Prosthesis Rehabilitation Research Articles

Maxillary obturator prosthesis rehabilitation following maxillectomy for ameloblastoma: Case series of five patients

Purpose The purpose of this case report is to demonstrate the benefits and applicability of appropriate maxillofacial prosthetic rehabilitation following surgical resection of ameloblastoma of the maxilla in Kenya. Materials and methods Five patients presenting with ameloblastoma of the maxilla over 3 years were studied with respect to histologic type, site of tumor, resultant surgical defect, and form of definitive obturator prosthesis. Impressions were taken using irreversible hydrocolloid and poured with dental stone. Immediate surgical obturators were fabricated from casts using clear autopolymerizing acrylic resin. One patient had bilateral partial maxillectomy, whereas the rest had unilateral partial maxillectomy. Immediate surgical obturators were fitted intraoperatively and held in place using Adams clasps on the remaining natural dentition for all patients, except the one who had undergone bilateral partial maxillectomy, whose surgical obturator was held loosely using circumzygomatic wires. After 6 to 8 weeks, surgical obturators and packing were withdrawn, and new impressions were taken to fabricate definitive obturators. Patients were reviewed every 2 weeks for 3 months, then once every 3 months per year for 3 years, and thereafter once per year. Results The immediate surgical obturators facilitated retention of the surgical packing, promoting healing with minimal postsurgical infection and scar contracture formation. This ensured the restoration of acceptable esthetics and maintenance of oral function at a reasonable level during the initial postoperative period. Definitive obturators restored esthetics, oral function, and ability to handle secretions to a satisfactory level. Conclusion Satisfactory functional and esthetic results are achievable in patients with extensive acquired maxillary defects by means of obturator prostheses fabricated using readily available materials.— Reprinted with permission of Quintessence Publishing.

Pre-definitive treatment: rehabilitation prostheses

Pre-definitive treatment: rehabilitation prostheses

Pre-definitive treatment: rehabilitation prostheses.

In this part, we will discuss: This article deals with the treatment of common conditions affecting the denture supporting tissues. Several preliminary (non-definitive) treatment options are presented along with a brief account of their rationale.

Temporary nasal prosthesis rehabilitation: A clinical report

Temporary nasal prosthesis rehabilitation: A clinical report

Ulcerated Below-the-Knee Stump

Ulcerative lesions appearing on a below-the-knee (BK) stump often delay permanent prosthesis fitting and rehabilitation or prevent the user of a perma nent prosthesis from resuming the ambulatory state. Seventeen patients (11 men, 6 women), with an average age of 61.4 (range 52 to 71) years, had under gone BK amputation for vascular disease (rest pain or gangrene, or both, with ankle:brachial index ratios < 0.15); 5 patients (3 men, 2 women) had diabetes controlled with insulin. All patients had a history of smoking with associated cardiovascular disease determined by physical examination or electrocardio gram, or both. Fourteen patients did not have initial healing after their BK amputation; the other 3 had a BK amputation in the distant past (twelve, eight een, and twenty months previously) and a nonhealing ulcer. All patients were referred for revision to an above-the-knee (AK) amputation; none came to AK amputation. All patients were treated with intravenous cephalosporins, de bridement, whirlpool, fine mesh gauze dressings, and a softstem air splint. The air splint prosthesis allowed proprioception, balance, gait, and total contact compression at 25 mm Hg when ambulatory. All wounds healed in fourteen to twenty-four days, allowing return to the permanent prosthesis in 3 patients and early measurement and fitting (no delay) of the remaining 14 patients for a permanent prosthesis. The softstem air splint temporary prosthesis represents an adjunctive measure in management of a nonhealing lesion on the stump of a BK amputee. It can facilitate rehabilitation via maintenance of gait, pro prioception, balance, and shape.

Therapeutic and Economic Impact of a Modern Amputation Program

The experience with 142 below-knee amputations for vascular occlusive disease and/or diabetes mellitus in 133 patients has been reviewed. The program utilized Xenon(133) skin bloodflow measurement for the selection of amputation level, emphasized the use of the long posterior skin flap as an important part of surgical technique, and employed immediate postoperative prosthesis with accelerated rehabilitation for postoperative management. The results of this program yielded a 0% postoperative mortality, 89% amputation healing, and 100% prosthesis rehabilitation of all unilateral below-knee amputees, and 93% rehabilitation of all bilateral below-knee amputees. The average time interval between amputation and fitting of a permanent prosthesis was 32 days. The use of Xenon(133) clearance as a measurement of capillary skin bloodflow for purposes of amputation level selection continues to be valid. All amputations with flows in excess of 2.6 ml/100 g tissue/min healed primarily, including the last 58 consecutive amputations. The total amputation of the 172 hospital V.A. system was surveyed and a cost analysis, based upon duration of postamputation hospitalization, comparing immediate postoperative prosthesis with conventional techniques, was performed. The savings to the system, taking into account start-up and maintenance costs for a program which employs immediate postoperative prosthesis, was projected to be $80,000,000 over five years. We conclude that a modern amputation program employing Xenon(133) clearance for amputation level selection and immediate postoperative prosthesis with accelerated rehabilitation is well justified based upon reduced morbidity, negligable mortality, and optimum patient prosthetic rehabilitation at a marked reduction in overall cost.