Fabrication of an immediate surgical obturator for a patient with resection of the maxillary antrum and bony orbital floor.

An immediate surgical obturator is necessary for maxillectomy procedures to minimize functional disabilities in speech, swallowing, and egress of food and liquid into the surgical defect. Sometimes the extent of the tumor may be such that it may even require the removal of the maxillary sinus along with resection of the orbital floor. The resected orbital floor can be surgically reconstructed with autogenous soft and/or hard tissues or with alloplastic materials. This clinical report highlights one such situation where the surgical resection of the maxilla and the orbital floor were rehabilitated with an immediate surgical obturator extending to the orbital floor to support the visual apparatus.

Closed hollow bulb obturator--one-step fabrication: a clinical report.

A method is described for the fabrication of a closed hollow bulb obturator prosthesis using a hard thermoforming splint material and heat-cured acrylic resin. The technique allowed the thickness of the thermoformed bulb to be optimized for weight reduction, while the autopolymerized seal area was covered in heat-cured acrylic resin, thus eliminating potential leakage and discoloration. This technique permits the obturator prosthesis to be processed to completion from the wax trial denture without additional laboratory investing, flasking, and processing.

Rehabilitation of an extraoral and intraoral defect complicated with microstomia. A study case.

A 72-year-old man was referred from the surgery department for rehabilitation following surgical resection of Basaloid carcinoma. The first surgical intervention involved the anterior palatal region and was restored with a simple obturator. Two years later further surgery was undertaken to excise a recurrent tumor in the nose and part of the cheek. This resulted in an exposed nasal cavity and maxillary sinus. In addition, there was a small oral aperture composed of thin tissue that stretched to its maximum due to scar formation. The defect was restored with a full thickness skin flap but it subsequently broke down leaving the midface exposed with limited mouth opening due to tissue contraction and scar formation after the flap operation. The defect was rehabilitated with Co-Cr obturator intraorally and a silicone nose retained to the naso-palatal extension of the obturator by a magnet extraorally. This resulted in practically good retention, placement, and adaptation of the two parts of the prosthesis.

Prosthodontic rehabilitation of patients with orofacial defects.

In 2007 in the UK, 5410 people were diagnosed with an oral cancer. It is therefore imperative that all dentists, medical practitioners and dental care practitioners are vigilant when examining the oral cavity so that any suspicious ulcers, swellings or changes in colour of the mucosa are referred at the earliest stage. To give the patient the best prognosis with an orofacial defect following tumour removal or trauma, it is most important to have the appropriate skills in a multidisciplinary team. The management of patients comprises pre-surgical, surgical and post-surgical phases.

A fiber-reinforced composite prosthesis restoring a lateral midfacial defect: a clinical report.

This clinical report describes the use of a glass fiber-reinforced composite (FRC) substructure to reinforce the silicone elastomer of a large facial prosthesis. The FRC substructure was shaped into a framework and embedded into the silicone elastomer to form a reinforced facial prosthesis. The prosthesis is designed to overcome the disadvantages associated with traditionally fabricated prostheses; namely, delamination of the silicone of the acrylic base, poor marginal adaptation over time, and poor simulation of facial expressions.

Prosthetic rehabilitation of a complete bilateral maxillectomy patient using a simple magnetically connected hollow obturator: a case report.

