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1.
Oral Oncol ; 132: 105980, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35749804

RESUMO

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.


Assuntos
Neoplasias , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Maxila/cirurgia , Neoplasias/cirurgia , Obturadores Palatinos , Qualidade de Vida , Estudos Retrospectivos , Retalhos Cirúrgicos/cirurgia
2.
J Prosthodont ; 31(7): 635-638, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35343606

RESUMO

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.


Assuntos
Implantes Dentários , Obturadores Palatinos , Desenho Assistido por Computador , Planejamento de Prótese Dentária/métodos , Humanos , Software
3.
Trials ; 23(1): 221, 2022 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-35303932

RESUMO

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.


Assuntos
Qualidade de Vida , Fala , Adulto , Estudos Cross-Over , Deglutição , Humanos , Obturadores Palatinos , Palato Mole/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Support Care Cancer ; 30(5): 4111-4120, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35067731

RESUMO

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.


Assuntos
Neoplasias de Cabeça e Pescoço , Qualidade de Vida , Idoso , Estudos Transversais , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Maxila/cirurgia , Obturadores Palatinos , Sobreviventes
5.
J Laryngol Otol ; 136(2): 173-175, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35000637

RESUMO

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.


Assuntos
COVID-19 , Maxila/cirurgia , Mucormicose/cirurgia , Doenças Orbitárias/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/reabilitação , Obturadores Palatinos , Poliuretanos , Rinite/cirurgia , Desbridamento , Atenção à Saúde , Humanos , SARS-CoV-2
6.
J Craniofac Surg ; 33(2): 562-565, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34261961

RESUMO

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.


Assuntos
Fissura Palatina , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Obturadores Palatinos , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fala
7.
Cleft Palate Craniofac J ; 59(2): 262-267, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-33761802

RESUMO

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.


Assuntos
Fenda Labial , Fissura Palatina , Implantes Dentários , Criança , Pré-Escolar , Fenda Labial/terapia , Fissura Palatina/cirurgia , Humanos , Obturadores Palatinos , Fala
8.
J Oral Implantol ; 48(3): 215-219, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-33945615

RESUMO

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.


Assuntos
Carcinoma de Células Escamosas , Implantes Dentários , Neoplasias Maxilares , Carcinoma de Células Escamosas/cirurgia , Prótese Dentária Fixada por Implante , Estética Dentária , Humanos , Maxila/cirurgia , Neoplasias Maxilares/reabilitação , Neoplasias Maxilares/cirurgia , Obturadores Palatinos , Qualidade de Vida
9.
J Prosthodont Res ; 66(3): 514-518, 2022 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34645718

RESUMO

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.


Assuntos
Neoplasias Maxilares , Obturadores Palatinos , Idoso , Humanos , Masculino , Maxila/cirurgia , Neoplasias Maxilares/cirurgia , Avaliação Nutricional , Período Pré-Operatório , Qualidade de Vida
10.
Rev. Bras. Cancerol. (Online) ; 68(2)Abr.-Jun. 2022.
Artigo em Português | LILACS | ID: biblio-1378912

RESUMO

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


Assuntos
Humanos , Feminino , Obturadores Palatinos , Neoplasias Bucais , Prótese Parcial Removível , Carcinoma de Células Escamosas de Cabeça e Pescoço , Reabilitação Bucal
11.
Artigo em Inglês | MEDLINE | ID: mdl-34886250

RESUMO

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.


Assuntos
Prótese Maxilofacial , Obturadores Palatinos , Humanos , Maxila/cirurgia
12.
Plast Reconstr Surg ; 148(6): 1335-1346, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34847122

