Long-term impact of living with an obturator following a maxillectomy: A qualitative study.

OBJECTIVES: To explore the long-term impact for patients living with an obturator prosthesis, following a maxillectomy for a head and neck neoplasm. METHODS: A qualitative approach was employed, using semi-structured interviews. A purposive sample of eight men and four women, living with an obturator prosthesis for at least five years, were recruited. Interviews were digitally recorded and transcribed. Using thematic analysis, two researchers analysed the data. RESULTS: The data were categorised into four themes: 1. Preparedness for living with an obturator, 2. Impact of living with an obturator - what changes to expect, 3. Stability and retention of the obturator, and 4. Coping strategies to aid adjustment. Long-term effects of living with an obturator spanned many aspects of life to include: chewing and eating, speaking, dealing with nasal leakage and altered body image, employment and intimacy issues, along with embarrassment during social encounters. Optimal retention and stability of the obturator, as perceived by the patient, lead to improved social confidence and engagement. The emotional impact varied greatly on peoples' lives. CONCLUSIONS: Patients experiencing the greatest long-term challenges had larger defects, were of employment age and had not returned to work. Gaining an improved understanding of the psychology of coping overtime is clearly important, as this can inform interventions to facilitate adjustment for those who are emotionally struggling. Furthermore, the findings of this study could inform the design of a communication tool to facilitate shared-decision making and aid preparedness for living with an obturator following a maxillectomy. CLINICAL SIGNIFICANCE: The multidisciplinary head and neck team should provide patients with detailed pre-operative information, including potential effects on social, work and personal relationships. The restorative dentistry team has a pivotal role in the long-term management of these patients, as obturators have a finite lifespan with ongoing maintenance necessary to promote optimal retention and stability.

Maxillofacial prostheses challenges in resource constrained regions.

BACKGROUND: This study reviewed the current state of maxillofacial rehabilitation in resource-limited nations. METHOD: A rigorous literature review was undertaken using several technical and clinical databases using a variety of key words pertinent to maxillofacial prosthetic rehabilitation and resource-limited areas. In addition, interviews were conducted with researchers, clinicians and prosthetists that had direct experience of volunteering or working in resource-limited countries. RESULTS: Results from the review and interviews suggest rehabilitating patients in resource-limited countries remains challenging and efforts to improve the situation requires a multifactorial approach. CONCLUSIONS: In conclusion, public health awareness programmes to reduce the causation of injuries and bespoke maxillofacial prosthetics training programmes to suit these countries, as opposed to attempting to replicate Western training programmes. It is also possible that usage of locally sourced and cheaper materials and the use of low-cost technologies could greatly improve maxillofacial rehabilitation efforts in these localities. Implications for Rehabilitation More information and support needs to be provided to maxillofacial defect/injuries patients and to their families or guardians in a culturally sensitive manner by governments. The health needs, economic and psychological needs of the patients need to be taken into account during the rehabilitation process by clinicians and healthcare organizations. The possibility of developing training programs to suit these resource limited countries and not necessarily follow conventional fabrication methods must be looked into further by educational entities.

Maxillofacial prosthetic treatment factors affecting oral health-related quality of life after surgery for patients with oral cancer.

STATEMENT OF PROBLEM: After oral cancer surgery, tissue defects can cause deformity and limited mobility, complicating many essential functions. For patients with mandibular, tongue, and oral floor defects, evidence regarding the effects of maxillofacial prosthetics on their oral health-related quality of life (OHRQoL) is lacking. Therefore, maxillofacial prosthetic reconstruction has been implemented with no clear treatment goals. PURPOSE: The purpose of this clinical study was to identify factors affecting the improvement of OHRQoL by using maxillofacial prosthetic treatment after surgery to repair maxillary, mandibular, tongue, and oral floor defects. MATERIAL AND METHODS: All individuals who agreed to maxillofacial prosthetics after surgery for oral cancer were enrolled. Oral function and OHRQoL were evaluated before maxillofacial prosthesis placement and 1 month after final adjustments. The oral functions evaluated included masticatory function, swallowing function, and articulatory function. The Oral Health Impact Profile (OHIP-J54) was used to evaluate OHRQoL. Factors affecting changes in the OHIP-J54 score for participants' background and oral functions before and after treatment were analyzed through logistic regression analysis (stepwise method). RESULTS: Participants included 34 men and 16 women with an average age of 72.4 ±8.7 years. "Psychological discomfort" was correlated with the patient's sex and masticatory function. "Physical disability" was related to articulatory function. "Handicap" was related to the swallowing function. "Additional Japanese questions" were related to the patient's sex. CONCLUSIONS: Participants' sex and their oral functions, including masticatory, swallowing, and articulatory functions, were associated with improved OHRQoL because of maxillofacial prosthetics after surgery for oral cancer.

