ABSTRACT
Maxillary necrosis can occur due to bacterial infections such as osteomyelitis, viral infections, such as herpes zoster or fungal infections, such as mucormycosis, aspergillosis etc. Mucormycosis is an opportunistic fungal infection, which mainly infects immunocompromised patients. Once the maxilla is involved, surgical resection and debridement of the necrosed areas can result in extensive maxillary defects. The clinician is to face many a challenge in order to replace not only the missing teeth, but also the lost soft tissues and bone, including hard palate and alveolar ridges. The prosthesis (Obturator) lacks a bony base and the lost structures of the posterior palatal seal area compromise retention of the prosthesis. Furthermore, the post surgical soft tissues are scarred and tense, which exert strong dislodging forces. The present article describes the prosthetic rehabilitation of maxillary necrosis secondary to mucormycosis in two cases, one completely edentulous and the other partially edentulous.
Subject(s)
Dental Prosthesis Design , Maxillary Diseases/microbiology , Mucormycosis/surgery , Palatal Obturators , Adult , Dental Impression Technique , Dental Prosthesis Retention , Denture Design , Denture Retention , Denture, Complete, Upper , Denture, Partial, Removable , Female , Follow-Up Studies , Humans , Jaw, Edentulous/rehabilitation , Jaw, Edentulous, Partially/rehabilitation , Maxilla/surgery , Maxillary Diseases/rehabilitation , Maxillary Diseases/surgery , Maxillary Sinus/surgery , Middle Aged , Mucormycosis/rehabilitation , Oroantral Fistula/rehabilitation , Oroantral Fistula/surgery , Osteomyelitis/microbiology , Osteomyelitis/rehabilitation , Osteomyelitis/surgery , Palate, Hard/surgery , Patient Satisfaction , Treatment OutcomeABSTRACT
This report presents a new use for rehabilitation protocol for oral sinus communications in patients with antiresorptive agent-induced osteonecrosis of the jaw. The treatment plan consisted of constructing an atraumatic complete denture with rounded edges, made with nontoxic resin, to prevent any injury to the mucosa and recurrence of the disease. The patient was followed up for 4 years, without any complications, and was socially reintegrated by resuming the normal life he experienced before tooth loss.
Subject(s)
Bisphosphonate-Associated Osteonecrosis of the Jaw/complications , Denture, Complete, Upper , Oroantral Fistula/rehabilitation , Palatal Obturators , Patient Care Planning , Adenocarcinoma/therapy , Aged , Bone Density Conservation Agents/administration & dosage , Clinical Protocols , Dental Prosthesis Design , Denture Design , Diphosphonates/administration & dosage , Follow-Up Studies , Humans , Imidazoles/administration & dosage , Jaw, Edentulous/therapy , Male , Maxilla/pathology , Neoadjuvant Therapy/methods , Oroantral Fistula/etiology , Prostatic Neoplasms/therapy , Zoledronic AcidABSTRACT
Palatopharyngeal dysfunction may take place when palatopharyngeal valve is unable to perform its own closing due to a lack of tissue (palatopharyngeal insufficiency) or lack of proper movement (palatopharyngeal incompetence). Palatopharyngeal insufficiency induces nasal regurgitation of liquids, hypernasal speech, nasal escape, disarticulations and impaired speech intelligibility. Prosthetic management of palatopharyngeal insufficiency requires a close co-operation between an otolaryngologist and a speech pathologist. As a result, the patient can be socially and physically rehabilitated with the improved speech quality as well as prevention of leakage of liquids.
Subject(s)
Palatal Obturators/psychology , Quality of Life , Velopharyngeal Insufficiency/psychology , Articulation Disorders/etiology , Cleft Palate/surgery , Humans , Male , Oroantral Fistula/rehabilitation , Palate, Soft/pathology , Respiratory Aspiration/etiology , Speech Disorders/etiology , Speech Intelligibility/physiology , Velopharyngeal Insufficiency/complications , Voice Disorders/etiology , Young AdultABSTRACT
Bone transport distraction is a reliable procedure in various maxillofacial bony defect reconstruction techniques. It is minimally invasive and it eliminates donor site morbidity. We introduce a new surgical technique for maxillary backward bone transport distraction reconstruction performed in a 77-year-old woman with a posterior partial maxillary defect. Transport distraction was successful for posterior maxillary alveolar bony regeneration, which helped close an oroantral fistula. One month after the distraction device was removed, 3 dental implants were placed in the reconstructed alveolus, followed by successful oral functional rehabilitation by use of an implant-anchored prosthesis. Two and a half years have passed since the patient's dental implant-based prosthesis was activated, and the functional occlusal reconstruction by use of bone transport distraction and dental implants after repair of the maxillectomy defect has proven to be effective with patient satisfaction.
Subject(s)
Bony Callus/growth & development , Dental Implantation, Endosseous , Maxilla/surgery , Oroantral Fistula/surgery , Osteogenesis, Distraction/methods , Plastic Surgery Procedures/methods , Surgical Flaps , Aged , Bone Regeneration , Dental Implants , Dental Prosthesis Retention/instrumentation , Dental Prosthesis, Implant-Supported , Denture, Overlay , Female , Humans , Magnetics/instrumentation , Oroantral Fistula/rehabilitation , Osteogenesis, Distraction/instrumentation , Osteotomy/methodsABSTRACT
The most frequent openings of the maxilla result from cleft palates or tumors that require either partial or total surgical removal of the palate. Intraoral defects in the maxilla can cause an opening into the nasopharynx complex. Cleft palates or surgically removed tumors can have a devastating effect on a patient's appearance and speech. Obturators allow patients to eat and drink without fear of food or drink entering the oronasal and/or oroantral cavities during mastication. This article reviews the three clinical situations in which obturators are used to correct intraoral defects and discusses a clinical case that was treated successfully by using an obturator. An alternative method for fabricating a hollow bulb obturator also is discussed.
Subject(s)
Dental Prosthesis Design , Palatal Obturators , Acrylic Resins/chemistry , Carcinoma, Squamous Cell/surgery , Dental Casting Technique , Dental Materials/chemistry , Denture Bases , Denture Design , Denture Liners , Denture, Complete, Upper , Female , Humans , Maxillary Neoplasms/surgery , Middle Aged , Orbit/surgery , Oroantral Fistula/rehabilitationABSTRACT
Patients with cleft lip or palate encounter a myriad of difficulties in their early years of life, some of which begin at birth. The defect often impairs suckling and deglutition in the neonate. It can hinder appropriate speech development and may impose undue social and psychological stresses. Surgical and orthodontic interventions are essential and prosthetic palatal appliances play an important role not only throughout the patient's treatment course, but also in the treatment of unfavorable surgical sequelae.
