Orofacial functions in patients with congenital and acquired maxillary defects: a fluoroscopic study

By means of videofluoroscopic recordings, chewing, swallowing and speech were monitored in nine patients with congenital and acquired maxillary defects. All of them were rehabilitated with a maxillary obturator prosthesis. The defective region was seldom used for chewing. No leakage between the obturator and surrounding tissue was observed, either for solids or for liquids. All of the prosthetic reconstructions were surprisingly stable during function. In the phonetic analysis, speech production was judged to be restored almost to normal. Videofluoroscopy may be valuable as a complement to other functional diagnostic procedures, and for the evaluation and improvement of rehabilitation with an obturator prosthesis.     

Reconstruction of orbital wall defects: critical review of 72 patients

Between January 1996 and December 2001, 72 out of 354 patients were included in a retrospective study analysing the outcome of repaired orbital wall defects. Selection was dependent on the availability of pre and postoperative CT scans and on ophthalmologic examination. In particular, orthoptical assessment was performed up to 1 year after operation. In 72 patients, 83 orbital wall defects were analysed and allocated to one of five categories. Accuracy and type of reconstruction were assessed in unilateral orbital wall defects (n=61) and compared with functional outcome. Reconstruction was performed by using PDS membrane (39%), calvarian bone (13%), titanium mesh (7%) or a combination of these materials (37%). Postoperatively, 91% of the patients had normal vision without double images within 20 degrees at every gaze. Accuracy of reconstruction correlated with severity of orbital injury and functional outcome. Functional outcome between category II and III fractures showed no significant difference. The medial margin of the lateral infraorbital fissure being preserved (category II fracture) facilitates reconstruction technically. Accuracy of orbital reconstruction is one important factor to obtain best functional outcome, but other determinants like displacement and/or atrophy of intramuscular cone fat should be considered.     

Prosthodontic management of acquired partial mandibulectomy discontinuity defects: a clinical report

Prosthetic rehabilitation of partial mandibulectomy defects without bony reconstruction is rarely presented. An in-depth understanding of the surgical and conventional prosthodontic principles is essential for prosthetic rehabilitation in this unique group of patients. Often, the application of modified prosthodontic principles is needed and success is not always possible. A clinical report is presented in this article.     

上颌骨大型缺损恢复功能方法的临床回顾与展望

上颌骨大型缺损常由外伤、肿瘤切除等原因所形成,对患者的面貌及口颌生理功能的影响极为严重和显著,对其功能尤其是咀嚼功能的恢复也极为困难。关于这个问题,国内外学者们已走过很长的道路,采取过很多措施,但仍有待改进与完善。时代在前进,医学在发展。当今时代,局部战争时有发生,火器伤在所难免;车祸频发,外伤亦在所难免;环境污染,恶性肿瘤的发生率也随之增加。但由于外伤急救措施的得力和对肿瘤的早期发现和及时治疗,伤病者的生存率增高,上颌骨缺损需要恢复功能的患者也就增多。如何使其能更好恢复功能,有必要加以进一步研…     

A congenital true teratoma with cleft lip, palate, and columellar sinus

Teratomas, the most common extragonadal germ cell tumor of childhood, involve at least two of the ectodermal, mesodermal, and endodermal layers. Of the teratomas seen in the first 2 months of life, 82% are sacrococcygeal. The head and neck region is the second most common location for teratomas in early infancy, accounting for five (14%) of those cases. We describe a female neonate with a teratoma of the nasopharyngeal area, bilateral cleft palate/lip, and columellar sinus pathologies. The mass, which was 8 x 5 x 7 cm and soft in consistency, blocked the airway and prevented oral feeding. On macroscopic examination of the excised mass, there was a notable typical cilia arrangement and lower eyelid appearance. The patient, who was diagnosed with a well-differentiated teratoma after the pathologic examination, did not have any complications in the postoperative period.     

Morphological description of distraction regenerates in children with congenital and acquired defects and facial skeleton bones hypoplasia

Results of the morphological study of regenerates received after distraction upper and lower jaws in children were described. It was established that maternal bone and regenerate (retention during 3 months) in children of different age groups varied according to the stage of their structures differentiation; regenerate bone tissue was always less mature than maternal bone irrespective of its localization; lag in differentiation of new growth regenerate bone structures in the group of patients with congenital pathology if compared with the same indicator in the group of children with acquired pathology.     

