Patients who undergo surgical resection of the maxillo-mandibular structures as a result of trauma, infection or malignancy, suffer from psycho-social setbacks which has a profound impact on their over-all quality of life. 1,2 These defects, especially those following maxillectomy, result in oroantral communication, facial deformation, impaired speech and difficulty in deglutition. For the rehabilitation of patients with such defects, surgical and prosthetic treatment options are available. As, not all patients can be successfully rehabilitated with reconstructive surgeries due to postoperative complications like graft rejection, the extent of the surgical defect and high psychological impact factor associated with repeated surgeries, prosthetic rehabilitation proves to be an alternative treatment option. The prosthetic rehabilitation of such patients is challenging as it requires restoration of the lost form, function and aesthetics, under constantly changing state of post-surgical intraoral tissues, with limited mouth opening. The maxillofacial prosthesis designed to close congenital or an acquired tissue opening, primarily of the hard palate, is known as an obturator. 3 The obturator has two functional components, one seals the surgical defect and the other replaces the lost dentoalveolarstructures.4-7 The design of an obturator may vary depending on the extent of the defect, remnant dentoalveolar complex, soft tissue undercuts and existent muscle physiology.8,9 Among the two designs, solid and hollow, hollow obturators are widely used. The bulb portion of the hollow obturator, which accommodates the surgical defect, can be open or closed9,10and its selection depends on the prosthodontist’s clinical decision-making skills and the ease of fabrication. In this article we have discussed the rehabilitated patients with single-piece, openhollow bulb definitive obturator. Patients undergo extensive maxillary surgical resections due to aggressive lesions like malignancies and deep fungal infections. Prosthetic rehabilitation of such patients with an obturator becomes of paramount importance as it separates the oropharynx from the nasopharynx, reduces the risk of recurrent infections, replaces lost dentoalveolar structures, permits intelligible speech, reinstates mastication and deglutition, restores facial contour and patient’s self-esteem. The bulb portion of the obturator extends into the defect and accommodates it, forming a hermetic seal. In this clinical report, we highlight the success of prosthetic rehabilitation of maxillectomy patients using single-piece, open-hollow bulb definitive obturator. The meticulous follow-up carried out reveals the success of the prosthesis and adds practice-based evidence to the maxillectomy rehabilitation outcome.
Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumor described by slow progression, vigorous growth, high vascularization, and increased recurrence rate. The aim of this article is to describe a case of JNA from our tertiary hospital and discuss the diagnosis and management in our current practice. A 16-year-old male patient presented with bleeding from the left nasal cavity. On examination, there was a non-pulsatile ovoid like mass occluding the entire left nasal cavity which was able to probe medially, superiorly, and laterally except inferiorly and on probing and it resulted in minimal bleed. Cold spatula test revealed decreased fogging on the left side. Contrast-enhanced computed tomography scan of the paranasal sinuses and nose showed the presence of a large ill-defined heterogeneously enhancing soft-tissue density mass lesion with its epicenter in posterior part of the left nasal cavity and left pterygopalatine fossa and was extending into the left orbit and left cavernous sinus. Complete embolization of the left nasopharyngeal vascular mass was done preoperatively. Two days post-embolization, surgical excision of JNA under general anesthesia was done. The approach was done through sublabial incision. This classic case of JNA was operated endoscopically because of its benefits over the conventional methods.
Isolated thyroid abscess is a rare entity in early childhood. Among thyroid disorders, thyroid abscess or acute suppurative thyroiditis constitutes about 0.7%–1% of all cases. The thyroid gland is normally resistant to infections due to its well-enveloped capsule, rich blood supply, and high iodine content.A child presented with tender neck swelling accompanied by fever for 3 days. Ultrasound of the neck showed features suggestive of left parapharyngeal abscess. Laboratory parameters including thyroid function test were within normal limits. Contrast-enhanced CT of the neck was done and showed an isolated thyroid abscess with no other abnormalities. The patient was started on intravenous antibiotics followed by incision and drainage of the abscess. The child improved symptomatically. This report discusses the differential diagnosis and management of this rare entity.
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