Surgical Obturator Research Articles

Active components delivery rate from acrylic resin maxillary surgical obturator: Part I

The purpose of this study was to observe the trend of compounds release from acrylic resin oral prosthesis when used for drug delivery as well as a restoration. In this study, 10 specimens of heat-cured polymethylmethacrylate material were prepared and loaded with methylene blue biological stain. The specimens were then submerged in vials with 5 ml distilled water for 24 hours. The extraction procedure continued for 4 days, each day the specimens were immersed in another 5 ml distilled water vial. All extracted solutions were analyzed by visible light spectroscopy for absorbance comparison. The statistical results showed that the absorbance values were significantly different in the first day of extraction than the following days. However, there was no statistical difference among the 2nd, 3rd and 4th days of extraction. Biological stain loading to acrylic resin at the mixing stage, and then after extraction in distilled water, showed a burst release during the first day followed by a constant release during the following few days.

Pre – planned surgical Obturator prosthesis followed by a definitive ones: a requisite for rehabilitation- a case report.

Effective obturation of the maxillectomy defect is a challenging task for the maxillofacial prosthodontist. Multidisciplinary treatment planning is essential to achieve adequate retention and function for the prosthesis. The demand for maxillofacial prosthetic devices for the rehabilitation of patients with congenital or acquired (post-surgical, post-trauma) defects has intensified in recent years. Most of the difficulties can be overcome, to an extent, with the placement of an immediate surgical obturator. This clinical report describes the fabrication of a pre-planned surgical template (immediate surgical obturator) which uses patient’s original occlusion and tooth position, made prior to the surgical resection and inserted at the time of surgery, to provide the patient with the additional benefits of masticatory efficiency, aesthetics and psychological comfort during the healing period followed by a definitive soft liner bulb obturator to accommodate resected lesion post surgery. Keywords: Mucormycosis, surgical template, obturator, silicone based permanent denture soft liner.

IMMEDIATE SURGICAL OBTURATOR AFTER MAXILLECTOMY: REVIEW OF 112 CASES FROM LITERATURE AND 2 ILLUSTRATIVE CASES

Objective To review 112 literature cases of patients who received maxillectomies and were rehabilitated with an immediate surgical obturator (ISO) and to discuss details such as sociodemographic data, histopathology, type of maxillary resection, type of prosthetic treatment, and follow-up period. Two illustrative cases of ISO installed after maxillectomy are also presented. Study Design The study was carried out in 2 steps. In the first, an electronic search of ISO for patients who received maxillectomies was performed on MEDLINE/PubMed. In the second, 2 cases diagnosed in children with maxillary neoplasms were reported. Results The review involved 71 (63%) male patients and 41 (37%) female patients with a mean age of 52.8 years. The predominant diagnosis reported was squamous cell carcinoma (67.4%). All patients were treated with conventional methods or by computer-aided design and computer-aided manufacturing method ISO with follow-up periods ranging from 3 weeks to 96 months. Pain and discomfort were reported by few patients. The illustrative cases were an odontogenic myxoma and a fibrous histiocytoma, both in the maxillary region. ISO was installed immediately after maxillectomy. Conclusions ISO was fundamental for the support and protection of the surgical dressing, maintaining facial contour, and enhancing speaking, swallowing, and chewing functions with a rapid return to normal function. Support: FAPEMIG and FMP-FO/UFMG. To review 112 literature cases of patients who received maxillectomies and were rehabilitated with an immediate surgical obturator (ISO) and to discuss details such as sociodemographic data, histopathology, type of maxillary resection, type of prosthetic treatment, and follow-up period. Two illustrative cases of ISO installed after maxillectomy are also presented. The study was carried out in 2 steps. In the first, an electronic search of ISO for patients who received maxillectomies was performed on MEDLINE/PubMed. In the second, 2 cases diagnosed in children with maxillary neoplasms were reported. The review involved 71 (63%) male patients and 41 (37%) female patients with a mean age of 52.8 years. The predominant diagnosis reported was squamous cell carcinoma (67.4%). All patients were treated with conventional methods or by computer-aided design and computer-aided manufacturing method ISO with follow-up periods ranging from 3 weeks to 96 months. Pain and discomfort were reported by few patients. The illustrative cases were an odontogenic myxoma and a fibrous histiocytoma, both in the maxillary region. ISO was installed immediately after maxillectomy. ISO was fundamental for the support and protection of the surgical dressing, maintaining facial contour, and enhancing speaking, swallowing, and chewing functions with a rapid return to normal function. Support: FAPEMIG and FMP-FO/UFMG.

