Surgical and prosthetic treatment of superficial carcinoma of the oral cavity.

A technique has been described for split-thickness skin grafting after resection of superficial carcinoma for both the mandibular and maxillary arch. The technique is a cooperative effort between the surgeon and the prosthodontist.

Oral endoscopy in prosthodontic management of the soft palate defect.

Telescopic oral endoscopy is an effective aid in the construction and modification of a speech aid prosthesis. The method is noninvasive and easy to perform, permits the prosthodontist to achieve the goal of functional effectiveness in prosthesis construction while keeping the weight and size of the pharyngeal extension at a minimum, decreases the number and length of patient visits required for modification, and when coupled to a fiberoptic teaching arm or a video camera and recording system, it becomes an excellent aid in teaching, patient education and orientation, and record keeping.

Prosthodontic considerations in the management of surgically compromised cleft palate patients.

Prosthodontic habilitation with speech aid prostheses for surgically compromised cleft palate patients has been discussed. It can be concluded that surgical redivision of the soft palate with removal of the levator veli palatini muscles as an aid to construction of a pharyngeal obturator is contraindicated. Surgical redivision with removal of the levator muscles prevents subsequent surgical procedures and commits the patient to a prosthesis for life. The management of nonfunctional pharyngeal flaps, large soft palate perforations, and patients with palatopharyngeal insufficiency and/or incompetency secondary to surgical repairs was also discussed. If the prosthodontist is routinely consulted in the initial treatment planning, alternatives to surgical management might be considered for patients with high potential for postsurgical deficiencies.

Speech considerations in prosthodontic rehabilitation of the glossectomy patient.

A knowledge of normal articulation is needed before the prosthodontist can assess the compensatory articulation used by glossectomy patients. The amount and portion of tongue resected is directly correlated with speech intelligibility. The loss of the tip of the tongue is more critical to intelligibility than a hemiglossectomy. Partial glossectomy speakers can often use the residual tongue stump to perform adaptive movements that approximate normal movements and should be treated as an articulation problem. The compensatory articulation used by the total glossectomy patient was reviewed. The prosthodontic management of patients with partial tongue resection often includes lowering the palatal vault, while the management of the total glossectomy patient usually requires a mandibular tongue prosthesis. These prostheses can be refined with the use of multiview videofluoroscopy, videotaping, and spectrographic analysis.

Compound splint for comminuted mandibular fracture.

Maintenance of an adequate airway, control of bleeding, and neurologic evaluation should take precedence over treatment of facial injuries. Comminuted mandibular fractures are rare and require the use of complex splints. Severe lacerations and bone displacement accompany comminuted mandibular fractures. Extraoral facial splints constructed from donor facial moulages can be used along with intraoral splints for these patients. Preaccident photographs and radiographs are excellent aids to help realign the fractured segments. The use of an extraoral "donor" splint in conjunction with an intraoral splint to stabilize comminuted mandibular fracture helps to eliminate unnecessary gross removal of mandibular bone.

Prosthetic auricular reconstruction.

Large lesions may necessitate resection of critical amounts of auricle, such that surgical reconstructive efforts may prove to be futile. We favor the prosthetic rehabilitation of patients requiring near total auriculectomy. Fifteen patients seen for the treatment of auricular lesions from 1976 to the present were reviewed. Near total auriculectomy with postoperative prosthetic management provided satisfactory functional and aesthetic results. This presentation will highlight the significant technical features of the surgical ablation and subsequent prosthetic management of patients with tumors of the auricle, such that postoperative rehabilitation will be facilitated.

Clinical evaluation of the mandibular staple bone plate.

Some of the problems in the use of the mandibular staple bone plate are improper placement of the implant labiolingually, gingival reaction around the pins, and compression loading of the implant. The use of the patient's denture to determine proper angulation and the preparation of the transosteal posts can eliminate improper placement. Mucogingival grafting can be used to treat the inflammatory gingival reaction around the posts, and compression loading can be controlled by proper recognition during processing, placement, and patient education.

Palatal neoplasms: reconstruction considerations.

Review of the literature and our personal experience with carcinoma of the palate indicates that a significant number of patients may benefit from palatal resection, either as an initial modality, in a planned combined treatment program, or for salvage after radiation therapy. Under any of these circumstances an integral part of the treatment program is rehabilitation of speech and swallowing function through prosthetic repair. Familiarity with the potentials and techniques of prosthetic rehabilitation after palatal resection is an important concern for the head and neck oncologist.

Prosthetic rehabilitation following major nasal resection.

Treatment of extensive carcinoma of the external nose has as an objective the eradication of disease and rehabilitation of the patient. We review our experience with 15 patients treated with total and subtotal rhinectomy. Prosthetic rehabilitation offers prompt recovery of both cosmesis and function without morbidity. We conclude that prosthetic reconstruction of major nasal defects deserves consideration when rehabilitation following rhinectomy is required.

Prosthodontic rehabilitation for glossectomy patients.

Patients with oral carcinomas often have resection of the tongue, the floor of the mouth, or the bone of the mandible. Postoperatively, these patients encounter chewing, swallowing, and speech problems. Oral rehabilitation through prosthetic management can aid in alleviating these problems. Designs of the prosthesis vary according to patient needs. A "snap-on" tongue prosthesis or palatal augmentation prosthesis can be constructed. Total glossectomy patients require prosthetic intervention on a mandibular framework. Partial glossectomy patients require prosthetic augmentation on a maxillary framework. Through prosthetic management of this type, articulation and resonance are improved, food is more easily directed into the esophagus, tissues are protected and socialization is enhanced through improved appearance.

Open-face custom tray for edentulous obturator impression.

1. A new, easy, and predictable method of border molding an edentulous obturator impression is presented. 2. The use of an open-face impression tray facilitates proper extension in the site of the defect. 3. The manipulation of the modeling compound through the open-face tray assures proper seal, compression, and extension of the prosthesis above the mucodermal scar band. 4. The retention of the obturator bulb is mainly mechanical and is dependent upon engaging under-cuts superior to both scar band and the palatal shelf. 5. There should be a continuous peripheral seal between the defect and nondefect side of the obturator.

Basic principles of obturator design for partially edentulous patients. Part II: design principles.

A classification for partially edentulous maxillectomy patients has been proposed, and a suggested design for each class is discussed. A simplified approach to the planning of resective surgery and a guide for the design of the maxillary obturator prosthesis have been presented.

Basic principles of obturator design for partially edentulous patients. Part I: classification.

A classification for partially edentulous maxillectomy dental arches is proposed. This classification is based on the frequency of occurrence of maxillary defects in a population of 123 patients.

Prosthetic reconstruction following resection of the hard and soft palate.

The restoration of the soft palate presents a challenge completely different from that of the hard palate. The mobility of the soft palate tends to interfere with velar extensions. The reduction in size of the soft palate extension to prevent impingement upon the mobile margins of the defect will lead to insufficient oronasal separation during functional activities. The solution is to construct a specially designed prosthesis to attain the maximum utilization of the remaining structures and their motility. Although each pharyngeal extension is different in shape, they give the patient an effective functional mechanism that enhances speech and swallowing.