Prosthetic rehabilitation after hemimaxillectomy: a case report.

Maxillofacial defects created by the surgical resection of a tumor negatively impact the mastication, phonation, swallowing, and psychological function of patients. A 68-year-old woman received a diagnosis of oral squamous cell carcinoma involving the hard palate. The hemimaxillectomy procedure for tumor resection created a defect on the left side of the palate. This case report describes the patient's cancer treatment from presurgical planning to final rehabilitation with a conventional obturator and subsequent follow-up care for 1 year. The rehabilitation strategy was satisfactory for the patient, reestablishing lost function and esthetics.

Influence of Apical Diameter on Filling Material Extrusion during Retreatment - A Micro-CT and CBCT evaluation.

AIM: To investigate whether foraminal widening performed at primary treatment has an effect on the amount of apically extruded obturator material during retreatment and to evaluate the sensitivity of cone beam computed tomography (CBCT) in detecting extruded obturator material. METHODS: Forty palatal roots of maxillary molars were selected based on micro-CT and divided into two groups (n=20): with foraminal widening (WE) and without foraminal widening (NE). To standardize the apical foramen, all specimens were instrumented to the foramen using the Protaper Next system, up to instrument X3. The WE group was instrumented to the foramen up to instrument X5, and the NE group was instrumented 1 mm lower. The canals were obturated 1 mm below the apical foramen with gutta-percha and AH Plus and stored for 7 days at 37 °C and 95% humidity. Roots were fixed in microtubes filled with 1.5% agar gel. The obturation material was removed with Reciproc R50. Scans of the teeth and agar were performed using micro-CT and CBCT. Comparison between groups and between methods was performed using Mann-Withney test (p ≤0.05). RESULTS: No statistical difference was found when comparing the extruded material between groups using micro-CT (p = 0.589) or CBCT (p = 0.953). CBCT measured a greater volume of extruded material than micro- CT (p = 0.0004). CONCLUSION: Foraminal widening had no effect on the extrusion of filling material during retreatment. The CBCT favored the evaluation of apically extruded filling material.

Intraoral customized Z-spring-retained delayed surgical obturator for rare cases of bilateral subtotal maxillectomy.

While dealing with a grave second wave of ongoing pandemic COVID-19, India also saw a surge in cases of COVID-19-associated mucormycosis, a systematic fungal infection caused by the Mucorales species. Mucormycosis is a highly angioinvasive, rapidly spreading fungal infection. In numerous cases of mucormycosis, bilateral subtotal maxillectomy was performed due to unpredictable and indefinable advancement of fungus clinically. Effective obturation of bilateral maxillectomy defect is a difficult task and as this is a relatively uncommon surgical problem, insufficient data are available on the construction of delayed surgical obturator for such cases. The aim of this article is to discuss the design of Z-spring-retained delayed surgical obturator which is easy to fabricate, easy to rectify, cost-effective, and comfortable for the patients compared to previous spring-retained obturators. This surgical obturator is retained through Z-spring made of 1.02 mm thick wire. Due to the thick gauge, this spring counters postsurgery trismus and develops the seal between the acrylic plate and dorsum of the tongue during deglutition thus helps the patient in taking a soft diet initially. Novelty in this case is the design of the spring, which makes it beneficial for both patient and prosthodontist.

Rehabilitation of a mid-facial defect using maxillary obturator with a maxillary expansion device and orbital prosthesis.

Midfacial defects are defined as congenital or acquired defects in the horizontal plane at the middle third of the face and communicate with intraoral maxillary defects. These defects lead to speaking difficulty, difficulty in saliva control and deglutition, mastication, and esthetics. Prosthetic rehabilitation of such defects with maxillofacial prosthesis is a challenging task. Maxillary defects with bilateral undercuts present are common. This case report explains to achieve retention by engaging the bilateral undercuts with the desired path of insertion and obtaining adequate retention of these prostheses. This clinical case report presents prosthetic rehabilitation of a mid-facial defect involving one orbit and the premaxilla region with the help of silicone orbital prostheses and magnets along with an expansion device. This dramatically improved the patient's speech, mastication, deglutition, esthetics, and self-confidence.

