Pharyngeal bulb prosthesis and speech outcome in patients with cleft palate / Obturador faríngeo e resultados de fala em pacientes com fissura palatina

Abstract Introduction: Individuals with cleft palate can present with velopharyngeal dysfunction after primary palatoplasty and require a secondary treatment due to insufficiency. In these cases, the pharyngeal bulb prosthesis can be used temporarily while awaiting secondary surgery. Objective: This study aimed to investigate the outcome of treatment of hypernasality with pharyngeal bulb prosthesis in patients with history of cleft palate presenting with velopharyngeal insufficiency after primary palatal surgery. We hypothesized that the use of the pharyngeal bulb prosthesis is an effective approach to eliminate hypernasality related to velopharyngeal insufficiency in patients with cleft palate. Methods: Thirty speakers of Brazilian Portuguese (15 males and 15 females) with operated cleft palate, ages ranging from 6 to 14 years (mean: 9 years; SD = 1.87 years), participated in the study. All patients were fitted with a pharyngeal bulb prosthesis to manage velopharyngeal insufficiency while they were awaiting corrective surgery to be scheduled. Auditory-perceptual analysis of speech recorded in the conditions with and without pharyngeal bulb prosthesis were obtained from three listeners who rated the presence or absence of hypernasality for this study. Results: Seventy percent of the patients eliminated hypernasality while employing the pharyngeal bulb prosthesis, while 30% still presented with hypernasality. The comparison was statistically significant (p < 0.001). Conclusion: The use of the pharyngeal bulb prosthesis is an effective approach to eliminate hypernasality related to velopharyngeal insufficiency.

Resumo Introdução: Indivíduos com fissura palatina podem apresentar disfunção velofaríngea após a palatoplastia primária e necessitam de um secundário devido à insuficiência velofaríngea. Nesses casos, o obturador faríngeo pode ser usado temporariamente enquanto se aguarda uma cirurgia secundária. Objetivo: Investigar o resultado do tratamento da hipernasalidade com o uso de obturador faríngeo em pacientes com histórico de fissura palatina que apresentam insuficiência velofaríngea após a palatoplastia primária. Nossa hipótese é que o uso do obturador faríngeo seja uma abordagem eficaz para eliminar a hipernasalidade relacionada à insuficiência velofaríngea em pacientes com fissura palatina Método: Participaram do estudo 30 indivíduos falantes do Português Brasileiro (15 homens e 15 mulheres) com fissura palatina operada, de 6 a 14 anos de idade (média: 9 anos; DP = 1,87 anos). Todos os pacientes receberam obturador faríngeo para o tratamento da insuficiência velofaríngea, enquanto aguardavam vaga para a cirurgia secundária. A análise perceptivo-auditiva da fala, realizada nas condições com e sem obturador faríngeo, foi realizada por três ouvintes, quanto à presença e ausência da hipernasalidade. Resultados: 70% dos pacientes eliminaram a hipernasalidade de fala com o uso do obturador faríngeo, enquanto 30% não eliminaram. A comparação foi estatisticamente significante (p < 0,001). Conclusão: O uso temporário do obturador faríngeo é uma abordagem efetiva para eliminar a hipernasalidade decorrente da insuficiência velofaríngea.

Prosthetic rehabilitation by double-processing technique for edentulous patient with soft palate defect after maxillectomy: A case report / 대한치과보철학회지

A patient who went through maxillectomy can have soft palate defects including oronasal fistulas and suffer from dysphagia and dysarthria due to velopharyngeal insufficiency. This defect causes the food to enter nasal cavity and creates hypernasal sound which debilitates a quality of life. An obturator can rehabilitate the substantial oral tissue defects. The maxillary obturator separates the nasopharynx from the oropharynx during speech and deglutition by closing of the defect. For edentulous obturator patient, it is difficult to obtain proper retention due to reduced peripheral sealing. Therefore, the contours of the defects must be used to maximize the retention, stability, and support. Hollow type obturator can improve physiologic function by reducing weight than the traditional obturator. This case report describes a patient with hemi-maxillectomy who recovers mastication, speech, deglutition, and appearance with a maxillary obturator using physiological border molding of the velopharyngeal area and double-processing method.

A cast partial obturator with hollow occlusal shim and semi-precision attachment

A maxillofacial patient's quality of life is distorted and social integration becomes difficult. An obturator is a maxillofacial prosthesis used to close a congenital or acquired tissue defect, primarily of the hard palate and/or contiguous alveolar/soft-tissue structures. Subsequently, it restores the esthetics, speech, and function. The present clinical report aimed for the prosthetic rehabilitation of a maxillectomy defect by the incorporation of a semi-precision attachment as PRECI-SAGIX – male part of 2.2 mm on fixed partial denture (#22 and #23 teeth) and matrix – plastic female part of size 2.2 mm and height 4.2 mm of yellow on cast partial in polymer base. It aids in the retention of a hollow lightweight obturator. The technique also described the method to make a bulbless obturator with a hollow self-cured acrylic resin occlusal shim. A patient is quite satisfied with bulb less, lightweight cast partial and hollow shim palatal obturator.

