ABSTRACT
PURPOSE: To establish an alternative method to design and fabricate an obturator prosthesis within the maxillectomy defect using a computer-aided design (CAD) and rapid prototyping (RP) technique and to evaluate the functional results of this technique. MATERIALS AND METHODS: Eleven patients with acquired maxillary defects resulting from head and neck cancers were treated using a protocol based on three-dimensional (3D) reconstruction, CAD, and RP technologies to fabricate obturator prostheses. To evaluate the quality of the obturator prostheses and the patients' satisfaction, the Obturator Functioning Scale (OFS) of the Memorial Sloan-Kettering Cancer Center was applied. RESULTS: Each patient received an individualized obturator that exactly matched the static shape and fit of the defect. Clinical modifications were required to improve border contours. The patients showed good results in all fields of functional outcomes and social acceptance. The OFS scores were comparable with those reported in other studies using traditional maxillectomy impression methods. CONCLUSIONS: This study combined CAD with RP technology to explore an alternative and feasible method for manufacturing individualized obturators for patients after maxillary resection. It has shown significant clinical value, especially for use in developing countries.
Subject(s)
Computer-Aided Design , Dental Prosthesis Design , Maxilla/surgery , Palatal Obturators , Adult , Aged , Dental Prosthesis Retention , Eating/physiology , Feasibility Studies , Female , Humans , Hypesthesia/etiology , Image Processing, Computer-Assisted/methods , Imaging, Three-Dimensional/methods , Interpersonal Relations , Lip Diseases/etiology , Male , Maxillary Neoplasms/rehabilitation , Maxillary Neoplasms/surgery , Middle Aged , Palatal Obturators/standards , Patient Satisfaction , Pilot Projects , Speech/physiology , Surface Properties , Tomography, Spiral Computed/methods , Treatment Outcome , Xerostomia/etiologyABSTRACT
Defects can form after tumors in the maxillary region are resected surgically. Maxillofacial defects can affect a patient's physical, psychological, and social status. Surgery reduces the residual teeth and tissue's ability to provide optimal cross-arch support, stability, and retention. The design of the obturator can improve the esthetics of the prosthesis and give it a more lifelike appearance. This case report describes the fabrication of a cast metal framework design for a partial obturator prosthesis in a maxillectomy patient.
Subject(s)
Dental Prosthesis Design/methods , Palatal Obturators , Dental Impression Technique , Esthetics, Dental , Female , Humans , Maxilla/surgery , Palatal Obturators/standards , Young AdultABSTRACT
UNLABELLED: The developing role of the prosthodontist in the head and neck cancer team is discussed and a sequence of care given for patients who will require the restoration by prosthetic means of surgically created palatal defects. Various styles of definitive obturators are described. CLINICAL RELEVANCE: A knowledge of the care of patients with palatal defects is of value to GDPs and to members of the head and neck cancer team.
Subject(s)
Dental Prosthesis Design , Dental Prosthesis Retention , Palatal Obturators/standards , Palate/surgery , Dental Prosthesis, Implant-Supported , Head and Neck Neoplasms/rehabilitation , HumansABSTRACT
Severe speech difficulty is often caused after surgery of an oral cancer. Prosthetic treatment with a removable obturator prosthesis is generally provided for such patients. Although some speech ability is recovered with prosthetic treatment, patients sometimes complain of continued dissatisfaction with their speech. However, it is difficult to evaluate the dissatisfaction. Therefore, a new method for evaluation is desirable. In this study, such a new method using the galvanic skin response as the index for the dissatisfaction of the patient was developed, and its objectivity was investigated. Eleven patients with maxillary bone defects were selected. Prior to the evaluation, improvement of speech with the removable prosthesis was confirmed using the speech intelligibility test and the visual analogue scale. The electrical resistant value at pronunciation was measured with the measuring system composed with the apparatus (galvanic skin response (GSR) measuring apparatus), the personal computer program. The changes for the electrical resistant value after pronunciation were evaluated by calculating the decrease ratio at pronunciation [(the mean electrical resistance before pronunciation - the mean electrical resistance after pronunciation)/the mean electrical resistance before pronunciation]. This decrease ratio at pronunciation was defined as the index of the speech dissatisfaction of the subject. The mean values for the decrease ratio with prosthesis were significantly smaller than the values without prosthesis (P < 0.05). From the results of this study, it is suggested that the measurement of the electrical resistance change of the skin during speech could be a new method for evaluating the speech dissatisfaction of the post-oral-cancer patient.