AIM: The purpose of this clinical report is to present a description of the prosthetic rehabilitation of a bilateral complete maxillectomy patient using a two piece magnetically connected prosthesis. BACKGROUND: A complete bilateral maxillectomy defect presents a considerable reconstructive challenge for the prosthodontist. It results in devastating effects on cosmetic, functional, and psychological aspects of the patient. REPORT: A 46-year-old woman reported with a chief complaint of missing teeth in the upper jaw. Her primary concerns were a poor facial appearance, inability to chew food, and regurgitation of the food into the nasal cavity. She was diagnosed with carcinoma of the maxillary sinus, for which a bilateral maxillectomy was done followed by post surgical radiation therapy. The prosthetic treatment objectives were to separate the nasal and oral cavities, restore the mid-facial contour, and improve her masticatory functions by providing a full complement of maxillary teeth using a two-piece connected hollow obturator prosthesis connected by a magnet. SUMMARY: Insertion and removal of a large prostheses used for rehabilitation of midfacial defects requires good neuromotor coordination and an adequate mouth opening. Because these factors were problematic for this patient, the treatment plan was to fabricate a two piece magnetically connected prosthesis. After fabrication and insertion of the prosthesis, the fit between two sections was evaluated and instructions for insertion, removal, and maintenance of the obturator were given. The patient's speech, masticatory efficiency, and swallowing dramatically improved after insertion.

Conventional prosthetic rehabilitation after free flap reconstruction of a maxillectomy defect: a clinical report.

Microvascular free flap reconstruction of maxillectomy defects has been advocated as a more desirable treatment option than conventional prosthetic rehabilitation. Free flap reconstruction can successfully separate the oral and sinonasal cavities, but the reconstructed defect may not improve the treatment outcome when compared with conventional prosthetic rehabilitation of a nonsurgically reconstructed defect. In this report, the prosthetic management of a patient who underwent immediate microvascular free flap reconstruction of a unilateral maxillectomy defect is described, and the issue of surgical versus nonsurgical reconstruction is discussed.

Reabilitação protética de paciente edêntulo após maxilectomia: um caso clínico / Prosthetic rehabilitation of edentulous patient after maxillectomy: a clinical report

Apesar de todos os avanços tecnológicos na realidade socioeconônica em que vivemos, tanto a reabilitação protética implanto-retida quanto a realização rotineira de exames caros como Tomografias Computadorizadas (TCs) e Imagem por Ressonância Magnética (IRMs) são restritas a uma parcela muito pequena da população, dando origem muitas vezes a casos de pacientes que sofreram maxilectomia há mais de 20 anos sem nunca terem sido reabilitados, sobrevivendo à margem da sociedade. Este artigo tem como objetivo apresentar um caso clínico, descrevendo uma técnica simples e acessível de reabilitação de pacientes submetidos à maxilectomia através da confecção de próteses totais obturadoras

Osteosarcoma of the jaw. The Chaim Sheba Medical Center experience.

OBJECTIVE: The purpose of this article is to present 14 cases of osteosarcoma of the jaw treated at our medical center from 1989 to 1998. These cases are discussed in the light of a comprehensive review of 774 cases reported in the English literature over the past 3 decades. Differences between osteosarcoma of the jaws and osteosarcoma of the long bones are examined. SUBJECTS AND METHODS: The patients ranged in age from 8 to 78 years, the mean age being 33 years. Each patient had a histopathologically established diagnosis of osteosarcoma of the jaw. Records were reviewed for epidemiologic data, treatment modalities, and survival. RESULTS: Of the 14 patients, 6 (42%) had tumors in the mandible and 8 (58%) had tumors in the maxilla. Of the mandibular tumors, 5 occurred in the body of the mandible; all maxillary tumors originated in the alveolar ridge and involved the maxillary sinus. The chief complaint was an intraoral or extraoral painless swelling. Histopathologic types included chondroblastic, osteoblastic, fibroblastic, and malignant fibrous histiocytoma-like. Pathologic grade was determined to be high (3 or 4) in 13 cases and low (1) in only 1 mandibular case. All patients underwent surgical resection and immediate reconstruction. Adjuvant therapy included postoperative radiation (5 patients), postoperative chemotherapy (2 patients), and preoperative chemotherapy and postoperative radiation (1 patient). CONCLUSIONS: The results of the present study support the literature indicating that osteosarcoma of the jaw differs from osteosarcoma of the long bones in its biological behavior even though they have the same histologic appearance. Because of differences in tumor characteristics, the introduction of chemotherapy did not dramatically alter the prognosis of osteosarcoma of the jaw. Early diagnosis and radical surgery are the keys to high survival rates.