RESUMO

BACKGROUND: Passive orthodontic appliances and gingivosupraperiosteoplasty are adjuncts that can be used by surgeons at the time of primary cleft lip repair. These treatments, along with the surgical technique of cleft lip and palate repair, may impact midface growth. The objective of this study was to describe the authors' protocol for unilateral and bilateral cleft lip repair and to evaluate midfacial growth in a cohort of patients at mixed dentition who had undergone presurgical passive orthodontic appliance therapy and gingivosupraperiosteoplasty at the time of unilateral and bilateral cleft lip repair. METHODS: Fifteen complete unilateral and 15 complete bilateral cleft lip and palate patients underwent passive orthodontic appliance treatment and primary lip repair with gingivosupraperiosteoplasty. Lateral cephalograms were analyzed by three blinded reviewers. Mean cephalometric measurements at mixed dentition were compared to cephalometric values for noncleft patients, unilateral cleft lip and palate patients who did not undergo gingivoperiosteoplasty or presurgical treatment, and unilateral cleft lip and palate patients who underwent gingivoperiosteoplasty/nasoalveolar molding with independent samples t tests. RESULTS: Mean cephalometric values were within age-specific normal values for sella-nasion-A point, sella-nasion-B point, A point-nasion-B point, and facial axis. Eighty-seven (13/15) percent of unilateral cleft lip and palate patients and 93 percent (14/15) of bilateral cleft lip and palate patients did not exhibit skeletal class III malocclusion. There was no significant difference between cephalometric values for our patients and patients who did not receive gingivosupraperiosteoplasty or presurgical treatment or who underwent the gingivoperiosteoplasty/nasoalveolar molding protocol. CONCLUSIONS: Presurgical passive orthodontic appliances, combined with gingivosupraperiosteoplasty at the time of lip repair, leads to normal maxillary development in most patients at mixed dentition. Assessment of midface growth at skeletal maturity is required. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Fenda Labial/terapia , Fissura Palatina/cirurgia , Gengivoplastia/métodos , Desenvolvimento Maxilofacial , Obturadores Palatinos , Cefalometria , Fenda Labial/complicações , Fissura Palatina/complicações , Dentição Mista , Face/anatomia & histologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Maxila/crescimento & desenvolvimento , Maxila/cirurgia , Aparelhos Ortodônticos , Periósteo/cirurgia , Resultado do Tratamento
13.
Plast Reconstr Surg ; 148(5): 775e-784e, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34705782

RESUMO

BACKGROUND: The cleft lip-nose deformity in unilateral cleft lip and palate is one of the most challenging problem for surgeons to correct. Although nasoalveolar molding has been shown to be effective in improving presurgical symmetry in patients with complete unilateral cleft lip and palate, there is need for better evidence regarding the long-term nasolabial aesthetics of patients who have received this therapy. METHODS: Thirty-eight patients treated with nasoalveolar molding and 48 patients not treated with nasoalveolar molding (but otherwise treated similarly) with unilateral cleft lip and palate were studied to assess and compare the nasolabial aesthetics. The objective evaluation of the nasal symmetry was performed on the basal view of two-dimensional photographs and the subjective nasolabial aesthetic evaluation was performed using the Asher-McDade scale. RESULTS: At 5-year postoperative follow-up, nasoalveolar molding group patients had better mean values on the objective scores; however, these were not statically significant. The nasoalveolar molding group of patients had a statistically significant improvement in the subjective evaluation in comparison to the non-nasoalveolar molding-treated patients. The number of lip revisions was also statistically higher in the non-nasoalveolar molding-treated group of patients. CONCLUSIONS: In this retrospective, single-center study, the authors found that at 5-year postoperative follow-up, nasoalveolar molding-treated patients had improved nasolabial aesthetics and fewer revision operations. These are, however, preliminary results and the patients will be followed up until the end of growth to assess the longer term effects of nasoalveolar molding on the nasolabial aesthetics in unilateral cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Moldagem Nasoalveolar/métodos , Pré-Escolar , Fenda Labial/diagnóstico , Fissura Palatina/diagnóstico , Estética , Feminino , Seguimentos , Humanos , Lactente , Masculino , Moldagem Nasoalveolar/instrumentação , Obturadores Palatinos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
14.
J Med Life ; 14(3): 383-389, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34377205

RESUMO

Prosthetic rehabilitation of a partial or total maxillectomy with an obturator is the most acceptable treatment option. The hollowing of the obturator prosthesis is beneficial as it reduces the stresses over the underlying and surrounding tissues. A simple technique of fabricating a hollow bulb obturator has been discussed in this article. At the step of the packing of a denture, the hollow wax pattern of the defect area is formed with modeling wax. This hollow wax pattern is filled with water and is allowed to freeze to form an ice block. This ice block is removed from the wax pattern and is interposed between two layers for heat-cured acrylic resin and is then cured. After processing the denture, the water is retrieved by making a small hole in denture base, which is packed after hollowing with a cold cure acrylic resin. A lightweight prosthesis with a uniform thickness was achieved with a readily available and easily retrievable material, i.e., ice.