Prosthetic management of a postsquamous cell carcinoma patient with maxillomandibular resection including lip.

Maxillofacial defects not only create esthetic and functional problems for the patient but also have psychological and social impact on the patient. The present clinical report describes the management of a patient who had undergone partial maxillectomy, hemimandibulectomy, and partial resection of the lip on the left side. Rehabilitation of this patient was done using silicone lip prosthesis and maxillary obturator. These prostheses improve the esthetics, function, and provide confidence to the patient, hence improving his social life. The lip prosthesis was retained by two magnets that were attached to the denture cum obturator to provide good retention and stability to the lip prosthesis.

Quality of life in patients with cancer-related Brown IIb maxillary defect: A comparison between conventional obturation rehabilitation and submental flap reconstruction.

OBJECTIVES: The purpose of this retrospective study was to compare the differences in quality of life (QOL) outcomes between the conventional obturator prostheses (COP) and the pedicled submental artery island flap (SAIF) in the reconstruction of Brown IIb maxillary defects. MATERIALS AND METHODS: The QOL of 116 eligible patients who had a lapse ≥ 12 months after the cancer-related maxilla ablation was evaluated by the University of Washington quality of life scale (UW-QOL), Performance Status Scale for Head and Neck (PSS-HN), and Obturator Functioning Scale (OFS). RESULTS: Patients in the SAIF group reported statistically and clinically significant higher overall QOL scores but lower chewing scores in the UW-QOL scale when compared with those in the COP group (P < 0.05). Clinically significantly higher scores were also observed in the recreation and anxiety domains in the UW-QOL scale for the SAIF group, but there was no statistical significances. The COP group reported more complaints about the nasal leakage when swallowing and the shape of the upper lip, and had a stronger willingness to avoid family or social events in the OFS (P < 0.05). CONCLUSIONS: For patients with Brown IIb defects, SAIF reconstruction can achieve reduced nasal leakage when swallowing, improved upper-lip contour, increased social activity, and superior overall QOL than COP. The inferior chewing function in the SAIF group indicated the need for dental rehabilitation with a conventional denture or osseointegrated implants.

CAD-CAM Hollow Obturator Prosthesis: A Technical Report.

An obturator with a hollow bulb can decrease the overall weight of the prosthesis, stress on the underlying tissues, and patient discomfort. Although many techniques and materials have been proposed in the literature for hollowing the obturator prosthesis, they are often time consuming and technique sensitive. This proposed technique used an open-source software program to hollow a digital design of a solid obturator base from a commercially available software in one single convenient step. The hollowing process allowed precise control of prosthesis thickness at the hollow space area for desirable hermetic seal and prosthesis strength.

Efficacy of a new membrane obturator prosthesis in terms of speech, swallowing, and the quality of life of patients with acquired soft palate defects: study protocol of the VELOMEMBRANE randomized crossover trial.

BACKGROUND: Soft palate defects created during oral cancer surgery may prevent complete palatal closure and trigger palatopharyngeal insufficiency. One current treatment employs a rigid obturator prosthesis; an extension of acrylic resin at the level of the hard palate ensures surface contact with the remaining musculature. Unfortunately, airflow escape often causes hypernasality, compromises speech intelligibility, and creates swallowing problems (including leakage of food and fluid into the nasal airway). We plan to test a new removable denture featuring a thick dental dam that serves as a membrane obturator. The principal objective of the clinical trial is a comparison of speech handicap levels after 1 month in patients with acquired velar insufficiencies who wear either the new device or a conventional, rigid obturator. The secondary objectives are between-device comparisons of the swallowing handicaps and the health-related qualities of life. METHODS: The VELOMEMBRANE trial is a superiority, open-labeled, two-way, random crossover clinical trial. Adult patients exhibiting velar or palatovelar substance loss after tumor excision and who are indicated for rigid obturator-mediated prosthetic rehabilitation will be recruited in two teaching hospitals in France. Fourteen participants will be randomly allocated to wear both prostheses for 1-month periods in either order. The new membrane obturator is a removable resin prosthesis incorporating a rigid extension that holds a dental dam to restore the soft palate. The primary outcome will be the extent of phonation-related disability (the overall score on the Voice Handicap Index [VHI]). The secondary outcomes will be the Deglutition Handicap Index and health-related quality of life scores of the European Organization for Research and Treatment of Cancer (EORTC). DISCUSSION: High-quality evidence will be provided to document the utility of a new medical device that may greatly improve the management and quality of life of patients with acquired velar insufficiency. TRIAL REGISTRATION: ClinicalTrials.gov NCT04009811 . Registered on 4 July 2019.