Changes in the quality of life and acoustic speech parameters of patients in various stages of prosthetic rehabilitation with an obturator after maxillectomy

Statement of problemProsthetic interventions at various stages help patients recover from esthetic and functional disabilities. However, little is known regarding their impact on patient quality of life (QOL) during various phases of treatment. PurposeThe purpose of this clinical study was to evaluate changes in the QOL and acoustic speech parameters of patients rehabilitated by using a prosthesis at various stages after undergoing maxillectomy. Material and methodsA total of 30 consecutive patients who underwent maxillectomy resection and successfully completed all phases of rehabilitation with obturator prostheses were included. The study was conducted in 4 phases. In the preoperative phase, patients were evaluated for QOL and speech, and dental impressions were made. In the immediate postoperative phase, patients were rehabilitated with a delayed surgical obturator on the fifth postoperative day and were evaluated for QOL and speech on the 12th postoperative day. In the interim obturator phase, patients were rehabilitated with an interim maxillary obturator between the 12th and 15th postoperative days and were evaluated for QOL and speech after using the prosthesis for a minimum of 1 week. In the definitive phase, nonradiated patients were rehabilitated with a definitive prosthesis in the sixth week, and radiated patients were rehabilitated with a definitive prosthesis in the sixth month. The QOL and speech parameters of the patients were evaluated after 1 week. QOL evaluation in each phase was performed by using the EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires. Speech parameters, namely intensity, fundamental frequency, habitual frequency, jitter, shimmer, maximum phonation time, and the S/Z ratio, were measured by using acoustic speech software. The change in QOL over various phases of rehabilitation with an obturator was analyzed by using repeated measures analysis of variance, whereas changes in acoustic speech parameters were analyzed by using the Friedman test (α=.05). ResultsA statistically significant difference (P<.05) was observed in the physical function, role function, fatigue, nausea, vomiting, dyspnea, sleep, and appetite loss domains of the EORTC QLQ-C30 and in the speech, social eating, social contact, mouth opening, dry mouth, sticky saliva, use of painkillers, and feeding tube domains of the EORTC QLQ-H&N35. The analysis of speech parameters also revealed significant improvement in intensity, jitter, shimmer, maximum phonation time, and the S/Z ratio, suggesting improvement in speech with the use of different types of obturators. ConclusionsThe overall QOL and speech of the patients showed increasing improvement with the use of surgical obturators, immediate obturators, and definitive obturators in that order. The disease symptoms and oral functions deteriorated in the immediate postoperative phase but improved steadily and approached the preoperative level with definitive obturator prostheses.

Surgical retention for immediate obturator in maxillectomy patients.

Total maxillectomy for patients with malignant lesions will often incapacitate the patient both functionally and aesthetically. An immediate surgical obturator prosthesis would be of utmost importance for patients in these critical situations to aid in deglutition, phonetics, respiration and effectively avoiding various post-surgical complications. This article emphasizes on utilizing circum-zygomatic wiring for retention of the immediate surgical obturator in cases of total maxillectomy or edentulous patients.

