Reconstruction of total maxillectomy defect with implant-retained obturator prosthesis

Total maxillectomy is a relatively uncommon surgical procedure. Lack of support, retention and stability are common prosthodontic treatment problems for patients who have had a maxillectomy. This clinical report describes the prosthodontic management of a patient treated for plasmacytoma who required a bilateral maxillectomy after the radiotherapy. Osseointegrated implants and ball attachments were used to provide retention, support and stability of the definitive obturator. Mastication, deglutition, articulation and the midfacial profile of the patient were rehabilitated.     

Effect of submental flap reconstruction versus obturator rehabilitation after maxillectomy on quality of life: a randomized clinical trial

The surgical removal of a maxillary tumour will result in an oronasal communication, which can negatively affect the patient’s life and daily functions. Following maxillectomy, the defect can be treated with a prosthetic obturator or microvascular flap. However, the gold standard technique remains controversial. The aim of this study was to evaluate and compare quality of life (QoL) outcomes of submental island flap versus maxillary obturator reconstruction after partial maxillectomy. Sixty patients indicated for maxillectomy were allocated randomly to two equal-sized groups. Control group patients underwent reconstruction with a surgical obturator, while intervention group patients underwent submental island flap reconstruction. Patient QoL was evaluated at the 6-month follow-up using the University of Washington Quality of Life Questionnaire. Statistically significant differences in QoL were found between the two groups. Chewing (P = 0.034), swallowing (P < 0.001), speech (P = 0.009), taste (P = 0.04), mood (P = 0.01), and anxiety (P = 0.003) domains showed a statistically significant improvement in the submental group compared to the obturator group. However, the obturator group showed a greater improvement in appearance (P < 0.001). The masticatory function scores in the obturator group were significantly higher after obturator rehabilitation (P < 0.001). In conclusion, this study found that submental flap reconstruction provided better function and QoL than the obturator. This reconstruction was associated with less pain and better pronouncing of words, chewing, swallowing food, and psychosocial adjustment.     

A new technique for constructing a one-piece hollow obturator after partial maxillectomy

A technique for fabrication of a one-piece hollow obturator for patients who have had maxillary resection has been described. The prosthesis is simple to construct, light in weight, and easy to clean. It requires little more laboratory time than is needed for making the usual complete denture.     

Speech outcomes in patients rehabilitated with maxillary obturator prostheses after maxillectomy: a prospective study

PURPOSE: Speech outcome measurements are valuable in guiding treatment and determining the effectiveness of rehabilitation with a maxillary obturator prosthesis in individuals with palatal resection. Although speech outcome data exist in the literature for such patients, relatively few reports have used clinical tools designed to measure the acoustic, physiologic, and perceptual bases of speech. This investigation reports these measures for individuals rehabilitated with a maxillary obturator. MATERIALS AND METHODS: Speech measurements were collected prospectively at three clinical visit times (preoperative, postresection without an obturator, and with a definitive obturator) for 12 patients assigned to three groups based on the extent of their resection (< half the hard palate, > or = half the hard palate, hard and soft palates). Acoustic data were obtained with the Nasometer, aeromechanical data were collected with the PERCI-SARS, and perceptual ratings of speech intelligibility were obtained through listener analysis. RESULTS: Significant differences existed among the three treatments for all dependent variables and revealed that speech without an obturator is significantly different from the preoperative state, while speech with an obturator does not differ significantly from preoperative function. Individuals with soft palate involvement exhibited significantly poorer nasalance values than individuals with involvement of the hard palate only. CONCLUSION: Rehabilitation with a maxillary obturator is successful in restoring preoperative speech function. Rehabilitation of individuals with involvement of the soft palate may be more challenging.     

Reconstruction of a total maxillectomy defect with a zygomatic implant-retained obturator

Treatment options of maxillary fibrous dysplasia are surgical recontouring or total or partial maxillectomy depending on the site and behavior of the lesion. Among the reconstruction procedures, which include many surgical options, reconstruction using a maxillary obturator is the least invasive one. This report describes a case of aggressive maxillary fibrous dysplasia that was treated with a total maxillectomy and reconstructed with a malar implant-retained maxillary obturator.     

Vascularized iliac crest with internal oblique muscle for immediate reconstruction after maxillectomy

The vascularized iliac crest graft with internal oblique muscle as a method of reconstruction after maxillectomy has been used routinely at the Regional Maxillofacial Unit in Liverpool since 1993. Twenty-four consecutive operations have now been done and this paper reports an audit of our experience. An analysis of case-notes was made retrospectively after checking theatre diaries and records. A detailed inspection of the case-notes was undertaken to ascertain the presenting diagnosis, the complications and the outcome in terms of recurrence and disease survival. The type of defect was recorded, as was whether it had been possible to rehabilitate the patient both dentally and facially. At the time of this study 9 patients (38%) had died of their disease leaving 15 surviving. In 13 cases full dental and facial rehabilitation had been achieved or patients were waiting for an implant-retained prosthesis. Donor site problems important enough to be recorded in the notes were minimal, one case of abdominal wall weakness was noted, which required no intervention. The vascularized iliac crest graft with internal oblique muscle offers a complete solution for reconstruction after maxillectomy, providing there has been no sacrifice of the overlying facial skin and oral sphincter. There is sufficient height and depth of bone to maintain a facial profile and the muscle epithelializes to provide an ideal oral and nasal lining. This flap provides a base to enable full dental and facial prosthetic rehabilitation with either implant-retained or conventional prostheses.     