Effectiveness of prosthetic rehabilitation and quality of life of older edentulous head and neck cancer survivors following resection of the maxilla: a cross-sectional study.

PURPOSE: To evaluate the effectiveness of prosthetic rehabilitation, as well as the quality of life (QOL) of older edentulous maxillectomy patients. METHODS: Effectiveness of the complete denture obturator prosthesis and QOL of N = 44 older edentulous patients who had resection of the maxilla and were restored with a definitive prosthesis that was in use for a minimum of 1 year was assessed using three instruments: European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30), Head and Neck Cancer Module (QLQ-HN35), and Obturator Functioning Scale (OFS). Data analysis was performed by one-way analysis of variance (ANOVA) on ranks, Spearman rank-order correlation, and hierarchical multivariable rank regression at α = .05 level of significance. RESULTS: Participants' gender (P < .001), adjuvant treatment (P = .016), surgical approach (P = .017), size of the maxillary defect (P = .028), participants' prosthetic history (P = .047), and dental status of the mandible (P = .038) were significantly related to the self-reported effectiveness of the complete denture obturator prosthesis. Perceived functioning of the prosthesis (P = .001), participants' gender (P = .002), the American Society of Anesthesiologists (ASA) physical status (P = .027), and surgical approach (P = .039) were significant predictors of QOL. CONCLUSION: Restoration of the edentulous maxillectomy defect is challenging. An effective definitive complete denture obturator appeared to be the strongest predictor for advanced quality of life in older maxillectomy patients. The physical status of the older participants significantly affected the overall QOL, but did not influence the self-reported functioning of the complete denture obturator prosthesis.

Temporary obturator using high-density polyurethane foam following maxillectomy during the coronavirus disease 2019 pandemic.

BACKGROUND: Rhino-orbital mucormycosis was seen in epidemic proportions during the second wave of the coronavirus disease 2019 pandemic. Many of these post-coronavirus rhino-orbital mucormycosis patients underwent maxillectomy for disease clearance. Rehabilitating such a large number of patients with surgical obturators as an emergency in a low-income setting was challenging. METHODS: High-density polyurethane foam was used to make a temporary obturator for patients who underwent maxillectomy. These obturators helped alleviate functional problems like dysphagia and nasal regurgitation, improving nutritional outcomes and shortening the hospital stay. CONCLUSION: The coronavirus disease 2019 pandemic gave physicians time-sensitive challenges, for which immediate alternatives to established care were required. A maxillary obturator made of high-density polyurethane foam is an innovative solution to rehabilitate maxillectomy patients in the immediate post-operative period.

Reconstrução de palato com malha de polipropileno e prótese acrílica para correção de fístula oronasal adquirida em cão / Palate reconstruction with polypropylene mesh and acrylic prosthesis in dog for correcton of acquired oronosal fistulae

As fístulas oronosais adquiridas são defeitos que permitem a comunicação anormal entre as cavidades oral e nasal. Inúmeras causas podem ser atribuídas à etiologia de tal defeito. O presente trabalho visa relatar o caso de um cão com fístula oronasal adquirida que foi submetido à reconstrução cirúrgica do palato com o uso de malha de polipropileno e prótese acrílica. Após estabilização do quadro clínico e remoção manual das larvas, o paciente foi encaminhado para o desbridamento cirúrgico das lesões orais e correção do defeito no palato. A palatoplastia foi realizada com o uso da malha e resina de polimetilmetacrilato autopolimerizável. A malha foi suturada sobre o defeito palatino com pontos simples separados e fio náilon 3-0 nas extremidades da ferida. Em seguida, a resina foi preparada e, ao atingir consistência adequada, foi aplicada e modelada sobre o a malha de polipropileno com o auxílio de um descolador de Molt, sendo também suturada nas bordas da fístula com pontos simples separados e fio náilon 3-0. No mesmo tempo cirúrgico foi inserida uma sonda esofágica para alimentação enteral. Devido complicações cirúrgicas no pós operatório, o paciente foi submetido a mais duas intervenções cirúrgicas para desfecho satisfatório do tratamento. Conclui-se que associação entre a tela de polipropileno e a prótese acrílica foi uma alternativa exequível para a palatoplastia em cão.

