A hollow delayed surgical obturator for a bilateral subtotal maxillectomy patient: a clinical report

Effective obturation of the bilateral maxillectomy defect is a difficult task for the maxillofacial prosthodontist. Multidisciplinary treatment planning is essential to achieve adequate retention and function for the prosthesis. This clinical report describes an original technique of engaging the inner aspect of the nasal aperture to augment anterior retention of a hollow obturator in a bilateral subtotal maxillectomy defect. This method is simple to execute, and may be used chairside for a surgical, interim, and/or definitive obturator.     

A hollow definitive obturator fabrication technique for management of partial maxillectomy

Maxillary obturator prosthesis is the most frequent treatment option for management of partial or total maxillectomy. Heavy weight of the obturators is often a dislocating factor. Hollowing the prosthesis to reduce its weight is the well established fact. The alternate technique to hollow-out the prosthesis has been described in this article which is a variation of previously described processing techniques. A pre-shaped wax-bolus was incorporated inside the flasks during packing of the heat-polymerized acrylic resin to automatically create the hollow space. The processing technique described is a single step flasking procedure to construct a closed-hollow-obturator prosthesis as a single unit. To best understand the technique, this article describes management of a patient who had undergone partial maxillectomy secondary to squamous cell carcinoma rehabilitated with a hollow-obturator prosthesis.     

One step polymerizing technique for fabricating a hollow obturator

PurposeAlthough a closed hollow obturator is often applied to post maxillectomy patients, it has a few problems such as complexity of fabrication and water leakage to inside. A one step curing technique to fabricate a closed hollow obturator by constructing a small hollow bulb made by two thermoplastic resin sheets is described in the present report.MethodsIn the one step curing technique, after dewaxing the wax denture fabricated conventionally, one size smaller hollow body was fabricated with two thermoplastic resin sheets and set into the investment mold as a core. Then the circumferential part of obturator was cured by the pour type resin.This technique was used to fabricate an obturator prosthesis in a 60-year-old post-maxillectomy patient. The weight of this obturator was well controlled and the definitive prosthesis weighed 22 g. At a one year follow-up, the obturator fared well without any water leakage or breakage.ConclusionsThis technique allows the fabricator to control the thickness and weight of the obturator by the amount of relief provided by the hollow bulb. It also rectifies the disadvantages of the closed hollow obturator such as water leakage and complexity of fabrication.     

A modified technique to fabricate a complete hollow obturator for bilateral maxillectomy in a patient with mucormycosis—A technical case report

Maxillectomy performed in acquired lesions is often very extensive or bilateral, sparing very less hard and soft tissue in the oral cavity. These defects need both surgical and prosthetic rehabilitation. A definitive prosthesis is inserted after complete healing, when the patient is accustomed to the interim prosthesis. Definitive obturator warrants better retention and stability and needs a meticulous planning in design for long‐term use. Conventional design has a few disadvantages; it needs modification many times to improve retention and psychological comfort of the patient. The article explains an easy technique in fabrication of an obturator. The conventional obturator design has a hollow antral part but usually a solid oral part, which adds to the weight of the prosthesis pressurizing the soft tissues in a maxillectomy, which affects the function and esthetics. This article demonstrates the hollowing of oral part, which bears the artificial teeth, and modifying the antral bulb, which covers the defect. It was designed considering the potential difficulties shared by the patient in wearing the single piece conventional hollow bulb design. This technique when followed was beneficial in reducing the weight of the prosthesis and enhancing retention, and allowed the patient to perform normal functional movements.     

Prosthetic Rehabilitation of a Maxillectomy with a Two‐Piece Hollow Bulb Obturator. A Clinical Report

Extensive bilateral midfacial defects involving the upper jaw, palate, and sinus present a formidable reconstructive challenge. A combination of total and subtotal maxillectomy is, in general, a rare surgical procedure that affects the cosmetic, functional, and psychological aspects of a patient's life. Prosthetic restoration has become the preferred method for the rehabilitation of such conditions. The use of magnets is an efficient means of providing combined prostheses with retention, quality, and stability. This clinical report describes the rehabilitation of a total and subtotal maxillectomy patient with a two‐piece hollow bulb obturator retained with the help of magnets and a retention clasp.     

