso

ABSTRACT Salivary gland tumors account for only 3%–5% of all tumors in the head and neck, 10%–15% of which originate from minor salivary glands. Pleomorphic adenoma is a benign lesion of the salivary gland, most commonly occurring in the region of the hard and soft palates. The treatment of choice for pleomorphic adenomas is with the partial or total function of the extension of the lesion, and placing palatal obturators are one method of reestablishing masticatory function and facial esthetics. This study aimed to rehabilitate a patient using a palatal implant following partial maxillectomy for the removal of a pleomorphic adenoma. A young patient with pleomorphic adenoma of the hard palate underwent a partial right-sided maxillectomy procedure which removed the hard palate and alveolar regions of the molars. Prior to surgery, the patient was assessed to make a surgical guide for resection of the tumor, as well as a provisional obturator plate using orthodontic wire clasps. After healing, the patient was rehabilitated using a palatal obturator which had been incorporated into a removable partial denture. The clinical sequence used to fabricate the final prosthesis was as follows: initial molding after surgery, prosthesis design, preparation of the mouth, work molding, structure testing and orientation planning, teeth testing and installation, and periodic maintenance. Thus, we can conclude that the palatal obturator is an excellent means of restoring a patient’s oral function, facial esthetics, and overall quality of life.

Rehabilitation of Maxillectomy Defect with Palatal Obturator Using Digital Technology: A Review

Rehabilitation of Maxillectomy Defect with Palatal Obturator Using Digital Technology: A Review

History of the palatal obturator

Palatal obturators were mechanical devices designed to cover palatal birth defects.

PALATE PROSTHESIS OBTURATOR IN AN ONCOLOGIC PATIENT: A CASE REPORT

Squamous cell carcinoma (SCC) in the hard palate is relatively rare but very aggressive and may invade adjacent structures. The treatment consists of total resection of the lesion associated with radiotherapy in more invasive cases. Removal of the tumor may cause tissue loss and oronasal communication that requires reconstruction with microsurgical flaps or palate obturator prostheses. This aim is to report the rehabilitation of a 79-year-old woman reporting speech and swallowing difficulties 4 years after surgical removal of a hard palate SCC. Clinically there was an area of oronasal communication on the palate. All maxillary teeth were absent. A total palatal obturator prosthesis, with a final adjustment made with rigid acrylic resin, improved speech, swallowing, breathing, esthetics, and overall quality of life.

NON-HODGKIN'S LYMPHOMA OF PALATE: A CASE REPORT OF A HIGHLY DESTRUCTIVE LESION

A 54-year-old female patient presented to a dental office with a chief complaint of pain in her palate. Intraoral physical examination revealed a 2-cm local swelling with a small, centered ulceration and dilated superficial capillaries in the left posterior palatal area. Cone beam computed tomography did not show bone destruction. An incisional biopsy was performed and the histopathologic exam was inconclusive. Immunohistochemistry was positive for Ki-67 marker; co-expression of CD45, CD20, BCL-2, and BCL-6 associated with a high proliferative index of Ki-67 established a diagnosis of diffuse large B-cell lymphoma. Positron emission tomography revealed the involvement of the hard and soft palate, palatine tonsil, cervical and axillary lymph nodes, and inguinal area. The palatal lesion showed very rapid growth, affecting the underlying bone, causing extensive destruction and leading to a buccosinusal communication in a short period of time. An acrylic palatal obturator was installed to improve the patient's quality of life during oncological treatment.