Inflatable hollow obturator prostheses for patients undergoing an extensive maxillectomy:a case report

The presence of a large palatal or maxillary defect after partial or total maxillectomy for tumor, trauma or congenital deformation poses a challenge to prosthodontists, particularly when the use of an implant cannot be considered. This case report described the use of an air valve in a hollow silicone obturator to manufacture an inflatable obturator that could be extended further into undercut area to retain itself. The inflatable obturator exhibited adequate retention, stability and border sealing, thereby improving the masticatory, pronunciation and swallowing functions of patients. It may be a suitable alternative treatment option to an implant-retained obturator.

Effectiveness of a Custom-Made Temporary Obturator after Bilateral Total Maxillectomy

Large oro-antral communication, associated with total maxillectomy, may lead speech and/or swallowing dysfunction. These surgical defects are packed with obuturator or prosthesis following surgery;however, achieving retention and stability is dependent on anatomical conditions. A 68-year-old Japanese female with large oro-antral communication arising because of bilateral total maxillectomy was referred for evaluating application of obturator. The temporary obturator was constructed as underlying 3 mm thick and covereing 1.5 - 2 mm thick ethylene vinyl acetate sheet (EVA). These two sheets formed the flexible hollow bulb portion, which aided retention and stability by engaging the undercut portion of the surgical defect. For the patients who have difficulty anatomical features for conventional prosthesis, this type of temporary obturator made with EVA sheets could be an effective solution in the early postoperative period.

Aesthetic rehabilitation of a patient with an anterior maxillectomy defect,using an innovative single-step,single unit,plastic-based hollow obturator

What could be better than improving the comfort and quality of life of a patient with a life-threatening disease?Maxillectomy,the partial or total removal of the maxilla in patients suffering from benign or malignant neoplasms,creates a challenging defect for the maxillofacial prosthodontist when attempting to provide an effective obturator.Although previous methods have been described for rehabilitation of such patients,our goal should be to devise one stage techniques that will allow the patient an improved quality of life as soon as possible.The present report describes the aesthetic rehabilitation of a maxillectomy patient by use of a hollow obturator.The obturator is fabricated through a processing technique which is a variation of other well-known techniques,consisting of the use of a single-step flasking procedure to fabricate a single-unit hollow obturator using the lost salt technique.As our aim is to aesthetically and functionally rehabilitate the patient as soon as possible,the present method of restoring the maxillectomy defect is cost-effective,time-saving and beneficial for the patient.

Oral Health Management of Three Head and Neck Cancer Patients Performed by Dental Hygienists

Introduction: Oral health management is often difficult in patients after surgical tumor resection and/or radiotherapy due to defects, bulky flaps, limitation of tongue movement, and trismus. In addition, patients who have undergone radiotherapy have serious disabilities such as oral mucositis, mucosal weakening, soft tissue fibrosis, salivary gland disorder, and osteoradionecrosis. Dental hygienists must understand the characteristics of patients after surgical tumor resection and/or radiotherapy. In this report, the oral health management of three patients after maxillectomy, mandibulectomy, and radiotherapy was shown. Case Description: Case 1: A 53-year-old male patient visited our clinic after chemotherapy, radiotherapy, and partial maxillectomy for cancer of the right maxillary gingiva. Case 2: A 65-year-old male patient visited our clinic after radiotherapy for a right-sided tongue cancer, partial mandibulectomy of the right tongue to the oropharynx, a right-sided segmental mandibulectomy and a speech aid and a mandibular prosthesis were provided. Case 3: A 36-year-old female visited our clinic for radiotherapy for left-sided tongue cancer. Dental hygienists provided oral health management to the patients. In oral health management, it was suggested that intervention before cancer treatment, oral hygiene instructions tailored to patients’ symptoms, and frequent professional care are important. Conclusion: Oral health management by dental hygienists is extremely important for patients undergoing maxillofacial cancer treatment to maintain their quality of life in the long term.