Assuntos
Membros Artificiais , Obturadores Palatinos , Humanos , Implantação de Prótese
15.
J Indian Prosthodont Soc ; 21(3): 249-255, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34380811

RESUMO

Aim: To compare speech intelligibility (SI), nasal resonance, and swallowing ability in maxillectomy patients with a customized obturator to the conventional obturator. Settings and Design: Non-randomized controlled study. Materials and Methods: Forty-eight maxillectomy patients were recruited and assessment of SI, nasal resonance, and swallowing ability was done at three situations: without obturator, with conventional obturator, and with customized obturator. Recordings of unrehearsed conversation, counting from number 1-20 and four sets of Chapel Hill Multilingual Intelligibility Test in the Hindi language were used to assess SI and nasal resonance. SI was evaluated by untrained listeners and graded according to a 6-point scale. Nasal resonance was evaluated by speech pathologists on a 7-point scale of severity. Swallowing ability was evaluated by water drinking test. Statistical Analysis Used: One-way ANOVA, Post hoc Bonferroni and Chi square test. Results: SI and nasal resonance showed a statistically significant difference between any two groups (P < 0.001). Water drinking time was significantly different between without obturator and with customized obturator (P < 0.001), but the difference was not statistically significant between without obturator and with obturator (P < 0.004). Conclusion: SI, nasal resonance, and swallowing ability improved with customized obturator in comparison to the conventional obturator.


Assuntos
Deglutição , Inteligibilidade da Fala , Ingestão de Líquidos , Humanos , Nariz , Obturadores Palatinos
16.
Arch. health invest ; 10(7): 1150-1155, July 2021. ilus
Artigo em Português | BBO - Odontologia | ID: biblio-1344592

RESUMO

A prótese obturadora constitui o principal método para a reabilitação de grandes defeitos maxilares. Tem como objetivo fechar o defeito, separar a cavidade oral da cavidade nasal, prevenir a fala anasalada e a regurgitação nasal de alimentos e líquidos e dar sustentação ao perfil facial. Este artigo visa relatar um caso de reabilitação com prótese obturadora maxilar após maxilectomia parcial. Paciente do gênero feminino, 72 anos, diagnosticada com carcinoma adenoide cístico na região de palato, foi submetida a maxilectomia parcial que resultou em extenso defeito maxilar e comunicação bucosinusal. Após anamnese, exames extra, intraorais e radiográfico, foi planejado para o período cicatricial e de uso da sonda nasogástrica, a confecção de uma placa obturadora para melhorar a deglutição e fala. Em seguida, confecção de uma prótese total obturadora superior e prótese parcial removível inferior. A placa obturadora foi confeccionada e utilizada até a remoção da sonda e instalação das próteses. Após moldagem das duas arcadas, foram obtidos modelos funcionais que foram montados em articulador após os ajustes dos planos de orientação e registro das relações intermaxilares. Foram realizadas provas estéticas e funcionais dos dentes artificiais e ajustes necessários. Posteriormente à acrilização, as próteses foram instaladas e o ajuste oclusal executado. Para obter retenção e estabilidade satisfatórias durante a utilização da prótese obturadora superior foi sugerido o uso de adesivo para dentadura. Três proservações foram realizadas. A prótese obturadora reabilitou a estética, fonética, função mastigatória e deglutição restabelecendo a autoestima e a ressocialização da paciente(AU)


The obturator prosthesis is the main method for the rehabilitation of large maxillary defects. With the purpose to closethe defect, separate the oral cavity from the nasal cavity, prevent hypernasal speech, nasal regurgitation of food and liquids and provide support for the facial profile. This article aims to report a case of rehabilitation with maxillary obturator prosthesis after partial maxillectomy. A 72-year-old female patient, diagnosed with adenoid cystic carcinoma in the palate region, underwent partial maxillectomy that resulted in extensive maxillary defect and bucco-sinus communication. After anamnesis, extra, intraoral and radiographic exams, the construction of a palatal plate was planned to be used with the nasogastric tube and during the healing process, to improve swallowing and speech. Then, the manufacture of a maxillary obturator prosthesis and a lower removable partial prosthesis. The palatal plate was made and used until the tube was removed and the insertion of the prostheses. After the impressions, master casts were made and mounted on an articulator after adjustment of wax occlusion rims and registration of the maxillo-mandibular relations. Functional elements of speech, occlusion, and appearance were evaluated during the try-in of the provisional set-up and adjusts were made.After the acrylization, the prostheses were inserted and the occlusal adjustment performed. To obtain satisfactory retention and stability when using the maxillary obturator prosthesis, it was suggested to use denture adhesive. Three post-insertions visits were carried out. The obturator prosthesis rehabilitated aesthetics, phonetics, masticatory function and swallowing, restoring the patient's self-esteem and improving social life(AU)