An Alternative Prosthetic Approach for Rehabilitation of Two Edentulous Maxillectomy Patients: Clinical Report

Obturator prosthesis is a common treatment method for maxillectomy patients for maintaining their oronasal separation and resuming their social lives. After tumor resection, the remaining anatomical structures have a significant effect on prosthesis retention. The present study describes the rehabilitation of two maxillectomy patients after cancer surgery using a prosthesis consisting of a denture and a special retentive obturator that is positioned in the anatomical undercuts of the nasal cavity. These patients have undergone total and subtotal maxillectomy surgery after the diagnosis of squamous cell carcinoma. The systemic and local health status of the total maxillectomy patient was not suitable for zygomatic implant surgery. Only one osseointegrated dental implant was placed into the left maxillary tuberosity area in the subtotal maxillectomy patient. In addition, the quality, vertical height, and horizontal width of the remaining bone structures in the maxilla limited the use of osseointegrated dental implants. Mechanical prosthesis retention was provided using a multiunit retentive mechanism composed of an orthodontic forsus fatigue resistant device (OFFRD), two Herbst appliances, and an acrylic piece associated with healthy keratinized mucosa. The OFFRD could easily apply a consistent force and push the acrylic pieces toward the retentive undercut under the control of the two Herbst appliances. Two OFFRD units in different directions were designed for the total maxillectomy patient, while only one OFFRD unit was placed on the opposite side of the osseointegrated implant in the subtotal maxillectomy patient. A sufficient retention was obtained for both patients. The patients were satisfied, and no major complications were observed in periodic controls.     

Fabricating a Hollow Obturator with Light-Cured Resin System

Tumor resection of a cancer lesion produces maxillary defects that can be easily restored with an obturator to close the defect area. Postsurgical maxillary defects predispose a patient to hypernasal speech, fluid leakage into the nasal cavity, and impaired masticatory function. Therefore, the primary aims of prosthetic rehabilitation in total and partial maxillectomy patients include: separation of oral and nasal cavities to allow adequate deglutition and articulation, possible support of orbital contents and support of soft tissue to restore mid-facial contours. A method of fabricating a simple hollow obturator for maxillectomy patients is described. The use of a relatively long-lasting light cure resin materials in making obturators allows stable, comfortable, and effective obturation. The hollow prosthesis is lightweight and sufficiently flexible to allow relatively simple placement in retentive undercut regions.     

Rehabilitation of a bilateral maxillectomy patient with a free fibula osteocutaneous flap

Rehabilitation of patients who have undergone bilateral maxillectomy is difficult because of extensive loss of bone and soft tissue. In this clinical report, prosthodontic rehabilitation of oral function in a bilateral maxillecitomy patient combined with a new fibular osteocutaneous flap, which was designed to have two oronasal slits for the retention of an obturator prosthesis, was described. A 58-year-old man with a maxillary alveolar carcinoma underwent bilateral maxillectomy. The defect was reconstructed using a vascularized fibular bone wrapped circumferentially with a peroneal flap, which was fixed with miniplates between the right malar prominence and cut edge of the left zygoma remaining two slits anterior and posterior to the graft. Two and half weeks after the surgery, a delayed surgical obturator was delivered and an obturator prosthesis was delivered 6 weeks after the surgery. This obturator prosthesis could be extended into the slits to engage the tissue undercuts, and was stable during use. Mastication, deglutition, articulation and the mid-facial profile of the patient were rehabilitated. After installation of the obturator prosthesis, relining of the prosthesis base was carried out alongside the healing process of the graft, and adjustment of occlusions and high-pressure spots was carried out. No clinical disorders were observed either in the grafted tissue or the obturator prosthesis with a 3-year prognosis. Newly designing a fibular osteocutaneous flap combined with tissue-borne obturator prosthesis is one successful approach to the restoration of oral function, and increases the patient's quality of life after bilateral maxillectomy.     