Differences of salivary cortisol levels between long-term and short-term wearers of dento-maxillary prosthesis due to head and neck cancer resection.

PURPOSE: The purpose of this study was to use cortisol awakening response (CAR) to investigate the differences in daily life stress experienced by individuals wearing either a long-term (LT) or a short-term (ST) dento-maxillary prosthesis following head and neck cancer (HNC) resection. Also we used the University of Washington Quality of Life (UW-QOL) version 4 questionnaire to evaluate the differences in quality of life (QOL) scores between ST and LT wearers of a dento-maxillary prosthesis. METHODS: Salivary samples were collected from 11 LT and 10 ST prosthesis wearers on two consecutive days at two time points, immediately after waking up (T0) and 30min later (T30), by passive drool collection. Cortisol levels were measured using a high sensitivity salivary cortisol enzyme immunoassay kit (Salimetrics, LLC, State College, PA, USA) and CAR (the differences between the cortisol levels at T0 and T30) was compared between LT and ST prosthesis wearers. In addition, both the groups completed the UW-QOL questionnaire and the scores were compared. RESULTS: A significant difference was observed in CAR between the two groups. CAR of the ST prosthesis wearers was significantly lower compared with that of the LT prosthesis wearers; moreover, the ST prosthesis wearers revealed significantly lower total UW-QOL scores and there were significant differences in appearance, activity, recreation, speech, and anxiety. CONCLUSION: Within the limitations of this study, the findings suggest that individuals wearing ST dento-maxillary prostheses following HNC resection experience some sort of daily life stress and complicated socio-demographic factors may influence their QOL.

The Toronto outcome measure for craniofacial prosthetics: reliability and validity of a condition-specific quality-of-life instrument.

PURPOSE: The purpose of this study was to refine the Toronto Outcome Measure for Craniofacial Prosthetics (TOMCP), present evidence for its reliability and validity, and use the instrument to explore differences in quality of life between prostheses made with chlorinated polyethylene (CPE) (experimental) and silicone (control). MATERIALS AND METHODS: As part of a multicenter prospective controlled randomized double-blind single-crossover clinical trial of the two materials, the TOMCP was administered at the start and end of two 4-month study arms, during which 42 patients wore prostheses made from one material then the other. Reliability was assessed at the crossover. To determine validity of the TOMCP, the Linear Analogue Self-Assessment (LASA-12) and the Short-Form 8 (SF-8) were also administered with the TOMCP. The TOMCP was reduced by removing items that were unreliable, had poorly distributed answers, showed increased internal consistency after their removal, or were too highly correlated with more than one other item. The tests of reliability and validity were then repeated. Finally, the reduced instrument was used to test for differences in quality of life between prostheses made of the two materials. RESULTS: The item reduction tactics pared the 52-item instrument down to 27 items. The correlations of both TOMCP versions with the LASA-12 and the SF-8 were found to be statistically significant, providing evidence of the validity of the TOMCP. The instrument revealed significantly better quality of life with silicone rather than CPE prostheses. CONCLUSIONS: Both versions of the TOMCP were found to be reliable and valid. The instrument was able to show differences in quality of life between two materials.

Maxillofacial prosthetic rehabilitation in the UK: a survey of maxillofacial prosthetists' and technologists' attitudes and opinions.