La prótesis obturadora es el método principal para la rehabilitación de grandes defectos maxilares. Tiene por objetivo cerrarel defecto, separar la cavidad bucal de la cavidad nasal, prevenir el habla nasal, la regurgitación nasal de alimentos y líquidos,dando apoyo al perfil facial. Este artículo tiene objetivo de reportar un caso de rehabilitación con prótesis obturadora maxilar tras maxilectomía parcial. Una paciente de 72 años, diagnosticada de carcinoma adenoide quístico en región del palato, fué sometida a maxilectomía parcial que resultó en extenso defecto maxilar y comunicación bucosinusal. Después de anamnesis, exámenes extra, intraorales y radiográficos, se planificó para el período de cicatrización y el uso de la sonda nasogástrica,la construcción de una placa obturadora para mejorar la deglución y el habla. Luego, la fabricación de una prótesis obturadora total superior y una prótesis parcial inferior removible. La placa obturadora se hizo y se utilizó hasta que se retiró la sonda y se instalaron las prótesis. Se realizón la impresión de ambos arcos, obtuvieron modelos funcionales que se montaron en articulador, tras ajustes de los planos de orientación y registro de relaciones intermaxilares. Se realizaron pruebas estéticas y funcionales en dientes artificiales y ajustes necesarios. Después de la acrilización se instalaron las prótesis y se realizó ajuste oclusal. Para obtener una retención y estabilidad satisfactoria al utilizar la prótesis obturadora superior, fue sugirió utilizar un adesivo para prótesis. Se realizaron tres proservaciones. La prótesis obturatriz rehabilitó estética, fonética, función masticatoria y deglución, devolviendo autoestima y resocialización al paciente(AU)


Assuntos
Humanos , Feminino , Idoso , Obturadores Palatinos , Carcinoma Adenoide Cístico , Prótese Parcial Removível , Resultado do Tratamento , Carcinoma Adenoide Cístico/cirurgia , Maxila/cirurgia , Prótese Maxilofacial
17.
Rev. Soc. Odontol. La Plata ; 31(60): 7-12, jul. 2021. ilus
Artigo em Espanhol | LILACS | ID: biblio-1284434

RESUMO

Objetivo: Describir el plan de tratamiento completo para el manejo de pacientes con fisura labio alvéolo palatina (F.L.A.P.), basado en nuestra experiencia clínica de más de 40 años. Casos clínicos: En nuestro protocolo consideramos fundamental el tratamiento ortopédico, teniendo en cuenta los tiempos de crecimiento y desarrollo del maxilar superior de cada paciente, para luego aplicar las técnicas quirúrgicas en un maxilar armónico, con un éxito más predecible. Se describirá una serie de casos clínicos con seguimiento de pacientes. Conclusión: Con este protocolo que pregonamos desde hace muchos años, nos diferenciamos principalmente de otras propuestas por considerar los tiempos biológicos de cada paciente en cuanto a crecimiento y desarrollo, y no por basarnos en tiempos quirúrgicos preestablecidos. Aplicando este protocolo obtenemos resultados predecibles que entendemos que solo son posibles de evaluar, al realizar el seguimiento del paciente hasta completar su desarrollo (AU)


Objective: To describe the comprehensive treatment plan aimed at managing patients with cleft lip and palate (CLP) on the basis of our more than forty years of clinical experience. Case reports: e orthopedic treatment is deemed fundamental in the present protocol, which takes into account the maxilla growth and development periods of each individual patient, to later perform a surgical technique in a harmonized maxilla, with a more predictable success. Clinical cases with the patient follow-up shall be described. Conclusion: e main difference between the present protocol that has been held for many years and others proposed approaches mainly lies in considering the unique growth and developmental biological stages of each patient and not in drawing on pre-established surgical timing. When applying this protocol, predictable results are achieved and they are only meant possible to be assessed during the thorough patient follow-up (AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Obturadores Palatinos , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Ortopedia/métodos , Equipe de Assistência ao Paciente , Periósteo/cirurgia , Desenvolvimento Maxilofacial
18.
BMJ Case Rep ; 14(3)2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33727288

RESUMO

Maxillectomy is done for a variety of disease conditions. Reconstruction following maxillectomy is done to restore the form and function. One of the important goals that are to be achieved in reconstruction is the separation of the oral and nasal cavities. In this article, we report the use of palatal flap by preserving the descending palatine artery during bilateral inferior partial maxillectomy, for separating the nasal cavity from the oral cavity. This technique eliminates the need for an obturator or another free or local flap for this purpose.


