Fabrication of a hollow bulb prosthesis for the rehabilitation of an acquired total maxillectomy defect

Abstract

The prosthodontic rehabilitation of maxillary defects is a challenging and demanding task which requires careful pre-surgical and post-surgical planning. Maxillary defects can be congenital or acquired. Acquired defects include those following trauma or surgical treatment of benign or malignant neoplasms. A prosthodontist encounters problems such as absence of support, poor retention, and lack of prosthesis stability in treating these patients. The present case report describes a procedure to fabricate a definitive hollow bulb obturator prosthesis for the rehabilitation of a total maxillectomy defect.

Palatal obturator prosthesis: case series

“…Patients with intraoral disability resulting from maxillectomy complain about swallowing difficulties and fluids reflux through the nasal cavity accompanied by speech/communication difficulties [5][6] , which were observed in the three cases described herein at the beginning of the treatment and noticed upon removal of the obturating prosthesis.…”

“…In case 3, the patient's difficulty in finding a Head and Neck Surgeon or a Plastic Surgeon that performed surgical reconstruction of the defective site reinforces the importance of an obturator in the rehabilitation of such individuals. The literature basically brings two types of materials for impressions of patients with oro-nasal/sinus communication: alginate 2 and silicone-based elastomeric materials 2,6 . All above-reported patients were molded with alginate, due to easy handling, fast setting and relatively lower cost compared to silicone, with satisfactory results.…”

“…When the disease affects the maxilla, the surgical treatment (partial or total maxillectomy) often results in communications between the oral cavity and nasal/sinus cavities [2][3][4] . Patients with oro-nasal/sinus communication face several problems, including fluid reflux through nasal cavity as well as difficulty chewing, swallowing and speaking, with immediate reduction in the quality of life [5][6] . The literature brings no consensus on rehabilitation of patients undergoing maxillectomies.…”

Oral and maxillofacial rehabilitation of a patient suffering from intraosseous adenoid cystic carcinoma

“…As a result, some techniques have been reported in the literature in respect of the development of the hollow-bulb obturator, which may be open or closed, and this reduces the weight of the prosthesis, making it more comfortable and effective for the patient [16][17] . The use of the closed hollow obturator has the advantage of possessing a configuration that is easier to clean, which would make it easier for patients with motor or visual difficulties 14 . In cases where the hollow obturator bulb is chosen, it is important to do the job without multiple reentry and smoothly, thereby facilitating cleaning.…”

“…Reaction to treatment included epithelitis, hyposalivation and grade I mucositis, as per the World Health Organization classification. Six months after surgery, the fabrication begins of new dentures, a complete upper obturator prosthesis and a lower removable partial denture (RPD), observing the following timetable: defects in patients who are either partly or fully edentulous can be a challenge 14 . With smaller defects, the obturator prosthesis succeeds in offsetting surgical loss together with the dental rehabilitation, with satisfactory esthetic and functional results.…”