Maxillofacial prostheses are constructed by maxillofacial prosthetists and technologists (MPTs), as an alternative treatment when maxillofacial defects cannot be surgically fulfilled. A questionnaire was conducted surveying 220 MPTs working in all UK maxillofacial units about their opinions, attitudes, and experience regarding several aspects related to maxillofacial silicone prostheses. Numbers and percentages of maxillofacial prostheses, their retention method, serviceability, reduced serviceability causes, and digital technologies (DT) used in constructing prostheses were analysed. Thousand hundred and ninety-three prostheses were constructed (42% ocular, 31% auricular, 13% orbital, 12% nasal, 1% composite, more than one facial prosthesis). Adhesives commonly retained orbital (48%) and nasal (45%) prostheses. Implant-retained bars commonly retained auricular prostheses (70%). Ocular prostheses were entirely retained by undercuts. Implant-retained prostheses remained serviceable for twice as long (19-24 months) as adhesive-retained prostheses (7-12 months). Causes for prosthesis replacement included colour changes (71%), poor maintenance (41%), and silicone tear (37%). Thirty-one percent of MPTs used DT computer software and programs for designing and constructing maxillofacial prostheses. In conclusion, adhesives, implant-retained bars and magnets are commonly used retentive methods. Prosthesis failure is caused mainly by colour change, poor maintenance, silicone tear and delamination. Different DTs are used by one-third of MPTs.

Quality of life in patients with maxillectomy prostheses.

BACKGROUND: This cross-sectional study sought to determine patient quality of life and function after prosthetic rehabilitation for maxillary and palate defects following cancer resection. METHODS: Sixty-nine patients were identified, 42 participated in the study (61%). The Obturator Functioning Scale (OFS) and 4 general quality of life measures (Mental Health Inventory [MHI], Impact of Events Scale [IES], Illness Intrusiveness Ratings Scale [IIRS], and Centre for Epidemiologic Studies Depression Scale [CES-D]) were correlated with clinical parameters. RESULTS: Leakage when swallowing foods was the most frequently reported problem with the obturator (29%). Positive correlation was noted between the OFS and both the IES subscales (p < .01) and CES-D (p < .001). Difficulty with speech and eating was associated with increased avoidance of social situations. The surgical approach had a significant effect on the OFS, IES, and MHI subscales (p < .01). CONCLUSION: These results support the findings that good obturator function is associated with a better quality of life.

Patient satisfaction with maxillofacial prosthesis. Literature review.

SUMMARY: Obturators and facial prostheses are important not only in rehabilitation and aesthetics, but also in patient re-socialisation. The level of reintegration is directly related to the degree of satisfaction with rehabilitation. So, the maxillofacial prosthetics must provide patient satisfaction during treatment. This study aimed to search information in database and conduct a literature review on patient satisfaction with maxillofacial prosthesis. The problems experienced by these patients may decrease when specialists keep the patient on regular inspection. Rehabilitation through alloplasty or prosthetic restoration provides satisfactory conditions in aesthetics and well-being and reinstates individuals in familial and social environment.

Rehabilitation of severely resorbed maxillae with zygomatic implants: an evaluation of implant stability, tissue conditions, and patients' opinion before and after treatment.

PURPOSE: The aim of the present study was to describe experiences of 11 consecutively treated patients who received zygomatic implants. Patient results were assessed through clinical and radiographic evaluations of tissue conditions, including resonance frequency analysis (RFA). MATERIALS AND METHODS: Eleven patients were treated with implant-retained fixed prostheses. A total of 64 implants were placed, 22 of which were placed in the zygoma. Fixed prostheses were removed to allow clinical and radiographic evaluations at a follow-up visit 18 to 46 months following implant placement. RFA was performed on all implants. A visual analog scale was used to assess patient satisfaction before and after treatment. RESULTS: All patients received implant-supported prostheses. All zygomatic implants demonstrated clinical signs of osseointegration. One anterior implant was lost during follow-up. Mean ISQ values for the zygomatic and anterior implants were 65.9 (range, 42 to 100) and 61.5 (range, 48 to 71), respectively. Twenty-four implants showed moderate inflammation, with 3 exhibiting severe inflammation. Most anterior implants (75.6%) showed a marginal bone recession of 1 thread or less. Four zygomatic implants showed bone loss of 4 to 5 threads, and 5 zygomatic implants exhibited no marginal bone support. Patients described significant improvement in chewing ability and esthetics but did not describe changes in speech. DISCUSSION: The use of zygomatic implants can help the clinician avoid the need for bone grafting and reduce morbidity. In addition, it can shorten the treatment time considerably. CONCLUSION: This preliminary report demonstrates that zygomatic implants can provide posterior support to fixed prostheses in patients who lack bone volume to place conventional implants without encroaching upon the maxillary sinus.