Reconstruction plates to bridge mandibular defects: a clinical and experimental investigation in biomechanical aspects

A retrospective study of 68 patients was carried out to assess the complications arising from the use of reconstruction plates in the maintainance of space and contour following mandibular segmental resection. Skin or mucosal perforation, plate fracture and loss of screw retention were the main complications. The most susceptible sites to screw loosening in the plates were situated nearest to and farthest from the resection margin on the proximal residual segments. Some of the possible causative biomechanical mechanisms of plate failure were studied using photoelastic models simulating the types of mandibular defect and plate fixation. Isochromatic fringe analysis was used to analyse stress lines in the bone surrounding screws. It was found that, during functional loading, moment and shear forces produced high concentrations of squeeze and press stress in this bone, causing bone resorption with consequent loss of screw retention.     

Reconstruction of mandibular defects by autogenous bone grafts: a review of 37 cases.

Thirty-seven cases of autogenous bone grafted to the mandible at the maxillofacial unit, Kaduna, Nigeria, were reviewed. The ilium was used in the majority of cases. In four cases where the recipient beds were vascular, the rib was used. The various techniques for restoring the central arch defects of the mandible are discussed and the methods we used are described. The superiority of autogenous bone grafts over homografts and heterografts is emphasized.     

Evaluation of speech in patients with partial surgically acquired defects: pre and post prosthetic obturation

AIM: Maxillectomy often results in a high level of morbidity with significant psychological and functional implications for the patient. Such disabilities include inability to masticate, deglutition, and speech disturbance. Unfortunately, little is known about the nature of the speech disturbance and the influence of the class of surgical defects in this group of patients. The aims of the present study were to assess the effectiveness of the maxillary obturator as a speech rehabilitation aid and to examine the influence of the classes of surgical defects on speech intelligibility (SI). MATERIALS AND METHODS: Twelve patients aged between 18 and 60 years with surgically acquired partial maxillary defects were included in this study. The patients were given immediate surgical obturators six to ten days after surgery, which were then converted to interim obturators by relining with tissue conditioner. Interim prostheses were used for two to three months until healing and resorption were found satisfactory after which the definitive obturators were fabricated. The SI test described by Plank et al. and Wheeler et al. was employed in this study. There were significant improvements in the mean SI score from 59.8% without prosthetic obturation, to 89.2% following interim obturation, and 94.7% following definitive obturation (p<0.005). Nine patients (75%) had class I surgical defects, two patients (16.67%) had class II defects, while only one patient (8.33%) had a class VI surgical defect. None of the patients had class III, IV, or class V surgical defects. There was an improvement in the SI score from class I to class VI without obturation, after insertion of interim obturator, and after insertion of the definitive obturator. CONCLUSION: Results support the widely held view that the maxillary obturator is a useful speech rehabilitation aid. It also shows immediate, interim, and definitive obturators are all important in the speech rehabilitation of patients with surgically acquired maxillary defects. Moreover SI is affected by the class of defect.     

Neural tube defects and their significance in clinical dentistry: a mini review

Neural tube defects are common congenital malformations that could be apparent at birth or manifested in later stages of life. Morbidity is high in anencephaly, whereas in spina bifida, there are neurological and motor disorders. These defects deserve paramount importance in clinical dentistry. Latex allergy, dental caries, difficulty in mouth opening, and sitting in a dental chair are common problems. There is a high risk of anaphylactic response during anaesthesia. There could be associated craniosynostosis causing maxillary deficiency, and malformed sella turcica might be seen. An association of the defects has been linked with orofacial clefts and Down syndrome.     

Prosthodontic and psychological factors in treating patients with congenital and craniofacial defects

This article addresses treatment of patients with various types of congenital defects, including partial and total anodontia, hypohydrotic ectodermal dysplasia, dentinogenesis imperfecta, and cleft lip and palate. The psychosocial aspects of these patients and rehabilitation with removable, fixed, and implant-supported prostheses are discussed. The factors to be considered are altered anatomy, lack of teeth or malformed teeth, teeth in abnormal positions, lack of facial growth, and altered arch development. The short- and long-term treatment of patients in these categories is discussed.