Acquired oronosal fistulae are abnormal communication between the oral and nasal cavities. A oronasal fistula can be the result of different causes, like oral myiasis. The objetctive of these paper is to report the case of a dog with acquired oronasal fistula that underwent surgical reconstruction of the palate using polypropylene mesh and acrylic prosthesis. After stabilization of the patient ́s clinical condition and mecanic removal of the larvae, the dog was referred for surgical debridement of the oral lesions and correction of the defect in the palate. Palatoplasty was performed using a mesh and polymethylmethacrylate resin. The mesh was sutured over the palatal defect with separate simple suture and 3-0 naylon thread at the ends of the wound. Then, the resin was prepared and, upon reaching adequate consistency, it was applied and shaped over the polypropylene mesh with Molt peeler. It was also sutured on the edges of the fistula with separate simple suture and 3-0 nylon suture. At the same surgical time, an esophageal tube was inserted for enteral feeding. Due to complications, the dog underwent two more surgical interventions for a satisfactory treatment outcome. It is concluded that the association between the polypropylene mesh and the acrylic prosthesis was a practical alternative for palatoplasty in dogs after oral myiasis.

Changes in Quality of Life After Secondary Closure of Palatal Defects: Prosthetic Obturation Versus Surgical Reconstruction.

BACKGROUND: The closure of palatal defects after tumor resection or irradiation is performed with either a prosthesis or autogenous tissue; however, there are no clear criteria regarding selection of the method. Thus, this study aimed to investigate the real-world situation and problems of palatal closure using prostheses, and examined patient opinion on how palatal closure using autogenous tissue improved their postoperative quality of life (QOL). METHODS: In 5 patients whose palatal defects resulted from treatment for head and neck cancer and were closed with a prosthesis, the palate was closed secondarily with autogenous tissue; a questionnaire on daily life was administered pre- and post-operatively. RESULTS: Functional improvements in terms of speech and eating were achieved in all and in 4 of 5 cases, respectively. In all cases, the QOL was better for palatal closure with autogenous tissue than with the prosthesis. CONCLUSIONS: As postoperative QOL was considered to be better when reconstructing the palate with autogenous tissue than with the prosthesis, we recommend to actively select autogenous tissue for palate reconstruction.

Nutritional assessment in a maxillectomy patient from the preoperative period to definitive obturator insertion: A case report.

PATIENT: A 69-year-old Japanese male with squamous cell carcinoma of the right maxilla (T4M0N0) was referred to our department for a preoperative examination. An immediate surgical obturator was fabricated before surgery. He underwent surgical treatment, which included right subtotal maxillectomy and reconstruction with a split skin graft. One week postoperatively, the immediate surgical obturator was modified to expand the nasal cavity for obturator prosthesis. Oral intake was started 12 days postoperatively with an immediate surgical obturator in situ. The definitive obturator was fabricated after the wound surface had healed 8 months postoperatively. Assessment of the nutritional status included body mass index, serum albumin level, resting energy expenditure (REE) measured using indirect calorimetry, and predicted REE using the Harris-Benedict equation. These assessments were performed several times, from the time of admission until the definitive obturator was applied. DISCUSSION: Malnutrition occurs frequently in patients with head and neck cancer because this region is vital for swallowing and mastication. Maxillectomy patients require a maxillofacial prosthesis to improve their nutritional status from the preoperative period to recovery. This case report describes maxillofacial prosthetic treatment from the perspective of nutrition. The patient wore the immediate surgical obturator postoperatively, which was followed by marked weight loss after restoration, and then weight gain returned to the normal range when wearing the definitive obturator. CONCLUSION: Maxillofacial prosthetic treatments should make efforts to maintain nutritional status and achieve optimal function and quality of life in patients with head and neck cancers.