A Comfortable Palatal Delayed Surgical Obturator for Hemimaxillectomy Patients

A surgical obturator prosthesis is commonly used as an effective means for rehabilitating patient with hemi-maxillectomy defect. The obturator supports the soft tissues after surgery and minimizes the contraction of scar and disfigurement thereby making a positive effect on patient’s overall function and psychology. The goal of prosthodontics to restore missing orofacial structures for improving facial esthetics and oral function for such patients. The inability to achieve adequate retention, stability, support and comfort due to the friability of healing tissues are the common problems associated with prosthetic treatment in the initial phase of treatment. This case report demonstrates a simple technique to overcome such difficulties by the use of soft lining materials in the delayed surgical obturator.

The Effect of Immediate Obturator Reconstruction after Radical Maxillary Resections on Speech and other Functions

Objective: Maxillectomy often results in a high level of morbidity with significant psychological and functional implications for patients. The aims of the present study were to assess the effectiveness of the maxillary obturator as a speech rehabilitation aid, to examine the influence of dentition on speech intelligibility, to restore patients’ regular daily activity as soon as possible, and to maintain patients’ psychological well-being throughout the treatment. Patients and Methods: Forty-one palatomaxillary immediate obturator and definitive reconstruction patient treatments were reviewed at a clinic (Ankara, Turkey). Patients aged between 20 and 73 years with surgically acquired partial maxillary defects were included in this study. All patients were rehabilitated with immediate and definitive obturators. The patients were given immediate surgical obturators which were adjusted to the defect area with a tissue conditioner. By employing this procedure and relining with the tissue conditioner weekly, immediate obturators were used in the interim stage of the treatment. As interim obturators, prostheses were used for two to three months until healing and resorption were found satisfactory, after which the definitive obturators were fabricated. Results: The speech intelligibility test (SIT) was employed for the evaluation of the speech ability. Significant improvements were found in the mean speech intelligibility test score (SITS), from 0.02% in patients without prosthetic obturation to 94.10% in patients with immediate obturation on the second day, 95.60% in patients with immediate obturation on the 20th day, and 95.97% in patients with definitive obturation.

A novel digital workflow to manufacture personalized three-dimensional-printed hollow surgical obturators after maxillectomy

Partial or complete resection of the maxilla during tumour surgery causes oronasal defects, leading to oral-maxillofacial dysfunction, for which the surgical obturator (SO) is an important treatment option. Traditional manufacturing of SOs is complex, time-consuming, and often results in inadequate fit and function. This technical note describes a novel digital workflow to design and manufacture a three-dimensional (3D)-printed hollow SO. Registered computed tomography and magnetic resonance imaging images are used for gross tumour delineation. The produced RTStruct set is exported as a stereolitography (STL) file and merged with a 3D model of the dental status. Based on these merged files, a personalized and hollow digital SO design is created, and 3D printed. Due to the proper fit of the prefabricated SO, a soft silicone lining material can be used during surgery to adapt the prosthesis to the oronasal defect, instead of putty materials that are not suitable for this purpose. An STL file of this final SO is created during surgery, based on a scan of the relined SO. The digital workflow results in a SO weight reduction, an increased fit, an up-to-date digital SO copy, and overall easier clinical handling.

SILVER-NANOPARTICLES MODIFIED SOFT LINER MATERIAL FOR OBTURATOR WEARERS WITH ACQUIRED PALATAL DEFECT. MICROBIOLOGICAL CROSSOVER STUDY

