Soft Palate Defects Research Articles

Prosthetic and surgical management of osteogenic sarcoma of the maxilla

Maxillary surgical defects resulting from resection of oral neoplasms vary in size from small perforations of the hard and soft palate to complete removal of these structures. Osteogenic sarcoma is of unknown etiology and is a rapidly growing tumor that may produce pain, paresthesia, and anesthesia. The recommended treatment of radical resection often results in defects that produce significant orofacial disfigurement. These defects, regardless of size, present significant functional disability, with compromised esthetics, mastication, and deglutition. Restoration with a maxillary obturator prosthesis can reestablish the physical separation between oral and nasal cavities and, in soft palate defects, enable normal palatopharyngeal function. Most patients can be rehabilitated successfully with restoration of speech and swallowing to normal levels and significant improvement in appearance.

Reconstruction of huge soft palate defect using elongated pharyngeal flap

Reconstruction of huge soft palate defect using elongated pharyngeal flap

口蓋弁による軟口蓋再建の２例

Two cases of immediate reconstruction using palatal flap for defect following excision of the soft palatal tumor were reported.A reconstruction for palatal defect of the soft palate using palatal island flap was very useful in following advantages. The flap was able to transfer from adjacent hard palate. There were no functional disturbances in the hard palate and no necrosis of the flap because of excellent blood supply. The flap was very movable so that it could transfer even to posterior border of the soft palate. This procedure which could achieve in only one stage without delay was easier than in other flaps.On the other hand, in a reconstruction for defect of the entier soft palate, atrophy of the flap was remarkable after 2 or 3 months so that it should be simultaneously used with pharyngeal flap.

Comparison of rigid and flexible obturation for surgical cleft of the soft palate

S urgical removal of tumors in or adjacent to the maxillae is the most common cause of acquired palatal defects.’ As surgical techniques advance, prosthodontic needs advance, and more patients become candidates for maxillofacial reconstruction. In the treatment of soft palate defects, many concepts have been presented since the flap velum was first reported in 177g2 The flap velum attempted only to cover the tissue defect with a mechanical seal in the hope of improving speech and function. At the present time, conventional or rigid obturation similarly involves extending methyl methacrylate resin to the level of greatest muscular activity exhibited by the residual palatopharyngeal complex.3 This prevents leakage of material into the nasal cavity during swallowing and modifies hypernasality during speech. However, as early as 1871 the idea of replacing missing tissue as well as stimulating its physiologic function was presented. The use of unvulcanized rubber had been proposed in 1823 for a soft palate prosthesis.’ Thus we hypothesize that a flexible silicone obturator might better serve the needs of patients with surgically acquired defects of the soft palate. This hypothesis is based on the dynamic changes of the normal soft palate. During speech, the normal soft palate and pharyngeal muscle complex will always be in dynamic equilibrium among the three positions shown4 (Fig. 1). The nasal and oral cavities will be momentarily but perfectly occluded at the positions shown in Fig. l., B, and Fig. 1, C, respectively. These diagrams also represent the position of the soft palate during articulation of consonants and vowels (Fig. 1, B) and nasalized phonemes /m/, /n/, and /ng/ (Fig. 1, C). Would a flexible, silicone obturator be more likely to approximate these positions than the static acrylic resin obturator? Would the patient sound better or worse with the new material? The answers were sought through instrumental and perceptual tests of one rigid and two flexible obturators.

Oral endoscopy in prosthodontic management of the soft palate defect

Telescopic oral endoscopy is an effective aid in the construction and modification of a speech aid prosthesis. The method is (1) noninvasive and easy to perform, (2) permits the prosthodontist to achieve the goal of functional effectiveness in prosthesis construction while keeping the weight and size of the pharyngeal extension at a minimum, (3) decreases the number and length of patient visits required for modification, and (4) when coupled to a fiberoptic teaching arm or a video camera and recording system, it becomes an excellent aid in teaching, patient education and orientation, and record keeping.

Button obturator for a soft palate defect

1. Make a preliminary impression in a stock rim-lock tray using irreversible hydrocolloid, and pour in dental stone (Fig. 2). The tray is extended with plastic modeling compound and sprayed with an adhesive.t 2. Adapt one thickness of baseplate wax relief to the denture-bearing surfaces of the lubricated cast. 3. Construct a custom impression tray with autopolymerizing acrylic resin. 4. Remove the tray from the cast with the wax spacer inside, finish, polish, and perforate with a No. 8 round bur (Fig. 3). 5. Border mold the custom tray in the mouth with green stick modeling compound. 6. Remove the wax spacer from the tray. 7. Spray the tray with adhesive. 8. Make the final impression with vacuum-mixed irreversible hydrocolloid. A. low water-to-powder ratio (62 cc roorn-temperature distilled water to 28 gm powderx) is ideal for this impression. 9. Cleanse the impression, and immerse briefly in 2% potassium sulfate solution (Fig. 4). 10. Box the impression on a plaster patty with boxing wax, and pour with vacuum-mixed dental stone.

The versatile palatal island flap: Its use in soft palate reconstruction and nasopharyngeal and choanal atresia

The mucoperiosteal island flap, first designed to provide nasal lining during pushback lengthening of a short cleft palate, has been used to assist in reconstruction of large soft palate defects following resection for cancer, to create and maintain patency of the velopharyngeal aperture after stenosis and to maintain patency of the nasal airway after resection of bony choanal atresia.

Palatal reconstruction utilizing retrieved forehead flap.

Ablation of tumors involving the tonsil and retromolar trigone complex often require partial resection of the soft palate. The pharyngeal wall defect is well reconstructed with the forehead flap. We have used the distal portion of the severed inserted forehead flap to reconstruct the soft palate defect successfully in 35 cases. The nasopharyngeal surface is lined with a book-flap from the remaining palate. This provides full palatal reconstruction with nasopharyngeal mucosa lining: thus preventing flap contracture and the unwanted sequelae of nasopharyngeal air and fluid reflux.

Prosthetic management of postsurgical soft palate defects

Acquired defects of the soft palate were classified into four different groups according to their site. The rationales behind the different modalities of treatment and impression techniques were discussed. The treatment of a patient was described to demonstrate the use of the “velar speech aid” prosthesis.

Repair of a large defect of the hard and soft palate by means of a Filatov flap

Repair of a large defect of the hard and soft palate by means of a Filatov flap