Extraoral maxillofacial prosthetic rehabilitation at the M. D. Anderson Cancer Center: a survey of patient attitudes and opinions.

STATEMENT OF PROBLEM: Measures of satisfaction after extraoral maxillofacial prosthetic rehabilitation have been sparsely reported. PURPOSE: This article reviews the care-related opinions of patients who were provided extraoral prostheses at the M. D. Anderson Cancer Center over the course of 10 years. MATERIAL AND METHODS: A questionnaire was delivered to 263 extraoral prosthetic patients to elucidate their degree of satisfaction with several parameters, including prosthetic use, care, quality, durability, longevity, and cost. In addition, issues relating to self-image, socialization frequency, and income-earning ability before and after rehabilitation were surveyed. RESULTS: The views of 76 respondents demonstrated a general satisfaction with their prostheses. A majority believed that their prostheses fit comfortably, and most were satisfied with cosmesis. In addition, a preponderance of respondents reported no substantial alteration in social activity after rehabilitation. Although the number of respondents relying on their own employment fell by more than 50% after rehabilitation, nearly all reported a relatively static income before and after rehabilitation. CONCLUSION: The survey revealed a high degree of patient satisfaction with extraoral maxillofacial prostheses. Nevertheless, areas of potential improvement were not lost on the survey's population. The patients desired prostheses that last longer and have improved color stability. An interest in improved retentive mechanisms was mentioned by several patients, and only about half of the respondents perceived prosthetic cost to be completely reasonable.

Patients with reconstruction of craniofacial or intraoral defects: development of instruments to measure quality of life.

Patients with reconstruction of craniofacial or intraoral defects experience a profound impact on their quality of life (QOL). This impact on QOL is influenced by the patients' medical conditions and the treatment interventions. Instruments to measure general QOL have been available for many years. A major criticism of QOL instruments is that too often the questions are not specific to the particular problems of a disease or condition. A search of the literature regarding QOL measurement for patients with maxillofacial implant-supported prostheses produced a short list of instruments, none of which were sufficiently developed or suited to the patients involved in reconstructive treatment. This study was designed to develop pretreatment and posttreatment questionnaires for measuring QOL for patients with reconstruction of a craniofacial defect and patients with reconstruction of loss of specific intraoral structures utilizing an implant-supported prosthesis (e.g., severe resorption of the maxilla or mandible or both). The goal was to develop brief, targeted instruments for this specific patient population. The produced instruments were sensitive and easy to administer and score, and no disruption of clinical care occurred with the administration of the questionnaires. The instruments were used with equal success both in face-to-face interviews and via mail.

Usefulness of dental implants in maxillofacial reconstruction.

Fabricating maxillofacial prosthesis can be challenging. Placement of implants can have a dramatic effect on the stability and retention of the prosthesis in patients. This article provides clinical retrospective analysis of osseointegrated implants used for maxillofacial reconstruction. Patient charts and radiographs were reviewed to determine implant status, stability of prosthesis, and masticatory and speech function. Of the 104 implants placed, there were 4 implant failures. The overall survival rate for implants in this patient population was 96.1%. The stability of maxillofacial prostheses demonstrated significant improvement after anchorage to implants. Implant-borne maxillofacial prostheses are better stabilized and retained than non-implant-borne prostheses, providing an improved quality of life to patients requiring prosthesis rehabilitation of maxillofacial defects.

Quality of life of maxillectomy patients using an obturator prosthesis.