Assuntos
Neoplasias Maxilares , Procedimentos Cirúrgicos Reconstrutivos , Craniotomia , Humanos , Maxila/diagnóstico por imagem , Maxila/cirurgia , Neoplasias Maxilares/cirurgia , Obturadores Palatinos , Retalhos Cirúrgicos
19.
Plast Reconstr Surg ; 147(3): 444-454, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33620939

RESUMO

BACKGROUND: Value-based health-care reform requires assessment of outcomes and costs of medical interventions. In cleft care, presurgical infant orthopedics is still being evaluated for clinical benefits and risks; however, the cost of these procedures has been largely ignored. This study uses robust accounting methods to quantify the cost of providing two types of presurgical infant orthopedics: Latham appliance treatment and nasoalveolar molding. METHODS: This is a prospective study of patients with nonsyndromic cleft lip and/or palate who underwent treatment with presurgical infant orthopedics from 2017 to 2019 at two academic centers. Costs were measured using time-driven activity-based costing. Personnel costs, facility costs (operating room, clinic, and inpatient ward), and equipment costs were included. Travel expenses were incorporated as an estimate of direct costs borne by the family, but indirect costs (e.g., time off from work) were not considered. RESULTS: Twenty-three patients were treated with Latham appliance treatment and 14 were treated with nasoalveolar molding. For Latham appliance treatment, average total cost was $7553 per patient ($1041 for personnel, $637 for equipment, $4871 for facility, and $1004 for travel over 6.5 visits). Unilateral and bilateral costs were $6891 and $8860, respectively. For nasoalveolar molding, average cost totaled $2541 ($364 for personnel, $151 for equipment, $300 for facility, and $1726 for travel over 13 visits); $2120 for unilateral and $3048 for bilateral treatment. CONCLUSIONS: The major difference in cost is attributable to operative placement of the Latham device. Travel cost for nasoalveolar molding is often higher because of frequent clinical encounters required. Future investigation should focus on whether outcomes achieved by presurgical infant orthopedics justify the $2100 to $8900 expenditure for these adjunctive procedures.


Assuntos
Fenda Labial/economia , Fenda Labial/terapia , Fissura Palatina/economia , Fissura Palatina/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Moldagem Nasoalveolar/instrumentação , Obturadores Palatinos/economia , Boston , Efeitos Psicossociais da Doença , Feminino , Seguimentos , Humanos , Lactente , Masculino , Moldagem Nasoalveolar/economia , Moldagem Nasoalveolar/métodos , North Carolina , Estudos Prospectivos
20.
Int J Oral Maxillofac Surg ; 50(9): 1156-1160, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33386202

RESUMO

The surgical removal of a maxillary tumour will result in an oronasal communication, which can negatively affect the patient's life and daily functions. Following maxillectomy, the defect can be treated with a prosthetic obturator or microvascular flap. However, the gold standard technique remains controversial. The aim of this study was to evaluate and compare quality of life (QoL) outcomes of submental island flap versus maxillary obturator reconstruction after partial maxillectomy. Sixty patients indicated for maxillectomy were allocated randomly to two equal-sized groups. Control group patients underwent reconstruction with a surgical obturator, while intervention group patients underwent submental island flap reconstruction. Patient QoL was evaluated at the 6-month follow-up using the University of Washington Quality of Life Questionnaire. Statistically significant differences in QoL were found between the two groups. Chewing (P = 0.034), swallowing (P < 0.001), speech (P = 0.009), taste (P = 0.04), mood (P = 0.01), and anxiety (P = 0.003) domains showed a statistically significant improvement in the submental group compared to the obturator group. However, the obturator group showed a greater improvement in appearance (P < 0.001). The masticatory function scores in the obturator group were significantly higher after obturator rehabilitation (P < 0.001). In conclusion, this study found that submental flap reconstruction provided better function and QoL than the obturator. This reconstruction was associated with less pain and better pronouncing of words, chewing, swallowing food, and psychosocial adjustment.


Assuntos
Neoplasias Maxilares , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Neoplasias Maxilares/cirurgia , Obturadores Palatinos , Qualidade de Vida , Retalhos Cirúrgicos , Inquéritos e Questionários
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