A new immediate temporary lightweight obturator for maxillectomy cavities

A method of producing a soft, comfortable, lightweight immediate obturator is described. This can be changed in an out-patient environment.     

Oral rehabilitation of patients after maxillectomy. A systematic review

Patients who have maxillectomy can be rehabilitated with reconstructive surgery or obturator prostheses with or without osseointegratable implants. To identify studies on possible treatments in this group, we systematically searched the Scopus, Embase, PubMed/Medline, and Cochrane databases to collect data on patients’ characteristics, radiotherapy, and results related to speech, swallowing, mastication or diet, chewing, aesthetics, and quality of life. Of the 1376 papers found, six were included, and one other was included after an additional search of references. A total of 252 patients were included, and of them, 86 had reconstructive surgery, 91 were treated with obturator prostheses, 39 had reconstructive surgery or obturator prostheses associated with implants, and 36 had reconstruction plus an obturator prosthesis. Data on radiotherapy were incomplete. There is a lack of consensus about the indication for rehabilitation, as the treatment must be based on the individual characteristics of each patient.     

Vomer-palatal flap, reconstruction of the palatal defect after maxillectomy

Rotational palatal flaps are frequently used to repair defects after partial or total maxillectomy procedures. However, their use is determined by the availability of sound tissues for defect closure. In an attempt to increase the amount of tissues available, we developed a vomer-palatal flap to include a part of vomer mucoperiosteum. The technique proved efficiency in a series of patients treated at Seoul National University Dental Hospital.     

A simplified technique for construction of an interim obturator for a bilateral total maxillectomy defect

PURPOSE: This report describes a simplified method for construction of an interim obturator for a huge maxillary defect. MATERIALS AND METHODS: A medical grade-silicone obturator was fabricated indirectly on a duplicate cast of the surgical defect for a patient with a bilateral total maxillectomy. This silicone obturator was attached to an acrylic plate by means of mushroom-like extension tags projecting from the fitting surface of the acrylic palatal plate. RESULTS: The obturator was well retained in the patient's mouth and markedly improved his ability to speak and swallow. CONCLUSION: This technique proved to be a simple, quick, and cost-effective method for construction of obturators for huge maxillary defects.     

分体式阻塞器修复双侧上颌骨缺失1例报告

通过为一例双侧上颌骨缺失患者制作分体式阻塞器及硅橡胶赝复体,探讨修复双侧上颌骨缺失的一种新方法。     

Oral rehabilitation by prosthetic restoration after maxillectomy for malignant tumors.

In maxillectomy patients, speech intelligibility between before and after insertion of prostheses has been reviewed by many investigators. Speech intelligibility was not related to the size of the defect, but rather to the defect region. Speech intelligibility was considerably improved by the use of prostheses. A great difference could not be found in escape rate from the nasal cavity between before and after insertion of prostheses, but there was a remarkable change in the spirometer. Postmaxillectomy functions are also easily restored by prosthetic oral rehabilitation, necessary to aid surgical procedure.     

The effect of obturator bulb height on speech in maxillectomy patients

Summary The purpose of this study was to compare the speech function of low height bulb obturators with that of high height bulb obturators. Thirteen maxillectomy patients, who underwent post‐operative prosthodontic rehabilitations, were included. Two obturators of the same design except for different bulb heights were fabricated for each maxillectomy patient. One of the two obturators had high bulb design and the other had low bulb design. After one of the obturators was used for a period of 3 weeks, the patient’s speaking functions were evaluated by measuring nasalance scores, formant frequencies, and vowel working space areas. The same procedures were repeated with the second obturator following another 3‐ week period of usage. In addition, the effect of delivery sequence and anatomic conditions related to maxillectomy were analysed. The results demonstrated that the nasalance scores with the low bulb obturators were significantly higher than those with the high bulb obturators. There were no significant differences in formant frequencies based on the bulb height of the obturators. The vowel working spaces for the two obturators were similar in shape and there were no significant differences between the vowel working space areas created by the two obturators. The delivery sequence affected the results. However, there were no significant differences related to the other anatomical variables. Although low bulb obturators might function similarly with high bulb obturators in terms of the articulation of speech, they would exhibit a difficulty in controlling hypernasality in maxillectomy patients.     

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.     

Effect of varying bulb height on articulation and nasalance in maxillectomy patients with hollow bulb obturator

PurposeTo evaluate the effect of bulb height of hollow bulb obturator prosthesis on articulation and nasalance.MethodA total of 10 patients, who were to undergo maxillectomy falling under Aramany class-I and II, with normal speech and hearing pattern were selected for the study. They were provided 2 maxillary obturators, one extending full height of the defect and other with bulb height approximately up to inferior nasal concha. The patients were asked to wear each obturator for 6 weeks and the speech analysis was done to measure changes in articulation and nasalance at 6 different stages of treatment i.e. preoperative, postoperative (after complete healing), 24 h and 6 weeks after providing full bulb height obturator and reduced bulb height obturator. Articulation was measured objectively for distortion, addition, substitution and omission by speech pathologist and nasalance was measured by Dr. SPEECH software.ResultComparison between full and reduced bulb height for nasalance and articulation, showed that there was no statistical significant difference (P > 0.05) between the two for both the parametres.ConclusionArticulation and nasality improves after providing obturator. Articulation and nasalance both are independent of bulb height.