Three-Dimensional Printing: A Novel Approach to the Creation of Obturator Prostheses Following Palatal Resection for Malignant Palate Tumors.

BACKGROUND: A subgroup of patients who have an oronasal fistula live in areas that have limited access to oral prosthetics. For these individuals, a temporary prosthesis, such as a palatal obturator, may be necessary in order to speak, eat, and breath properly. The creation of an obturator, which requires a highly trained prosthodontist, can take time and can be expensive. Through the current proof-of-concept study, there is an attempt to create a patient-specific palatal obturator through use of free and publicly available software, and a low-cost desktop 3-dimensional printer. The ascribed study may provide a means to increase global access to oral prosthetics if suitable biomaterials are developed. METHODS: Computerized tomography data were acquired from a patient who had an oronasal fistula. Through use of free software, these data were converted into a 3-dimensional image. The image was manipulated in order to isolate the patient's maxilla and was subsequently printed. The palatal obturator models were designed, and reformed, in correspondence with the maxilla model design. A final suitable obturator was determined and printed with 2 differing materials in order to better simulate a patient obturator. RESULTS: Creating a suitable palatal obturator for the specified patient model was possible with a low-cost printer and free software. CONCLUSIONS: With further development in biomaterials, it may be possible to design and create an oral prosthesis through use of low-cost 3-dimensional printing technology and freeware. This can empower individuals to attain good healthcare, even if they live in rural, developing, or underserviced areas.

Rehabilitation of Oncology Patients with Hard Palate Defects Part 3: Construction of an Acrylic Hollow Box Obturator.

This article will discuss the clinical stages in the fabrication of a definitive acrylic hollow box obturator to restore a hard palate defect. The first two papers described the restorative/surgical planning phase and the principles of obturator design. CPD/CLINICAL RELEVANCE: Each of the clinical stages required to make a hollow box obturator must be performed to the highest possible standard to ensure than an optimal prosthesis.is fabricated.

Rehabilitation of oncology patients with hard palate defects. Part 1: The surgical planning phase.

This article is the first in a series of three papers that will discuss the conventional non-implant retained prosthodontic rehabilitation of oncology patients with surgically acquired hard palate defects. In this first paper, the dental challenges posed by the oncology patients will briefly be discussed. The interface between the specialist restorative dentist and the maxillofacial surgeon when planning the conventional dental rehabilitation of an oncology patient with a hard palate defect will be discussed in detail. Clinical Relevance: To highlight the importance of the restorative dentistry/surgical interface when planning a treatment for a patient requiring a maxillectomy and conventional obturation.

Rehabilitation of Oncology Patients with Hard Palate Defects Part 2: Principles of Obturator Design.

The first part of this series on the conventional rehabilitation of oncology patients with hard palate defects discussed the dental challenges posed by oncology patients and the surgical/restorative planning interface for conventional dental rehabilitation. This article will describe Aramany's classification of hard palate defects, Brown's classification of palatal defects and focus on the basic principles of obturator design which need to be appreciated when prosthetically rehabilitating a patient with a hard palate defect. CPD/CLINICAL RELEVANCE: A good understanding of basic removable prosthodontic theory relating to denture design, dental materials science and head and neck anatomy is a prerequisite when designing an obturator for a patient.

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.

[The tongue flap in palatal defect reconstruction]. / Le lambeau de langue dans la reconstruction des pertes de substances du palais.

INTRODUCTION: A palatal defect with bucconasal fistula often follows exeresis of palatal tumors. It cannot be directly sutured. Several techniques have been used to cure such defects: palatal obturator, free, or local flaps. TECHNICAL NOTE: The tongue pediculated flap is an easy, safe, and reliable surgical option to reconstruct palatal defects. The tongue flap is a double-layer muscular and mucosal flap that requires two surgeries. During the first, the flap is harvested on the tongue and partially sutured on the anterior portion of the palatal defect. During the second, the pedicle is freed from the tongue and sutured to the posterior portion of the palatal defect. Between these two surgeries the patient is fed through a nasogastric tube. DISCUSSION: The tongue flap is easy and reproducible. It can be recommended in mediopalatal defects after cancer palatal surgery. Its esthetical and functional results are excellent. It is an alternative to palatal obturator, which are not well tolerated in the long run. Similar but uneven results are obtained with free flaps. Free flaps do not require a second surgery but are more difficult to implement in developing countries.