BACKGROUND: The psychosocial adaptation of patients who had undergone a resection of the maxilla for cancer of the maxillary antrum and/or hard palate with the placement of an obturator prosthesis to restore speech and eating function was studied. METHODS: Forty-seven patients were interviewed who had a maxillectomy with an obturator prosthesis at Memorial Sloan-Kettering Cancer Center, an average of 5.2 years (SD = 2.4 years) ago, 94% of whom had some of their soft palate resected. Interviews were conducted by telephone by a trained research interviewer, using a series of questionnaires to assess their satisfaction with the functioning of their obturator, and the psychological, vocational, family, social, and sexual adjustment. Measures included the Obturator Functioning Scale (OFS). Psychosocial Adjustment to Illness Scale (PAIS), Mental Health Inventory (MHI), Impact of Event Scale, and Family Functioning Scale. RESULTS: Using multiple regression and discriminant function analyses, satisfactory functioning of the obturator prosthesis, as measured by the OFS, was found to be (1) the most highly significant predictor of adjustment, as measured by the PAIS (p < .0001) and the MHI Global Psychological Distress Subscale (MHI-GPD) (p < .001), and (2) significantly related to their perception of the negative socioeconomic impact of cancer upon their lives. The most significant predictor of better obturator functioning were the extent of resection of their soft palate (one third or less, p < .001), and hard palate (one fourth or less, p < .01). Specific aspects of obturator functioning that most significantly correlated with better adjustment (PAIS, MHI-GPD) were: less difficulty in pronouncing words (r = .40 and r = .51, respectively, p < .01), chewing and swallowing food (r = .27-.46, p < .05), and less change in their voice quality after surgery (r = .52 and r = .56, respectively, p < .001). CONCLUSIONS: These findings suggest that a well-functioning obturator significantly contributes to improving the quality of life of maxillectomy patients.

Oral rehabilitation and quality of life following the treatment of oral cancer.

This is the first of two articles concerning the surgical and prosthodontic rehabilitation of patients who have undergone surgery for cancer of the mouth. This article discusses the morbidity associated with treatment and its effect on quality of life. The second article will consider aspects of the prosthodontic rehabilitation particularly with regard to obturator construction following maxillectomy.

Diverse applications of the osseointegration technique: the maxillofacial patient.

The maxillofacial patient faces many challenges that go beyond those of edentulism. These obstacles leave the patient handicapped and socially vulnerable. One of the greatest of these difficulties is retention of the craniofacial prosthesis. Ingenious strategies based on experience have provided limited success. For selected patients, however, the osseointegrated implant has largely eliminated this vexing technical predicament, thus freeing the patient to enjoy a more normal lifestyle. The treatment indications for this service, the remaining unresolved patient problems, the new planning criteria, and the requirement to document success all point to the need for well-validated instruments to measure the effectiveness of this newly augmented service.

[Evaluation of epithesis by others].

The present study aims at recognizing how maxillofacial prostheses prepared by us for out patients are evaluated by persons in contact with them. Questionnaire was sent to 158 persons (125 fifth year students of The Nippon Dental University, School of Dentistry at Niigata, 17 dental hygienists and nurses and 12 hospital clerical employees). The following results were obtained: 1) Upon seeing a maxillofacial defective patient momentarily, 91.8% of the answers regarded his inserted maxillofacial prostheses as agreeable. 2) Upon being opposite to such a patient without conversation for a comparatively long time, 18.3 and 80.4% of the answers regarded his covering the defective part with gauze and his inserted maxillofacial prostheses, respectively as agreeable. 3) Upon conversing with such a patient, 86.1 and 9.5% of the answers regarded his inserted maxillofacial prostheses and his covering the defective part with gauze, respectively as agreeable. 4) In the case of close relatives of such a patient, 67.7, 20.3 and 5.7% regarded his inserted maxillofacial prostheses, his covering the defective part with gauze and his leaving the defective part as it is, respectively, as agreeable. 5) With respect to the facial aesthetics of the case presented as one of reference, 42.7, 15.9 and 13.3% pointed out mandibular deviation, ocular prostheses and condition of contact of the maxillofacial prostheses with the skin, respectively, to be unnatural.