A Systematic Review of Feeding Interventions for Infants with Cleft Palate.

OBJECTIVE: Various devices and techniques have been proposed to reduce feeding difficulties experienced by infants with cleft palate. The aim of this review is to identify and assess the scope and quality of evidence for these interventions. METHODS: A systematic review of published literature evaluating feeding interventions for infants with cleft palate (with or without cleft lip) from database inception to 2021 was conducted using Preferred Reporting Items for Systematic Reviews guidelines. Quality appraisal of included studies was conducted using a methodological index for nonrandomized studies, Cochrane, or a measurement tool to assess systematic reviews 2 instruments, according to study type. RESULTS: Fourteen studies met inclusion criteria, with the majority (71%) of studies consisting of second-level evidence. Included interventions were specialty bottles (21%), alternative feeding delivery systems (14%), obturators (14%), and educational programs (14%). Specialty bottles and palatal obturators did not appear to offer any substantial growth advantages compared to traditional bottles or no intervention, respectively. Designated education programs for the mothers of infants with clefts had a positive impact on infant growth. CONCLUSIONS: Overall evidence evaluating feeding interventions for infants with cleft palate was moderate to low. While it does not appear that specialized feeding delivery systems or palatal obturators significantly improve growth in infants with clefts compared to children without cleft conditions, education programs do appear to be beneficial.

Implant-Supported Prosthetic Rehabilitation of a Patient With Squamous Cell Carcinoma: A Case Report.

Patients who have undergone maxillary resection procedures are rehabilitated with dental obturators or microvascular reconstruction. This case report describes implant-supported prosthetic rehabilitation of a patient who underwent maxillary resection because of squamous cell carcinoma. After maxillectomy surgery, the patient was rehabilitated using a surgical obturator for 1 week, followed by an interim obturator until the surgical field was completely healed. For definitive prosthesis, different treatment options were presented from which the patient selected an implant-supported maxillofacial prosthesis and a removable mandibular partial prosthesis. Under general anesthesia, 2 zygomatic implants and 4 conventional implants to the posterior maxilla were inserted. After a healing period, the bar-retained maxillofacial prosthesis and removable mandibular partial denture were fabricated. The patient was satisfied regarding function, esthetics, speech, and swallowing. No problems, except slight discoloration of the prosthesis, were noted at the 6-month follow-up. Implant-supported maxillofacial prostheses are a valuable treatment option to improve quality of life after maxillary resection.

Intraoral Digital Impression for Speech Aid/Obturator in Children: Report of 2 Cases.

Cleft patients may develop an abnormal opening (fistula) between the oral and the nasal cavities. Surgical repair minimizes the adverse effect on speech and feeding. However, an obturator prosthesis is a nonsurgical approach to help close the communication. The purpose of the case report presented is to show the clinical use of an intraoral digital impression in the fabrication of obturator/speech aid appliances in children with cleft lip and palate deformity. Minimal adjustments were needed, and patients and caregivers responded positively. Prostheses demonstrated good stability and retention at delivery. The use of digital technology seems to have several benefits as an alternative method for capturing impressions, especially in young children with cleft lip and palate deformity.

Éxito de la ortopedia prequirúrgica en pacientes con labio fisurado y paladar hendido ­ Revisión de alcance / Sucesso pré-cirúrgico em ortopedia em pacientes com fissura de labio e palato - Revisão da abordagem / Pre-surgical orthopedics success in patients with cleft lip and cleft palate - Scoping review