Reverse facial artery-submental artery deepithelialised submental island flap to reconstruct maxillary defects following cancer ablation.

OBJECTIVE: The present study assessed the reliability of the reverse facial artery-submental artery deepithelialised submental island technique to reconstruct maxillary defects. METHODS: The study included 13 patients (9 men and 4 women; 43-62 years) with maxillary defects resulting from cancer ablation. Ten patients presented with maxillary gingival squamous cell carcinoma and the remaining 3 cases were hard palate squamous cell carcinomas. The maxilla was resected and the remaining defects were classified as Class 2a. Reverse facial artery-submental artery deepithelialised submental island flaps measuring 8-10 cm in length and 4-5 cm in width were used to reconstruct the defects. RESULTS: Twelve of the 13 flaps survived. No donor-site problems or palsy of the marginal mandibular branch of the facial nerve occurred. The follow-up period ranged from 8 to 24 months, 1 patient died as a result of local tumour recurrence and 2 patients developed cervical recurrence. CONCLUSION: The reverse facial artery-submental artery deepithelialised submental island flap is safe, quick and simple to use or elevate. The flap is a reliable technique for reconstructing maxillary defects following cancer ablation.

Functional and aesthetic reconstruction of extensive oral ablative defects using temporalis muscle flap: a case report and a sort review.

PURPOSE: Temporalis muscle flap (TMF) provides a reliable solution in reconstruction of extensive intraoral ablative defects, providing a valuable alternative to more complex and extensive reconstructive procedures, combining excellent functional and aesthetic rehabilitation with minimal complications. In this article is described in detail the TMF surgical technique with attention to specific methods useful for preventing facial nerve injury and donor-site deformity. MATERIALS AND METHODS: It is presented the case of a patient with malignant tumour in the region of the upper jaw, palate and inferior half of the nasal cavity, who underwent extensive surgical excision and the resultant defect was successfully reconstructed with TMF. RESULTS: The reconstructive procedure resulted in excellent immediate and long-term functional (aspiration, feeding and speech) and aesthetic results. During the 5-year follow-up period no complications associated with the flap or the temporal implant, used for donor-site reconstruction were encountered and no local recurrence or tumour metastasis was observed. CONCLUSION: The TMF is a reliable, technically easy and anatomically sound technique, which combines excellent aesthetic and functional results with minimal complications, if performed correctly.

Reverse facial-submental artery island flap for the reconstruction of maxillary defects after cancer ablation.

This study assessed the reliability of the reverse facial-submental artery island flap for reconstructing maxillary defects. Twelve patients with cancer underwent surgical resection and sequential maxillary reconstruction using a reverse facial-submental artery island flap. There were 9 men and 3 women. The patients ranged in age from 42 to 73 years. Palate squamous cell carcinoma was present in 7 cases; and maxillary gingival squamous cell carcinoma, in 5 cases. The remaining defects were classified as class 1 in one case, class 2a in 8 cases, and class 3b in 3 cases. The sizes of the skin paddle varied from a minimum of 4 x 12 cm to a maximum of 5 x 12 cm. No flaps failed. There were no donor-site problems. The patients were followed up for 16 to 30 months; one case of tumor local recurrence was observed. The reverse facial-submental artery island flap is safe, quick, and simple to elevate. The flap can be used reliably for reconstructing maxillary defects.

[Provisional silicone obturator for closure of hard and soft palatal defects].

Treatment of intraoral squamous cell carcinomas is guided by the clinical stage of the disease and includes surgical resection. The resulting defect may be closed surgically or prosthodontically. This article describes a technique for provisional closure of a surgical defect. The interim obturator permits normal oral functioning until permanent rehabilitation is performed.

Implant-prosthetic rehabilitation after excision of hard palate gland carcinoma.