Subject(s)
Maxilla/surgery , Mouth Neoplasms/surgery , Postoperative Complications/rehabilitation , Speech Disorders/rehabilitation , Speech Intelligibility , Female , Humans , Male , Middle Aged , Palatal Obturators/standards , Patient Satisfaction , Postoperative Complications/psychology , Speech Disorders/etiology , Speech Disorders/psychologyABSTRACT
El trabajo del equipo multidisciplinario fue el camino para obtener las ventajas biológicas, psicológicas, cosméticas y funcionales. La prótesis interna fue importante para mantener la simetría de la cara; el obturador sostuvo el colgajo palatino en su lugar manteniendo su nutrición y la vitalidad del mismo. Después de este tratamiento, el paciente se recuperó totalmente y no tuvo secuelas psicológicas ya que nadie podía percibir su defecto
Subject(s)
Humans , Female , Fibroma, Ossifying/surgery , Fibroma, Ossifying/therapy , Maxillofacial Prosthesis/standards , Dimethylpolysiloxanes/therapeutic use , Maxilla/surgery , Palatal Obturators/standards , Palate, Soft/transplantation , Mouth Rehabilitation/methods , Silicones/therapeutic use , Surgical FlapsSubject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Cleft Lip/classification , Cleft Lip/embryology , Cleft Lip/rehabilitation , Cleft Palate/classification , Cleft Palate/embryology , Cleft Palate/rehabilitation , Patient Care Team , Comprehensive Dental Care/methods , Cleft Lip/diet therapy , Cleft Lip/surgery , Cleft Lip/therapy , Cleft Palate/diet therapy , Cleft Palate/surgery , Cleft Palate/therapy , Palatal Obturators/standards , Speech TherapyABSTRACT
Se describe el tratamiento ortopédico del niño que presenta la "secuencia de Pierre Robin" (anteriormente llamado Sindrome de Pierre Robin), el cual se comienza a partir de la primera semana de vida. El tratamiento ortopédico se efectúa con una prótesis de acrílico, cuyo flanco vestibular va adosado al reborde alveolar superior, presentando a nivel del "post daming" una prolongación posterior (tipo coleta) que coincide con la fisura. Gracias a ella, la lengua encuentra un punto de apoyo posterosuperior que le permite descender y adelantarse progresivamente, solucionando en parte el micrognatismo y la glosoptosis características de esta patología, logrando que el niño pueda ser alimentado con biberón. Este recurso terapéutico, sumado al uso de tetinas y chupetes anatómicos y a un tratamiento postural adecuado (posición supino-prono), permiten una correcta alimentación y mejoran también los problemas respiratorios característicos de estos niños. El enfoque ortopédico es preparatorio para un exitoso cierre quirúrgico de la fisura, que complementado con el tratamiento fonoaudiológico y el apoyo psicológico, permiten la rehabilitación de estos niños antes de la edad escolar, mediante un trabajo multi e interdisciplinario (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Pierre Robin Syndrome/diagnosis , Pierre Robin Syndrome/therapy , Palatal Obturators/standards , Cleft Palate/therapy , Cleft Lip/therapy , Micrognathism/therapy , Patient Care Team , Logotherapy/methods , Tongue/physiopathology , Posture/physiologyABSTRACT
Se describe el tratamiento ortopédico del niño que presenta la "secuencia de Pierre Robin" (anteriormente llamado Sindrome de Pierre Robin), el cual se comienza a partir de la primera semana de vida. El tratamiento ortopédico se efectúa con una prótesis de acrílico, cuyo flanco vestibular va adosado al reborde alveolar superior, presentando a nivel del "post daming" una prolongación posterior (tipo coleta) que coincide con la fisura. Gracias a ella, la lengua encuentra un punto de apoyo posterosuperior que le permite descender y adelantarse progresivamente, solucionando en parte el micrognatismo y la glosoptosis características de esta patología, logrando que el niño pueda ser alimentado con biberón. Este recurso terapéutico, sumado al uso de tetinas y chupetes anatómicos y a un tratamiento postural adecuado (posición supino-prono), permiten una correcta alimentación y mejoran también los problemas respiratorios característicos de estos niños. El enfoque ortopédico es preparatorio para un exitoso cierre quirúrgico de la fisura, que complementado con el tratamiento fonoaudiológico y el apoyo psicológico, permiten la rehabilitación de estos niños antes de la edad escolar, mediante un trabajo multi e interdisciplinario
Subject(s)
Humans , Male , Female , Infant, Newborn , Palatal Obturators/standards , Pierre Robin Syndrome/diagnosis , Pierre Robin Syndrome/therapy , Cleft Lip/therapy , Cleft Palate/therapy , Micrognathism/therapy , Patient Care Team , Posture/physiology , Speech Therapy , Tongue/physiopathologyABSTRACT
Se describe una técnica para construir prótesis para fisurados palatinos teniendo en consideración las variantes que ofrecen cada caso en particular y las distintas formas de tratamiento que derivan de la técnica general (AU)
Subject(s)
Palatal Obturators/standards , Cleft Palate/rehabilitation , Phonetics , DeglutitionABSTRACT
Se describe una técnica para construir prótesis para fisurados palatinos teniendo en consideración las variantes que ofrecen cada caso en particular y las distintas formas de tratamiento que derivan de la técnica general