Resumen: Kerr McNeil, protesista escocés introdujo la ortopedia maxilar neonatal hace más de dos siglos, fue así que sugirió inicialmente que la reposición de los segmentos maxilares mediante aparatos ortopédicos producía una maxila aparentemente normal. Se han descrito distintos tipos de aparatología ortopédica prequirúgica, divididos en tres categorías: activos, semiactivos y pasivos. Objetivo: Realizar una búsqueda de la literatura en bases de datos indexadas sobre el éxito de la ortopedia prequirúrgica en pacientes con labio fisurado y paladar hendido. Metodología: Se realizó una búsqueda computarizada en las siguientes bases de datos electrónicas: PUBMED, SCIENCEDIRECT, PROQUEST, COCHRANE, OVIDSP SCOPUS, Y MEDLINE. Los buscadores booleanos utilizados en las diferentes bases de datos fueron OR, AND, NOT. Resultados: Trece artículos cumplieron con los criterios de elegibilidad y se incluyeron en esta revisión, 4 son estudios observacionales descriptivos longitudinales y prospectivos, 5 son reportes de casos clínicos, 1 es en estudio retrospectivo, 1 es una revisión Cochrane, 2 son casos y controles; el uso de la ortopedia dependía del caso de extensión y severidad según la fisura labiopalatina y el tiempo de uso debía ser desde el momento del nacimiento del bebé hasta los 3 meses de vida. Conclusión:La ortopedia prequirúrgica es exitosa si se usa desde el momento del nacimiento y hasta los tres meses de vida, ofreciendo resultados satisfactorios y de manera eficaz disminuyendo la hendidura palatina, la deformidad nasal y la fisura labial antes de practicar la queilorrafia y la palatorrafia.

Resumo: Kerr McNeil, um protesista escocês introduziu a ortopedia maxilar neonatal há dois séculos, estabelecendo o conceito de uso de peças ortopédicas para produzir uma maxila mais natural. Três tipos diferentes de ortopedia pré-cirúrgica foram descritos. São eles: ativo, semi-ativo e passivo. Objetivo: Realizar uma pesquisa em dados indexados sobre o sucesso do tratamento ortopédico pré-cirúrgico em pacientes com quadro de fissura labiopalatina. Metodologia: Foi realizada pesquisa informatizada em bancos de dados eletrônicos como: PUBMED, SCIENCEDIRECT, PROQUEST, COCHRANE, OVIDSP SCOPUS e MEDLINE. As pesquisas booleanas utilizadas nas bases de dados múltiplas foram OR, AND, NOT. Resultados: Treze artigos atenderam aos padrões de elegibilidade e foram incluídos nesta revisão. 4 (quatro) deles são estudos observacionais descritivos, longitudinais e prospectivos. 5 (cinco) são relatórios clínicos, 1 (um) é um estudo retrospectivo, 1 (um) é uma revisão Cochrane e 2 (dois) são casos clínicos e check ups. A implantação do tratamento ortopédico dependeu do tipo de extensão dos casos e da gravidade da fenda palatina. Conclusão: a ortopedia pré-cirúrgica tem sucesso se implementada ao nascimento até os 3 meses de idade. Assegura resultados satisfatórios diminuindo consideravelmente a fenda palatina, a malformação nasal e a fenda labial antes da realização dos procedimentos de Queilorrafia e Palatorrafia

Kerr McNeil, Scottish prosthetic introduced the Neonatal maxillary orthopedics two centuries ago setting the concept of using orthopedic parts to. Three different types of pre-surgical orthopedics have been described. These are: active, semi-active and passive. Objective: Perform a research in indexed data regarding the success of pre-surgical orthopedics treatment in patients with a condition of cleft lip and cleft palate. Methodology: A computer based research was performed at electronic data bases such as: PUBMED, SCIENCEDIRECT, PROQUEST, COCHRANE, OVIDSP SCOPUS, and MEDLINE. The Booleans researches used in the multiples data bases were OR, AND, NOT. Findings: Thirteen papers met the eligibility standards and were included in this review. 4 (four) of them are descriptive, longitudinal and prospective observational studies. 5 (five) are clinic reports, 1 (one) is a retrospective study, 1 (one) is a Cochrane review, and 2 (two) are clinic cases and check ups. The orthopedics treatment implementation depended on the kind of extension cases and severity of the cleft palate. Conclusion: the pre-surgical orthopedics is successful if it is implemented at birth up to 3 months of age. It assures satisfactory results decreasing considerably cleft palate, nasal malformation, and cleft lip before performing Cheilorrhaphy and Palatorrhaphy procedures. Key words: Cleft lip, cleft palate, orthopedic surgery, palatal obturators, nose deformities