Replacement of an obturator section of an existing two-piece implant-retained edentulous obturator.

There is an increasing number of people in the community who have postablative surgery for tumors of the maxilla. Postsurgical defects these individuals have are usually restored by means of a complete or partial denture obturator with various materials, including resilient silicone extensions. These patients require long-term maintenance of their obturator prostheses, which must be considered in the context of their general health and ongoing medical care. When a resilient silicone bulb is used to obturate the defect, the silicone sometimes deteriorates, whereas the denture base remains functional. This article describes a simple procedure to construct a replacement, resilient silicone bulb obturator while retaining the original complete or partial denture base.

Sectional prosthesis for total maxillectomy patients: a clinical report.

Total maxillectomy is a relatively uncommon surgical procedure and usually results in a surgical and prosthetic reconstructive challenge. The goals of prosthetic treatment include separation of oral and nasal cavities, which allows for adequate speech and deglutition, along with restoration of esthetics. Treatment of a patient with total maxillectomy due to verrucous carcinoma was presented in this clinical report. Clinical and laboratory procedures of the prosthetic treatment were described. The sectional prosthesis retained by magnets eliminated long-term use of a nasogastric tube, rehabilitated the patient's speech, and restored proper midfacial esthetic contour.

Primary maxillary reconstruction after radical maxillectomy using a combined free flap and secondary dynamic suspension.

We report a case of maxillary reconstruction aimed at optimizing facial contour, oral function, and facial animation after radical maxillectomy. In the first stage, using combined latissimus dorsi serratus anterior flaps attached with ribs, we performed a three-dimensional restoration for midface defects. In the second stage, we performed dynamic reconstruction of the nasolabial fold and upper lip using a temporal muscle transposition. As a result, the upper lip was able to be elevated as much as 10 mm when the patient clenched his teeth, and the outcome was judged to be both aesthetically and functionally satisfactory.

The temporalis muscle flap: an evaluation and review of 38 cases.

This article analyzes the authors' experience with the temporal myofascial flap in orbital, maxillary, floor of the mouth, tongue, retromolar trigone, and buccal mucosa reconstruction after oncologic surgery. Thirty-eight patients were treated and evaluated after using this technique. Four of the patients received the flap to restore orbital defects; the other 34 flaps were used in oral reconstruction. The flap remained viable in all instances. Most of the patients experienced no perioperative complications. Ten patients (29.4%) with flaps transposed to the oral cavity showed partial wound dehiscence. Two patients experienced temporomandibular joint dysfunction, two severe reduction in the oral aperture, 22 had mild depression of the temporal fossa, and four had mild to severe alteration in the facial aesthetics secondary to bone resection. All flaps transposed to the oral cavity showed good epithelialization and adaptation to the recipient site.

Transmolar pin and magnetic carrier for midfacial reconstruction: a clinical report.

With previous prosthetic restorations of bilateral maxillary resections, tissue erosion and bleeding on the cephalic parts of the cavity have been caused by movement and pressure from the prosthesis. Retention of a prosthesis is a major determinant in its successful use. Physical and psychologic stresses are common when one is unable to use a prosthesis comfortably. The use of a musculocutaneous flap and an obturator prosthesis had provided near-immediate reconstruction of a massive midfacial defect. This method of reconstruction resulted in soft tissue replacement for appearance and functional rehabilitation of the upper lip while maintaining sound oncologic principles.

New surgical obturator prosthesis for hemimaxillectomy patients.

Many materials have been used to make immediate and intermediate obturator prostheses for the hemimaxillectomy patient. The weight of the obturator prosthesis is a major hindrance. A new thermoplastic material, Polysar, is described to create a hollow obturator extension for immediate and intermediate lightweight obturator prostheses.