Maxillary Sinus Schwannoma—A Rare Tumor with Rarer Site of Occurrence

Schwannoma or neurilemmoma is a neurogenic tumor. Around 25% - 45% cases of schwannomas occur in the head and neck, of which less than 4% occurs in the nasal cavity and the paranasal sinuses. Isolated schwannomas of the maxillary sinus appear to be extremely rare. We present one such rare case of Right Maxillary Sinus schwannoma in a 48-year-old lady with swelling in the right cheek for 3 years. Infrastructure maxillectomy of the right side was done using Weber-Fergusson approach with Dieffenbach’s modification. The patient made a good postoperative recovery. We report this case keeping in mind the rarity in occurrence of isolated maxillary schwannomas.

A Review of Inverted Papilloma at a Tertiary Centre: A Six-Year Experience

Objectives: To evaluate the clinical presentation and treatment outcome of all patients treated for inverted papilloma at the University Malaya Medical Centre, Malaysia. Methods: A retrospective review of 22 patients with inverted papilloma, treated at our centre, from 1st January 2005 to 31st August 2011. The demographic data, clinical features, radiological findings, surgical procedures, recurrent rate and malignant transformation were assessed. Result: The commonest presentation was a unilateral nasal blockage, comprising 77.3% cases. A total of 19 patients had undergone endoscopic surgery while three patients had open surgery performed. The mean duration of the follow-up period was 30.5 months. Seven (31.7%) patients were detected of tumour recurrence during the entire course of follow-up. However, throughout the follow-up period, none had demonstrated malignant transformation. Conclusion: Endoscopic medial maxillectomy is a well-accepted approach in treating inverted papilloma. Nevertheless, open surgery still plays an important role in extensive diseases and in cases of malignancy. Unilateral nasal obstruction is the most important symptom. Repeated pre-operative biopsy or perhaps frozen section of intraoperative biopsies is necessary to avoid misdiagnosis. Krouse stage II disease showed the highest recurrent rate of 18.2%. Lifelong follow-up and emphasis on adherence is mandatory for early detection of recurrence and malignant transformation.

Surgical obturator duplicating original tissue-form restores esthetics and function in oral cancer

Oral cancer treatment primarily focused on the surgical removal of cancer tissues followed by surgical/prosthetic reconstruction.Restoration of the missing structures immediately after surgery shortens recovery time and allows patient to return to community as a functioning member.The most practiced surgical obturators are simple resin prosthetic bases without incorporation of the teeth.This article highlights a technique to fabricate a surgical obturator that duplicates patient’s original tissue form including teeth,alveolus and palatal tissues.The obturator is placed immediately after surgery and make patient feel unaware of surgical deformity.The obturator prosthesis fabricated with this technique supports soft tissues and minimizes the scar contracture.We have clinically tried this technique in 11 patients.Patients’satisfaction level was recorded on visual analogue scale(VAS)and it ranges between 74%and 94%(with average of 87%).Four different prosthodontists have visually evaluated facial asymmetry of patients at6 mo recall and their average perception on VAS varies between 71%and 93%(with average of 84%).

Management of the recalcitrant upper lip

The aim of this study was to present our experience in the management of the recalcitrant upper lip and describe the surgical technique. We took a retrospective chart review of all patients who underwent reconstruction of the recalcitrant upper lip after maxillectomy and radiation therapy. Three female patients were identified. All patients had a history of malignant maxillary tumors, mucoepidermoid carcinoma (n = 1), verrucous carcinoma (n = 1), squamous cell carcinoma (n = 1). Tumor extirpation was carried out through total maxillectomy (n = 2), and bilateral subtotal maxillectomy (n = 1). Primary reconstruction was accomplished with scapula free flap (n = 1), fibula free flap (n = 1), and nonvascularized iliac crest bone graft (n = 1). Two patients underwent adjuvant radiotherapy. All patients developed recalcitrant upper lip. All patients had secondary reconstruction to correct of the recalcitrant upper lip using radial forearm free flap. All patients had successful dental rehabilitation. The mean follow-up was 5 years (range 3-7 years). Subjective functional and aesthetic outcome was assessed in all patients at the last follow up visit. All patients reported subjective improvement in speech, mastication and aesthetics. Free tissue transfer provides an ideal method to reconstruct the recalcitrant upper lip. Favorable functional and aesthetic outcomes can be successfully achieved using the technique described in this series.