Aim: This research aimed to clinically investigate the microbecidal power of silver nano-par­ticles modified autopolymerized soft lining material for acquired palatal defect obturator wearers. Materials and methods: A total of sixteen patients with acquired palatal defect were selected from the Mansoura Oncology center and referred to the Removable Prosthodontics Department, Faculty of Dentistry, Mansoura University. For each patient, immediate surgical obturator was constructed and then replaced by temporary obturator two weeks after the surgery. At definitive abturator construction, random assigning of patients into two equal groups (eight patients each) was done. Within patient cross over study design was followed with respect to silver nanoparticles (AgNps) percentages added to the self-cure soft liner material where: Patient’s obturators in group I were lined with untreated soft liner followed by modified soft liner with 0.05 % loading by weight of AgNps added to 5gm of the polymer powder followed by modified soft liner with 0.2 % loading by weight of AgNps for one month of each soft liner application. In group II the sequence was reversed. Microbiological investigation was performed to identify bacterial colonization count related to different soft liner samples. Results: The highest mean of bacterial count was recorded with the soft liner samples without AgNps additives [mean =( 762.5 ± 85.08) x103]; while the lowest mean recorded with soft liner with 0.2% AgNps by weight [mean = (0.634 ± 0.73) x103]. (ANOVA) test indicated a significant reduction in bacterial count within increased AgNps concentration. Wilks’ lambda = 0.14, f = 40.75 and p = 0.001. Conclusions: Within parameters of this study, it could be concluded that: Modification of autopolymerized acrylic-based soft liner with AgNps is a simple reliable method to enhance its bactericidal activity especially for obturator wearers. The antimicrobial efficacy of AgNps modified soft liner seemed to be concentration dependent.

A chairside technique to add customized anterior acrylic resin teeth to a surgical obturator

A surgical obturator may need to be modified during the healing process after tissue resection. Apart from relining the fitting surfaces to accommodate the healing wound and changes in the surrounding tissues, other modifications such as adding teeth are sometimes required to improve esthetics and speech. This article describes a chairside technique to add customized acrylic resin teeth to an existing surgical obturator.

Digital Design and Fabrication of Surgical Obturators Based Only on Preoperative Computed Tomography Data

This article describes the digital fabrication of a surgical obturator (SO) using only computed tomography (CT) data from the tumor area. This procedure is a departure from the traditional method of making an impression and obtaining a patient cast prior to surgery to allow for SO fabrication. The present approach allows for a virtual resection based on the patient's CT image; the SO is digitally designed with animation software and fabricated by 3D printing. The SO is relined with a denture reliner at the time of surgery to complete the obturation of the maxillectomy defect.

Instant cast for an immediate obturator

Obturators are constructed to prevent the oro-antral communication that is ensued in maxillary lesions postsurgery. Often, the postsurgical rehabilitation of patients with maxillary defects is not given adequate time, which results in hypernasality and compensatory articulation. To prevent such complications fabricating immediate obturators within the minimal time that is often allotted to the dentist will be of immense aid to the patient. Fabrication of cast for these immediate obturators is often elaborate and time consuming. This article highlights a unique technique of making a cast that is instant, precise, and economical for construction of immediate surgical obturator.

Surgical to Interim–Chairside Management of Hemimaxillectomy Patient

Purpose: Fabrication of Interim obturator immediately after surgical procedure may be difficult for the patient due to pain and associated trauma. Method: Use of existing surgical obturator as an impression tray and modifying it into interim obturator is simple and quick procedure Conclusion: Reducing the agony of the patient, maintaining the function and improving the quality of the patient is the primary goal of maxillofacial prosthodontist which is achieved by the technique explained in this article.

Prosthetic reconstruction with an obturator using swing-lock attachment for a patient underwent maxillectomy: A clinical report.

Patients who underwent resection of maxilla due to benign or malignant tumor, or accident will have defect in palatal area. They get retention, support and stability from remaining tissues which are hardly optimal. The advantage of swing-lock attachment design is having multiple contacts on labial and lingual side of the abutment teeth by retentive strut and palatal bracing component. Because the force is distributed equally to abutment teeth, abutment teeth of poor prognosis can be benefited from it. It is also more advantageous to cover soft tissue defects which are hard to reach with conventional prosthesis. A 56-year-old female patient who had undergone a maxillectomy due to malignant melanoma complaining of loose and unstable surgical obturator. Surveyed crowns were placed on #12, 26, and 27. Teeth #11, 21, 22, and 23 had lingual rest seat and #24 had mesial rest seat to improve stability and support of the obturator. This clinical report presents the prosthetic management of a patient treated with obturator on the maxilla using swing-lock attachment to the remaining teeth.

