Mandibular pathological fracture during treatment with a dynamic mouth opening device: A clinical report.

Trismus is a well-known complication of head and neck cancer treatment. It is defined as a progressive tonic contraction of the muscles of mastication that results in decreased mouth opening. This condition can lead to impairment of speech and eating, malnutrition, poor oral hygiene, and difficulty with dental treatment. Its prevalence in patients with head and neck cancer ranges from 5% to 38%. Different treatments are available to improve muscle length and function. Mouth opening devices along with exercising of the mandible immediately after surgery and/or radiation therapy have been found to be effective in reducing the trismus induced by cancer therapy. Presently, only limited defined guidelines are available for initiating or monitoring trismus therapy in this patient population. This clinical report presents a patient with head and neck cancer and a history of progressive recurrent trismus as a sequela of extensive surgery and chemoradiation, who experienced a pathological fracture of the mandible during treatment with a mouth opening device.

Rhinorrhea triggered by obturator prosthesis after surgical intervention of partial maxillary resection: a clinical report.

This clinical report describes a case of rhinorrhea that arose after surgical intervention of partial maxillary resection and obturator prosthesis positioning. Ultimately, the diagnosis was that rhinorrhea was induced by mechanical irritation of the nasal mucosa determined by the nasal part of the obturator prosthesis. The differential diagnosis of nasal irritation, vasomotor rhinitis, gustatory rhinorrhea are presented and discussed, as well as the technical notes and measures taken to reach the final diagnosis and a satisfactory functional and aesthetic result for the patient.

Airway compromise by dislodged obturator in a patient with severe trismus.

A patient presented with impending airway obstruction due to a dislodged interim maxillary obturator. The removal was complicated by the presence of severe trismus due to previous maxillectomy and recent radiotherapy. An emergency tracheotomy with the patient under local anesthetic was required to provide a definitive airway and to permit subsequent removal of the obturator with the patient under general anesthesia. The situation highlights the risks associated with interim obturators while awaiting the provision of an ideally fitted, well-retained, definitive obturator. Displaced obturators are potentially life threatening and difficult to remove in emergency situations.

Orthodontic occlusal reconstruction after conservative treatment of unicystic ameloblastoma in an adolescent patient: 10-year follow-up.

Conservative treatment of an ameloblastoma often requires an occlusal reconstruction. In this article, we report the successful interdisciplinary treatment of a 14-year-old girl with a unicystic ameloblastoma in the mandible. One year after the marsupialization, enucleation with bone curettage was performed with extraction of the impacted third molar, but the proximal second molar could be maintained. The conservative treatment required long-term use of an obturator, and it caused a total open bite. Additionally, the patient genetically had a Class II malocclusion with severe crowding. Consequently, orthodontic treatment was performed after 4 premolar extractions. There was no recurrence of the ameloblastoma 10 years after the enucleation.

Pierre Robin sequence: appearances and 25 years of experience with an innovative treatment protocol.

PURPOSE: The aim of the study was to evaluate the largest number of Pierre Robin sequence (PRS) cases to date and its treatment outcome. DESIGN: This is a retrospective study. SETTINGS: The study was conducted in a tertiary care university hospital. PATIENTS: One hundred eighty-eight patients with PRS have been subjected to analysis, defined by the clinical triad of glossoptosis, retro/micrognathia, and cleft or agenesis of the palate, for incidence, risk factors, associated syndromes, other concomitant abnormalities, airway and feeding difficulties, and outcome regarding the neonatal and perinatal surgical and nonsurgical management. RESULTS: The incidence of PRS was 6.02%. Risk factors were found in 41.5% of mothers with children with PRS. Eleven other syndromes/appearances were associated. Feeding difficulties were seen in 51.8% of the patients. Glossopexy (6.9%) and tracheotomy (2.13%) for airway management were performed very seldom. The suction and drinking plate as well as the surgical treatment protocol may be considered to be the reasons for reduced airway (up to 91.0%), feeding problems (up to 79.9%), and mortality rate (2.1%). CONCLUSION: The Pierre Robin sequence, as seen as a heterogeneous group, presents with variation of the cleft palate defects with glossoptosis and concomitant micrognathic mandible. The surgical management and certain prepalatal intervention as nonsurgical management with an innovative treatment strategy were evaluated.

Complications and solutions in presurgical nasoalveolar molding therapy.

OBJECTIVE: To outline three main categories of nasoalveolar molding complications, describe their etiologies and manifestations, and prescribe preventive and palliative therapy for their proper management. Estimates of the incidence of each complication also are provided. MATERIALS AND METHODS: Data were collected retrospectively from the charts of 27 patients with complete unilateral cleft lip and palate treated by the first author (D.L.-B.) at the University of Puerto Rico (n = 12) and the Medical College of Georgia (n = 15). Confidence intervals for the true incidence of each complication were calculated using exact methods based on the binomial distribution. A significance level of .05 was used for all statistical tests. RESULTS: Of the soft and hard tissue complications considered, only one (tissue irritation) had an estimated incidence greater than 10%. Compliance issues were of greater concern, with an estimated incidence of 30% for broken appointments and an estimated incidence of 26% for removal of the nasoalveolar molding appliance by the tongue. CONCLUSIONS: Although benefits outnumber the complications, it is important to address all complications in order to prevent any deleterious outcomes.

Rhinorrhea triggered by an obturator prosthesis: a clinical report.

This clinical report describes an unusual cause of nasal leakage in a patient with an obturator prosthesis who had previously undergone a maxillectomy. The diagnosis of gustatory rhinorrhea was determined by eliminating other possible causes of rhinitis. Gustatory rhinorrhea has been described as a complication of a maxillectomy.

