Fabrication of a Movable Obturator Following Maxillary Reconstruction with Slit‐Shaped Fenestration

Extensive maxillary resection has generally been reconstructed with free skin flaps. Because drooping of the transferred flap causes instability of the obturator prosthesis, maxillary reconstruction often incorporates a slit‐shaped oronasal fenestration. Although obturator prostheses for edentulous patients are stabilized with the help of oronasal slits, those for dentate patients are unstable because of flap mobility, resulting in a harmful lateral force exerted on the abutment teeth, causing dislodging of the denture. This report evaluates the benefits of a movable obturator prosthesis for a 60‐year‐old dentulous patient with maxillary sinus carcinoma. The patient underwent left‐sided total maxillectomy, and the defect was reconstructed with a slit‐shaped fenestration using a rectus abdominis flap. A conventional obturator prosthesis was inserted; however, drooping of the flap caused instability of the obturator, resulting in nasal regurgitation and fracture of the clasp. To solve this problem, we designed an obturator prosthesis with a movable connection consisting of a ball attachment (patrix) in the metal base and a socket (matrix) in the obturator, which acted as a stress breaker against the harmful force exerted by the flap. Application of this movable obturator prosthesis was a useful solution for a compromising situation created by the surgical procedure. No clinical disorders were observed at the 3‐year follow‐up.