Rehabilitación protésica híbrida en un defecto orofacial. Presentación de un caso / Prosthetic hybrid rehabilitation in orofacial defect. Case presentation

Los procesos tumorales que comprometen la región de cabeza y cuello, pueden afectar particularmente la identidad del ser humano. Para la eliminación de estas neoplasias existen diferentes alternativas terapéuticas, que generan secuelas de tipo funcional, afectando: la fonación, deglución y masticación, además de defectos estéticos y alteraciones psicológicas. Por consiguiente, el enfoque para el tratamiento de pacientes con cáncer se basa no solamente en el control de la enfermedad, sino también en la supervivencia, rehabilitación y su reintegración a la sociedad. A continuación se presenta el caso de un paciente con defecto orofacial, resultado del tratamiento ante un carcinoma basocelular, con radioterapia y su posterior resección quirúrgica tras recidiva tumoral. Se rehabilita mediante la elaboración de una prótesis híbrida (obturador intraoral y prótesis facial) con el objetivo de compensar parcialmente las pérdidas funcionales, estéticas, incidiendo positivamente en su estado psicosocial.

Tumor processes compromising the head and neck region can particularly affect the identity of the human being. There are different therapeutic alternatives to remove these dysplasias, which generate functional sequels affecting phonation deglutition and mastication. Therefore, approach for cancer patients is not only based on control of the disease, but additionally in patient's survival, rehabilitation and reinsertion in society. We hereby present the case of a patient with an orofacial defect resulting from treatment of basal cell carcinoma with X-ray therapy and later surgical resection after tumor recurrence. The patient was rehabilitated with manufacture of a hybrid prosthesis (intraoral obturator and facial prosthesis) which was achieved with the purpose of partially compensating functional and aesthetic losses and thus improving the patient's psychosocial circumstances.

Oral mucormycosis in an 18-month-old child: a rare case report with a literature review

Oral mucormycosis is a fungal infection observed mainly in elderly immunocompromised patients. In rare instances, the disease occurs in healthy individuals and those patients that are below preschool age. Although this condition mainly involves the maxilla, it may also manifest in any part of the oral cavity based on the source of infection. Mucormycosis of the maxilla spreads rapidly, leading to necrosis of the palatal bone and palatal perforation. Such patients are usually rehabilitated using bone grafting or free flap surgeries. However, when surgeries are delayed, palatal prosthesis is an interim treatment modality that can prevent nasal regurgitation and aspiration of food or fluids. Palatal prostheses also help with mastication, speech, and swallowing. The present case describes a rare case of oral mucormycosis in an 18-month-old male involving the maxilla that was managed by palatal prosthesis.

Implant assisted obturator in patient after maxillectomy: a case report

Reconstruction of the maxillectomy with an obturator is to restore masticatory, swallowing, phonetic and esthetic problems. Stress created by lateral forces is minimized by the proper selection of an occlusal scheme, elimination of premature occlusal contacts, and wide distribution of supporting area. It should be considered that properly designed retainers reduce the stresses transmitted to the abutment while the obturator is in function. The following clinical report presents palatal obturator treatment with implant assisted removable partial denture (IARPD) design that restores normal function and esthetics in patients who experienced maxillectomy and dental implant failure.

Abordagem odontológica com obturador palatino imediato em um paciente portador de tumor neuroectodérmico melanótico da infância: relato de caso / Dental strategy with immediate palatal obturator in a patient with melanotic neuroectodermal tumor of infancy: case report

O objetivo do presente artigo é relatar a abordagem odontológica com obturador palatino imediato diferenciado em um caso clínico de tumor neuroectodérmico melanótico da infância, ocorrido no Instituto Nacional de Câncer José Alencar Gomes da Silva, realizando uma revisão da literatura e abordando o atendimento multidisciplinar como garantia do cuidado integral ao paciente. Lactente, 4 meses, sexo masculino, tumoração em maxila esquerda, foi encaminhado à seção de Odontologia para confecção de obturador palatino com projeção maxilar. O paciente que é submetido a um tratamento mutilador na tentativa de cura de alguma neoplasia de cabeça e pescoço necessita de conforto, bem-estar e um cuidado integral da equipe multidisciplinar, sendo o cirurgião-dentista parte dessa equipe.

The aim of this paper is to report a dental strategy with a differentiated immediate palatal obturator in a case of melanotic neuroectodermal tumor of infancy, held at the National Cancer Institute José Alencar Gomes da Silva, by performing a literature review and addressing the multidisciplinary treatment as a guarantee of integral care for the patient. Infant, 4 months, male, tumor in the left maxilla, was referred to the Odontology section for a palatal obturator confection with maxillary projection. The patient who is submitted to a mutilating treatment in an attempt to cure any head and neck neoplasm needs comfort, wellness and integral care from the multidisciplinary team, being the dentist part of it.

Palatal obturator restoration of a cleft palate patient with velopharyngeal insufficiency: a clinical report / 대한치과보철학회지

Cleft lip and palate is congenital deformity in oral and maxillofacial area. Normal soft palate has velopharyngeal closure action by connecting oral cavity and nasal cavity at rest and moving upward at swallowing and specific pronunciation. Cleft palate patients with velopharyngeal insufficiency have difficulty in mastication, swallowing and pronunciation because velopharyngeal closure is incomplete. At this time, a prosthetic device used to cover palate defects is called a palatal obturator. A palatal obturator separates oral cavity and nasal cavity and recovers pronunciation, mastication, swallowing and esthetic function. The purpose of this case study is to report the results because it reaches a satisfactory result in functional and esthetic aspects through functional impression procedures using modeling compound and tissue conditioner for restoration of a cleft palate patient with velopharyngeal insufficiency.