Oral rehabilitation of a patient with sub - total maxillectomy

This clinical report describes oral rehabilitation of a patient with sub-total maxillectomy with palatine process of maxilla and horizontal plate of palatine bone intact to retain the maxillary obturator. Clinical examination has been performed to know the amount of favorable undercuts to be used for retention of the obturator for better functional efficiency. Successful prosthetic reconstruction of hemimaxillectomy defect is a challenging procedure that requires multidisciplinary expertise to achieve acceptable functional speech and swallowing outcomes. This article describes the oral rehabilitation of a patient with sub-total maxillectomy with a maxillary obturator. Oral rehabilitation of sub-total maxillectomy patient is a challenging task. Obturation of the defect depends on volume of the defect, and positioning of remaining hard and soft tissues to be used to retain, stabilize, and support the prosthesis. A maxillary obturator for edentulous patient must provide for retention, stability, support, patient comfort, and cleanliness.     

Prosthetic rehabilitation of a completely edentulous patient with palatal insufficiency.

This article presents a case report of a completely edentulous patient with palatal insufficiency successfully rehabilitated with closed hollow bulb obturator prosthesis and also describes a simple technique for fabricating a two-piece hollow bulb obturator that allows for control of the bulb's wall thickness and weight of the prosthesis.     

Patient-specific sub-periosteal zygoma implant for prosthetic rehabilitation of large maxillary defects after oncological resection

A 74-year-old woman needed a subtotal bilateral maxillectomy due to squamous cell carcinoma of the palate. Immediate and secondary reconstruction of the defect was not feasible, so the defect was closed with an obturator prosthesis wired to the zygoma complex. To improve the patient’s severely impaired speech and swallowing, a patient-specific sub-periosteal implant (psSPI) was designed that matched the remnants of the zygoma complex. First, the patient’s post-surgical anatomy was visualized through segmentation of the pre- and post-maxillectomy computed tomography data. Next, based on the data, a customized zygoma-supported framework was designed to support the obturator prosthesis. Surgical guides for intraoperative navigation were designed and three-dimensionally printed, along with an obturator prosthesis to fit the planned outcome situation. The preoperatively manufactured psSPI and obturator prosthesis matched the intraoperative conditions. The postoperative results were favourable; within a week after surgery the patient could speak and swallow normally without nasal leakage. No problems occurred during follow-up. These results indicate that a psSPI-retained prosthesis can be considered for the restoration of speech and oral functioning in cases with a largely compromised maxillary bone anatomy, accompanied by impaired oral functioning and no feasible conventional reconstruction options.     

A simple method of fabricating an interim obturator prosthesis by duplicating the existing teeth and palatal form

An interim obturator prosthesis is required for the restoration of speech, deglutition, and improvement of esthetics after maxillectomy. This article describes a simple method for fabricating the interim obturator prosthesis by duplicating the patient's teeth and palate. The interim obturator prosthesis fabricated by duplication of the presurgical appearance and contour may be more acceptable to the patient.     

Rhinorrhea triggered by an obturator prosthesis: a clinical report

This clinical report describes an unusual cause of nasal leakage in a patient with an obturator prosthesis who had previously undergone a maxillectomy. The diagnosis of gustatory rhinorrhea was determined by eliminating other possible causes of rhinitis. Gustatory rhinorrhea has been described as a complication of a maxillectomy.     

Use of Orbital Conformer to Improve Speech in Patients with Confluent Maxillectomy and Orbital Defects

The basic objective in prosthetic restoration of confluent maxillary and orbital defects is to achieve a comfortable, cosmetically acceptable prosthesis that restores speech, deglutition, and mastication. It is a challenging task complicated by the size and shape of the defects. The maxillary obturator prosthesis often satisfies the objective of adequate deglutition; however, orbital defects that are not obturated in the medial, septal, or posterior walls allow air to escape, negatively impacting phonation. This article describes a technique to achieve favorable prosthetic rehabilitation in a patient with a maxillectomy and ipsilateral orbital exenteration. The prosthetic components include maxillary obturator, orbital conformer, and orbital prosthesis connected using rigid magnetic attachments.     

