The nasolabial approach: a potential alternative to the lip-splitting incision for maxillectomy

First described by Weber and later modified by Fergusson, the Weber-Fergusson incision has undergone numerous modifications, but the fundamental approach to maxillectomy has largely remained the same. We report the potential benefit of a nasolabial incision for partial maxillectomy. The incision is hidden within the nasolabial fold and obviates the need for division of the upper lip, which may undergo atrophy and shortening after radiotherapy.     

Jaeger's jugal extended incision to approach the pterygomaxillary region

In oncological surgery of the pterygomaxillary fossa it is essential to achieve a wide access. For this purpose we have employed the old Jaeger's incision extended posteriorly in association with access osteotomies (zygoma and coronoid). In our experience (9 cases) the jugal access has provided good results without noticeable cutaneous scars. The technique is described with the presentation of 2 cases.     

Altered prosthodontic treatment approach for bilateral complete maxillectomy: a clinical report

Bilateral maxillary resection offers a significant challenge for prosthodontic rehabilitation with a removable tissue-borne prosthesis, owing in large part to a lack of adequate retention, support, and stability. The clinical management of a patient with a bilateral maxillectomy using an altered prosthodontic treatment sequence is described.     

Presurgical maxillectomy prosthesis

The use of the presurgical maxillary prosthesis in patients undergoing maxillectomy procedures for cancer greatly decreases the general morbidity connected with the procedure and aids the patient to adjust both physiologically and psychologically following the operation. Excellent speech quality and oral function can be attained almost universally.The historical, surgical, and prosthetic considerations concerning the presurgical maxillary prosthesis have been discussed, and the treatment of a patient is described to demonstrate the surgical and prosthetic principles involved in the management of cancer of the maxilla.     

Anterolateral approaches to the cervical spine: tips and tricks

The most common anterolateral approaches to the cervical spine are the low and high presternocleidomastoid approaches, which allow exposure of all levels of the cervical spine, from the base of the skull to the upper thoracic vertebrae. Proper positioning of the patient is a key point to gain good operative exposure and to prevent the potential complications of excessive pressure on neural or vascular structures. This is an important aspect of cervical spinal surgery, because of the depth and relative inaccessibility of the structures, the required accuracy for the determination of level and the inherent risks of the positions themselves. We describe the common anterolateral approaches to the cervical spine, complications, and some tips and tricks to avoid them.     

Anterolateral thigh flap as the ideal flap to full-thickness cheek reconstruction

Reconstruction of the cheek presents a number of challenges when seeking to recreate form and function. The use of the anterolateral thigh flap in various and novel configurations is argued as being the ideal reconstruction, illustrated by case reports.     

上颌窦癌术后颌骨缺损即时修复

目的:研究上颌窦癌手术后即刻修复使患者面容恢复和早期功能重建。方法:在颌骨切除前首先了解病人病情及手术范围。常规取印模,根据制备好的模型,参考X线片在模型上画出手术切除范围。用石膏刻刀削去手术区的石膏及石膏牙齿,使其形成一定的缺陷空腔。一侧颌骨切除,制作修复体首先要选择2-3个正常牙齿作固位,可制做成铸造钴铬合金卡环,也可弯制不锈钢卡环。双侧颌骨全切,修复体过大可制成空腔,高度过高可制成义颌和义齿两部分。结果:上颌窦癌术后即刻修复26例,其中上颌骨全切12例,半侧及部分颌骨切除的14例,共26例。不但早期恢复了患者的咀嚼功能,也给患者心理上减轻一定的负担,获得满意效果。结论:上颌窦癌术后即刻修复,是行之有效的治疗方法。     

Spectral characteristics of hypernasality in maxillectomy patients

To reveal the acoustic characteristics associated with hypernasality and to ascertain their correlation to the severity of hypernasality, 30 speech samples produced by 15 maxillectomy patients were acoustically analysed with and without an obturator prosthesis in place. The isolated, sustained Japanese vowel /i/ was used as the stimulus for acoustic measurement and perceptual judgment to evaluate the severity of hypernasality. Normalized 1/3-octave spectral analysis demonstrated the spectral characteristics of hypernasality as a rise in amplitude between the first and second formants around the 1 kHz region, and a reduction in amplitude of the frequencies higher than the second formant. High correlation was shown between the perceptual ratings and the predicted values derived from stepwise regression analysis.     

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.     

Reconstruction of maxillectomy defect by transport distraction osteogenesis

The study aimed to explore the feasibility of posterior maxillectomy reconstruction by transport distraction in a primate model. In each of 14 male adult rhesus monkeys, posterior partial maxillectomy was performed on one side of maxilla to create a posterior maxillary deflect. Immediately after the maxillectomy, a dentoalveolar segment anterior to the defect was osteotomized as transport segment and a custom-made transport distractor was fixed on the residual maxilla. After a latency period of 5 days, the distractor was activated 1 mm daily to move the transport segment backward to the defect. This process lasted about 2 weeks. The transport segment was allowed to consolidate and the animals were sacrificed at different defined intervals. Transport distraction was successful in six animals. Three other cases were completed with minor wound dehiscence and one had a small oro-antral fistula with subsequent maxillary sinusitis. New bone bridging the distraction gap was confirmed by radiography and histology in the animals completing distraction. Reconstruction of posterior maxillectomy defect is proven feasible by transport distraction osteogenesis.     

A two-part prosthesis for edentulous patients following maxillectomy

Conventional dentures constructed for edentulous patients who have undergone maxillectomy have serious deficiencies, not the least being the lack of employable support and retention. This paper describes a method for the construction of a prosthesis which incorporates a removable flexible obturator. This technique overcomes the anatomical problems which limit conventional restorations, and provides dentures which are retentive and stable in function and comfortable for the patient to wear.     

Surgical and prosthetic reconsiderations in patients with maxillectomy

Summary The purpose of this study was to establish and evaluate new possibilities for rehabilitation of patients with obturator prosthesis who had undergone partial or total maxillectomy because of tumour ablation surgery. Eleven patients with maxillary defects were reconstructed with a computer‐aided design/computer‐aided manufacturing designed prosthesis. Missing retention was gained by inserting implants in the remaining bone, so that an expansion of the surgical defect to gain further retention could be avoided. All patients were treated successfully according to the previously described treatment plan. The Obturator Functioning Scale (OFS) of the Memorial Sloan‐Kettering Cancer Centre was applied to evaluate the functional quality of the obturator prosthesis and patient’s satisfaction. It showed good results in all fields of functional outcome and social acceptance.     

Early rehabilitative management of the maxillectomy patient.

Combined surgical and prosthodontic management of the maxillectomy patient is mandatory. Prosthodontic treatment should begin in the preoperative period if the patient is to be provided with the best rehabilitative care. The use of preoperative evaluation and/or treatment is the key to providing successful rehabilitation services. If the patient's disease is cured but he is left a recluse because of his physiologic, esthetic, and psychological deficiencies, how valuable has the cure been to the patient?     

Hollow silicone obturators for patients after total maxillectomy

One technical approach for the treatment of a patient after complete removal of the hard palate and other supportive structures has been presented. This technique offers a means of obtaining a detailed impression of the defect and promptly provides the patient with a lightweight and flexible tissue-tolerant obturator. The patient can ultimately be provided with a hollow dental prosthesis attached to a removable hollow obturator.