Reabilitação Oral com Prótese Obturadora em Comunicação Buconasal após Ocorrência de Carcinoma de Células Escamosas: Relato de Caso / Oral Rehabilitation with Filling Prosthesis in Bucconasal Communication after the Occurrence of Squamous Cell Carcinoma: Case Report / Rehabilitación Oral con Prótesis Obturatriz en Comunicación Oral tras la Aparición de Carcinoma Epidermoide: Reporte de Caso

Introdução: O tratamento de neoplasia maligna pode consistir em ampla excisão cirúrgica. Em alguns casos, em razão do tratamento agressivo na remoção do tumor, há grande comprometimento das estruturas intrabucais. Assim, próteses são utilizadas para a obturação da cavidade maxilar, possibilitando a reconstrução da região afetada, juntamente com a reabilitação oral. Relato do caso: Paciente de 53 anos de idade, sexo feminino, ex-tabagista e ex-etilista, apresentou diagnóstico de carcinoma de células escamosas na região de palato mole, sendo necessária cirurgia de ressecção transoral associada à radioterapia. Após aproximadamente um ano, a paciente retornou com nova lesão em palato, que novamente evidenciou carcinoma de células escamosas, sendo necessária nova cirurgia de ressecção transoral. Após dois anos, a paciente retornou ao Departamento de Odontologia a fim de receber o tratamento reabilitador, pois a prótese parcial removível superior era provisória, não substituía todos os dentes ausentes e não obtinha adaptação adequada à comunicação buconasal. Foi realizado tratamento reabilitador definitivo com prótese parcial removível superior e com prótese total no rebordo residual inferior. Conclusão: A necessidade do acompanhamento odontológico nos casos de ocorrência de carcinoma de células escamosas oral bem como a importância do tratamento reabilitador e suas técnicas contribuem para a autoestima e a qualidade de vida do paciente

Introduction: The treatment of malignant neoplasm may consist in extensive surgical excision. In some cases, due to aggressive treatment in the removal of the tumor, intraoral structures are strongly compromised. Thus, prostheses are used to fill the maxillary cavity, allowing reconstruction of the affected region, together with oral rehabilitation. Case report: A 53-year-old female patient, ex-smoker and ex-alcoholic was diagnosed with squamous cell carcinoma in the soft palate region, requiring transoral resection surgery associated with radiotherapy. After approximately one year, the patient returned with a new palatal lesion, also diagnosed as squamous cell carcinoma, requiring further transoral resection surgery. After two years, the patient returned to the Dentistry Department to receive the rehabilitative treatment, as she had only a temporary removable upper partial denture, where all the missing teeth were not replaced and there was poor adaptation to bucconasal communication. A final rehabilitative treatment was performed with upper partial removable denture and total prosthesis in the inferior residual ridge. Conclusion: The need for dental follow-up in cases of oral squamous cell carcinoma as well as the importance of rehabilitation treatment and its techniques contribute for the patient's self-esteem and quality of life

Introducción: El tratamiento de las neoplasias malignas puede consistir en una exéresis quirúrgica extensa. En algunos casos, debido a un tratamiento agresivo para extirpar el tumor, existe un gran compromiso de las estructuras intraorales. Así, las prótesis se utilizan para rellenar la cavidad maxilar, permitiendo la reconstrucción de la región afectada, junto con la rehabilitación oral. Relato del caso: Paciente femenina de 53 años, exfumadora y exalcohólica, que presentó el diagnóstico de carcinoma epidermoide en la región del paladar blando, que requirió cirugía de resección transoral asociada a radioterapia. Después de aproximadamente un año, la paciente regresó con una nueva lesión en el paladar, en la que también se le diagnosticó un carcinoma epidermoide, requiriendo una nueva cirugía de resección transoral. A los dos años, la paciente volvió al Departamento de Odontología para recibir tratamiento rehabilitador, ya que la prótesis parcial superior removible era temporal, no reponía todos los dientes faltantes y no obtenía una adecuada adaptación a la comunicación bucconasal. El tratamiento de rehabilitación definitivo se realizó con una dentadura postiza parcial removible superior y una dentadura total en el reborde residual inferior. Conclusión: La necesidad de seguimiento odontológico en los casos de carcinoma epidermoide oral así como la importancia del tratamiento rehabilitador y sus técnicas contribuyen a la autoestima y calidad de vida del paciente