Rhinorrhea induced by loading of dental implants supporting an obturator prosthesis: a clinical report.

This clinical report describes an unusual situation of nasal discharge that was initially considered to be caused by a leaking obturator prosthesis in a partially repaired cleft palate patient. Ultimately, the diagnosis was rhinorrhea induced by the loading of dental implants that supported the obturator. The differential diagnoses of nasal irritation, blocking of nasal drainage posterior or anterior through a premaxillary defect, vasomotor rhinitis, and gustatory rhinorrhea are presented and discussed, as well as the measures taken to reach the final diagnosis.

Avaliaçäo de pacientes portadores de disfunçäo velofaríngea tratados com prótese de palato / Evaluation of patients with velopharyngeal insufficiency treated with intraoral speech prostheses

Este trabalho teve como objetivo avaliar, por meio de um questionário, o julgamento de pacientes portadores de disfunçäo velofaríngea, tratados com prótese de palato, em relaçäo à mastigaçäo, à fala, à estabilidade, à estética, à comodidade e à qualidade de vida. Além disto, o trabalho comparou a inteligibilidade de fala nas condiçöes, com e sem a prótese de palato, pelo julgamento de 5 fonoaudiólogos. A amostra consistiu em 48 pacientes, com idades variando entre 8 e 74 anos (X = 31,47ñ16,03), sendo 42 com insuficiência velofaríngea devido à fissura palatina congênita operada ou näo, 2 com insuficiência velofaríngea devido à resseçäo total ou parcial do palato (casos que tiveram câncer) e 4 com incompetência velofaríngea devido à paralisia total ou parcial do palato mole. Os resultados do questionário mostraram que: 1) a maioria dos pacientes preferiu se alimentar usando a prótese (81,2 por cento); 2) a maioria relatou melhora da fala com a prótese (85,4 por cento); 3) a prótese ficou estável para a maioria dos pacientes, tanto na alimentaçäo (75 por cento), quanto na fala (91,7 por cento); 4) a maior parte dos pacientes (79,2 por cento) sentiu-se confortável em usar a prótese; 5) a estética com a prótese foi satisfatória para a maioria dos pacientes (97,9 por cento); 6) a qualidade de vida da maioria dos pacientes (85,4 por cento) melhorou com o uso da prótese. Em relaçäo ao julgamento da inteligibilidade de fala pelos 5 fonoaudiólogos, concluiu-se que os resultados na condiçäo, com próteses de palato, foram estatisticamente melhores que os resultados na condiçäo, sem prótese, concordando com o julgamento dos próprios pacientes

Yeast counts as a measure of host resistance in dental patients.

This study was undertaken to determine whether yeast counts could be used as an indicator of decreased host resistance. One hundred subjects were investigated, 20 young healthy dentate and 20 edentulous adults, 20 adult and 20 geriatric denture wearers and 20 patients fitted with obturators and dentures. Eleven of these obturators were silicone and 9 were acrylic. The denture and the palate of each subject was sampled by taking Sabourauds agar impressions of the posterolateral palatal area and incubating the impressions aerobically at 37 degrees C for 48 hours. The number of yeast colonies were counted and the findings analysed statistically. Palates and dentures of debilitated patients showed high yeast counts and it is concluded that a decreased host resistance can be determined by the method used in this investigation.

Dental abrasion caused by a cobalt-chromium denture base.

A case of abrasive tooth surface loss caused by repeated sliding contact with the tissue surface of a cobalt-chromium denture base is described. The mode of material-tooth contact was brought about by an unusual patient habit which would have been difficult to foresee when the choice of denture base material was made.

Technique for assessing nasal airway resistance in patients treated prosthetically.

This investigation was designed to compare nasal airway resistance (Rnaw) values by use of "head-out" plethysmography and standard posterior pressure-flow rhinometry. Fourteen adults who had prostheses because of velopharyngeal inadequacy caused by a variety of etiologic conditions were examined. Each patient performed rest breathing and sustained /m/ productions to develop Rnaw values for comparison. The results revealed increased Rnaw and decreased cross-sectional nasal airway area and derived velopharyngeal orifice area when the appliances were in place. The two techniques for assessing Rnaw produced comparable results when certain conditions were met. Clinical implications for team assessment of patients involved with prosthetic management are discussed.

Tissue reaction to prosthetic obturator materials.

Two materials are currently used for construction of obturators to restore function when major maxillary defects are present: poly(methyl methacrylate) and poly(dimethyl siloxane). The advantages and disadvantages of the materials are examined and the physiologic response of the involved tissues is studied. Palatectomies were performed on primates and poly(methyl methacrylate) and poly(dimethyl siloxane) obturators were placed contacting antral and nasal mucosa. Serial biopsies and clinical evaluations revealed comparable histologic responses to both materials. Poly(dimethyl siloxane) exhibited a more favorable clinical tissue response than poly(methyl methacrylate).

Palatal lift prostheses for treatment of palatopharyngeal incompetence.

It appears that the palatal lift prosthesis is an effective prosthesis to improve palatopharyngeal incompetence in selected patients. Despite the inconvenience and problems associated with a prosthesis, this procedure is indicated for selected patients who have anatomically normal palates that are dysfunctional. The ultimate benefit of the palatal lift prostheses to the speech of the patients is not the subject of this report. However, it should be noted that many patients can benefit from speech therapy after a satisfactory prosthetic result has been achieved.