Adductor accessorius - an unusual supernumerary adductor muscle of thigh.

The knowledge of variant anatomy of medial compartment of thigh is extremely important in surgical procedures requiring obturator nerve block. The nerve block is also recommended for providing additional analgesia following major knee surgeries and for relieving painful adductor muscle spasm. The interfascial injection technique is commonly followed in ultrasound guided obturator nerve block. For this procedure it is imperative to identify the adductor muscles on sonography to inject the anesthetic solution in the intermuscular fascial planes. The presence of an additional muscle can prove useful in myocutaneous flap surgeries for reconstruction especially of perineum. We hereby report a case of such an anomalous supernumerary adductor muscle present between adductor brevis and proximal part of adductor magnus, in an adult Indian male cadaver, recorded during routine dissection in Department of Anatomy, Vardhman Mahavir Medical College and Safdarjung Hospital. The muscle was innervated by the posterior division of obturator nerve. The morphology, embryological basis and clinical aspects are also discussed.

TOTAL MAKSİLLER REZEKSİYONLARIN PROTETİK TEDAVİSİ: ILGU SUNUMU

In this study, the information was given about prosthetic treatments of total maxillary resection applied to a patient. The patient diagnosed with Squamous cell carcinoma was sent to the consultant doctor by Ear Nose Throat. Models and photographs were taken before operation, surgical obturator was fabricated for the surgical area provided and the patient was fed without the need to use the nasogastric probe. Hollow bulb obturator was applied to the patient within the 3 months following the operation. The lack of anatomical structures to provide adequate support and retention for prothesis in patients with total resection of maxillary is one of the biggest problems encountered during obturator prothesis fabricating. Key Words: Maxillectomy, Prosthetics Treatment, Obturators

The surgical obturator revisited

The rehabilitation of maxillectomy defects can be initiated at the time of resection through interactive treatment planning between the surgeon and maxillofacial prosthodontist. The purpose of this article is to familiarize the recent generations of head and neck surgeons and maxillofacial prosthodontists with the role of the surgical obturator and intraoperative techniques for optimal prosthesis design. The advantages of a surgical obturator and the consequences of not using a surgical obturator for maxillary resections are evaluated. Different types of defects are assessed from the initial presentation to completed design of cast and surgical obturator. The surgical and prosthetic techniques to aid fabrication of surgical obturators for three subjects with very different maxillary defects are shown. Emphasis is placed on the value and versatile functionality of a surgical obturator to initiate and promote successful rehabilitation of the maxillary defect.

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.

The Softurator: When, Where and How We do It?

ABSTRACT Factors that affect management of surgical defects are surgical site, amount of remaining support tissue, presence of teeth and defect characteristics. When these factors are not favorable, successful prosthetic management of surgical defect becomes more challenging. Simultaneously, prosthesis should be comfortable to supporting and surrounding tissues as well as surgical defect. In the presented case, we have used soft polyvinyl siloxane material for fabrication of temporary surgical obturator to cover the surgical defect at the junction of hard and soft palates. Soft, flexible material is used for better adaptation to the changing morphology of surgical defect and also improves functions like speaking and swallowing. How to cite this article Shah PD, Mukherji S. The Softurator: When, Where and How We do It? Int J Head Neck Surg 2015; 6(2):93-95.

Fabrication of an immediate surgical obturator for a patient with resection of the maxillary antrum and bony orbital floor

An immediate surgical obturator is necessary for maxillectomy procedures to minimize functional disabilities in speech, swallowing, and egress of food and liquid into the surgical defect. Sometimes the extent of the tumor may be such that it may even require the removal of the maxillary sinus along with resection of the orbital floor. The resected orbital floor can be surgically reconstructed with autogenous soft and/or hard tissues or with alloplastic materials. This clinical report highlights one such situation where the surgical resection of the maxilla and the orbital floor were rehabilitated with an immediate surgical obturator extending to the orbital floor to support the visual apparatus.