In Summer 2002, a patient with frequent epistaxis was admitted to the San Gerardo Hospital. Local examination showed a big mass in the nasal fossa. TC and RMN revealed a diffuse erosion of the palatal bone and infiltration of the maxilla. The tumor was removed and histological examination showed a gland carcinoma. The young age of the patient and the need of an adequate bone reconstruction led to use osteoperiosteal calf bone graft. Subsequently, using local anesthesia, 6 implants were positioned. After normal healing and the period of osteointegration, a Toronto bridge was made on implants that the patient wears with no problem.

Use of bar-clip attachments to enhance the retention of a maxillofacial prosthetic obturator: a clinical report.

Precision attachments are commonly used in prosthetic dentistry but are still questioned in maxillofacial prosthetics. The aesthetic enhancement and functional rigidity provided by attachments are favourable features to many challenging clinical situations such as class-III defect (Aramany's maxillectomy classification). Surgical reconstruction is the standard treatment for this type of defect repair. However, owing to the need for dental rehabilitation and patient reserve, prosthetic rehabilitation was the modality chosen in this clinical case. The use of bar attachments is described in this paper as providing increased stability and retention of the prosthesis, and improved obturator water and airtightness.

[Application of prosthetic replacement for bilateral maxillectomy defect].

A 59-year-old woman with large hard palate cancer underwent surgical resection. We constructed a maxillary prosthesis to be connected to the patient's mandibular denture. Bilateral maxillectomy resulted in total loss of the hard palate and bilateral alveolar and partial loss of the soft palate. A obturator prosthesis was prepared beforehand to fit the surgical cavity. The patient recovered functional speech and swallowing at a relatively early stage, achieving satisfactory cosmetic results.

The temporalis muscle flap in reconstruction of intraoral defects: an appraisal of the technique.

PURPOSE: The purpose of this article is to review the experience of the authors in the use of the temporalis muscle flap for reconstruction of intraoral defects. PATIENTS AND METHODS: This is a retrospective review of the use of the temporalis muscle flap for reconstruction of different types of intraoral defects in 8 patients. All patients in this series previously wore obturators as a nonsurgical treatment of their defects. Criteria used to evaluate the results of this technique included flap necrosis, facial nerve deficit, limitation of mandibular range of motion, and cosmetic deformity from scarring of the incision line or from loss of muscle volume in the temporal fossa. The patients were also evaluated for their degree of satisfaction with their speech and mastication with the obturator preoperatively and with the flap postoperatively. This article also reviews the success rates and complications with use of the temporalis muscle flap reported in the English-language literature during the past 14 years. RESULTS: All 8 patients in this series had their defects successfully reconstructed, completely eliminating any further need for prosthetic obturation of the defect. There were no incidents of flap necrosis, facial nerve deficit, or long-term changes in mandibular range of motion. Slight temporal hollowing was seen in the first 3 patients. Results of the literature review also showed a high success rate and a low incidence of complications with use of this flap. CONCLUSIONS: The temporalis flap is a useful, reliable, and versatile option for reconstruction of moderate to large sized defects. The muscle can provide abundant tissue, with minimal to no functional morbidity or esthetic deformity in the donor site.

Incorporation of an ERA attachment for obturator framework design: a clinical report.

Swinglock framework designs have been used to retain obturators for some time. One of the problems with Swinglock designs has been loss of retention due to wear of the metal latch assembly. This clinical report describes the incorporation of an ERA attachment as the latch assembly of a Swinglock framework for an obturator. The premise behind this design was that wear would be at the expense of the nylon retention male component, which is easily interchangeable, rather than the metal component of the assembly. The life of the latch assembly, framework, and prosthesis would thereby be prolonged.

An alternative method for fabricating a closed hollow obturator: a clinical report.

This article describes a procedure in which the fabrication of a closed hollow obturator can be made with three sections of a denture flask by using silicone. Ease of fabrication while controlling the thickness of the hollow portion and eliminating leakage and discoloration are major advantages of this technique while minimizing laboratory and clinical appointment time.