Reabilitação de pacientes com comunicação buco nasal: relato de casos / Rehabilitation of patients with oral and nasal communication: case report

A sobrevivência de pacientes com câncer de cabeça e pescoço vêm melhorando, entretanto, algumas deformidades podem ocorrer devido dos tratamentos cirúrgicos que geram mutilações bucomaxilofaciais como perda de dentes, estruturas do palato, língua ou assoalho, resultando em alterações na fonética, mastigação e deglutição. Nesses casos há a necessidade que seja realizado uma reabilitação protética buscando torná-los indivíduos com menos problemas sociais, psicológicos e físicos, visto que mais procedimentos cirúrgicos estão contra indicados para solucionar os efeitos colaterais gerados pelo tratamento das neoplasias. Esse tipo de reabilitação protética com prótese ou placa obturadora possibilita benefícios na fonética, facilita a convivência social e atividades nutricionais como alimentação e deglutição, permitindo ao paciente uma vida com menos constrangimentos. Este trabalho tem como objetivo relatar dois casos clínicos onde os pacientes foram submetidos a reabilitação com placa obturadora palatina feitos após cirurgias oncológicas. Os pacientes de gêneros diferentes e com comunicações buco-nasal similares receberam o mesmo planejamento reabilitador que foram confeccionadas a partir de um molde que foi enviado ao laboratório. Após a instalação foi possível verificar que houve sucesso no tratamento, notando uma melhora imediata comprovando a eficácia do método reabilitador(AU)

This paper relates two clinical cases where patients were recovered with a palatal splint made after oncological surgeries. Survival of patients and necks can occur, however, some deformities can occur during oral and maxillofacial treatment, such as the appearance of teeth, palate structures, mutilations or posterior jaws, leading to changes in aesthetics, surgery and swallowing. If the need to perform a prosthetic rehabilitation is necessary so that the results are seen with less problems, psychological and physical, that more procedures are performed so that the effects of neoplasms are contraindicated by the treatment. This type of prosthetic rehabilitation with prosthesis or obturator plate provides benefits in phonetics, facilitates social coexistence and nutritional activities such as eating and swallowing, allowing the patient a life with less constraints. Patients of different genders and with similar oral and nasal communications received the same rehabilitation plan that were made from a mold that was sent to the laboratory. After installation, it was possible to verify that the treatment was successful, noting an immediate improvement, proving the effectiveness of the rehabilitation method(AU)

Obturator Prosthesis Rehabilitation after Maxillectomy: Functional and Aesthetical Analysis in 25 Patients.

The number of patients undergoing a surgical resection of the maxilla for oncological reasons is constantly increasing, the most common complication of which remains the communication between oral and nasal cavities. On the basis of data arising from the literature regarding the treatment options of maxillary oncological post-surgical defects, obturator prosthesis remains the most used worldwide. We studied 25 patients (with at least 1-year follow up) rehabilitated by obturator prosthesis after maxillary resection leading to oro-nasal communication, providing data on the objective/subjective evaluation of such rehabilitation and mastication performance measured by a two-color chewing gum test. The type of defect was classified according to the classification system proposed by Aramany. Among the patients in our study, 72% rated a higher score for either stability and retention than for aesthetic appearance, as confirmed by the Kapur score rated by clinicians. The two-color chewing gum test shows similar results as only one patient had insufficient chewing function. Interestingly, we found no correlation between the masticatory function and residual denture, confirming that the maxillary obturator remains a predictable solution in such patients regardless of the anatomical alterations following surgery.