Anatomical and functional rehabilitation after total bilateral maxillectomy using a custom-made bone-anchored titanium prosthesis

Surgical reconstruction after a total maxillectomy remains challenging. The standard treatment is the microvascular free flap. In cases of surgical contraindication, oral rehabilitation is usually performed with a palatal obturator prosthesis (PAP). Acceptable anatomical and functional outcomes in terms of speech, mastication, aesthetic appearance, stability, and comfort are not often achieved with a PAP. This technical note describes a technique for reconstruction after total bilateral maxillectomy involving the implantation of a custom-made bone-anchored titanium prosthesis obtained by 3D printing. Good functional and anatomical outcomes were achieved with this technique. It combines the advantages of the obturator prosthesis (short duration of surgery and hospitalization, low morbidity) and free flap (aesthetic/anatomical reconstruction and irremovable comfortable functional rehabilitation). This technique constitutes a new therapeutic alternative for the restoration of large defects after total maxillectomy when free flaps are contraindicated.     

Construction of a maxillary prosthesis with a hollow obturator by the balloon technique and a case report

The authors devised a new method for making a maxillary prosthesis with a hollow obturator, which was named the Balloon Technique. This new technique has a number of advantages over the conventional method in that it not only facilitates the molding of a soft plastic hollow obturator in a single process, but also simplifies the trial fitting of the completed obturator. Furthermore, it makes possible firm adhesion of the hollow obturator and the denture base by the hot-melt method while the denture base resin is cured. Finally, the completed maxillary prosthesis is extremely light.     

Two-Piece Denture-Obturator Prosthesis for a Patient with Severe Trismus: A New Approach

Prosthetic intervention with maxillary obturator prosthesis is necessary to restore the contours of resected palate and to recreate the functional separation of the oral cavity and sinus and nasal cavity. Trismus occurs most frequently in maxillectomy patient following surgical procedure. Absence of graft placement and healing by secondary intention always results in healing contracture and trismus. Trismus could also be a result of post radiation sclerosis and scarring of muscles. Two-piece denture-obturator prosthesis is an alternative management to conventional acrylic resin obturator prosthesis for the patient with severe trismus as patient could not insert a large prosthesis in the mouth. The use of flexible or resilient material affords the opportunity to engage in undercut areas, needed to help in the retention of the prosthesis, without causing trauma to the soft, often sensitive, and easily irritable tissues.     

Rehabilitation of Partial Maxillectomy Defect with Implant Retained Hollow Bulb Obturator Prosthesis: A Case Report

Tissue integrated oral implants have initiated a new perspective in oral rehabilitation of tumor patients who have had undergone surgical resection procedure. The present case demonstrated a simple and predictable approach to rehabilitate a patient who had partial maxillectomy using dental implants. The use of an implant in conjunction with hollow bulb obturator shared remarkable improvement in retention and stability of the existing complete denture prosthesis.     

上颌中空式赝复体的改良制作

目的:降低赝复体的制作难度,提高赝复体的临床疗效.方法:选择单侧上颌骨缺损的患者11名,应用改良式赝复体修复缺损,评价疗效.结果:11名患者均对外观的恢复效果表示满意;口鼻腔通道封闭严密.制作技师认为降低技工室的制作难度.有利于临床医师制取理想颌位记录.结论:采用改良方式制作赝复体可较容易地获得一完整的中空式赝复体,降低了赝复体的制作难度.是一种对临床医师和技师均具有实用意义的修复体制作技术.     

Prosthetic rehabilitation of a patient after partial maxillectomy: A clinical report

Malignant melanoma of the oral cavity is very rare. This clinical report describes a method for prosthetic rehabilitation of a patient with malignant melanoma of the palate following partial maxillectomy with a closed hollow interim obturator.