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

Abstract

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.

Opportunities for Treatment With a Temporary Obturator Made of Thermoplastic Foil

“…& Chandra, J., 2020). Similar results are found with polyurethane foam (Aparna, G. et al, 2022). Treatment methods with light-cured acrylic resins are also used, which provides stability and resistance of the obturator as well as opportunity for its fast and easy correction (Da Silva, L. et al, 2004).…”

Prosthodontic restoration of a COVID‐19 associated mucormycosis defect: A clinical report

“…Usually as stated in relevant literature mucormycosis-related maxillectomy defects are left open without any surgical reconstruction since this facilitates monitoring by direct visual inspection for possible fungal recurrence. [15][16][17][18][19][20][21] In addition, from a prosthodontic standpoint, when the defect is unrepaired, the resulting prosthesis has enhanced stability and retention, since the impression material more efficiently engages the remaining tissue undercuts. However, in the present clinical report, and due to the patient's young age and increased anxiety regarding post-operative speech alteration and psychosocial restrictions, the surgeon decided to primarily reconstruct the maxillary defect leaving only two small oro-antral defects, an approach consistent with two previous case reports presenting the prosthodontic rehabilitation of maxillary mucormycosis related defects that were not however related to COVID-19 infection.…”

“…Consequently, a crucial demand for maxillofacial prosthetic rehabilitation arises in patients with mucormycosis‐related acquired maxillofacial defects to restore function and esthetics, preserving therefore, the patient's well‐being. Usually as stated in relevant literature mucormycosis‐related maxillectomy defects are left open without any surgical reconstruction since this facilitates monitoring by direct visual inspection for possible fungal recurrence 15–21 . In addition, from a prosthodontic standpoint, when the defect is unrepaired, the resulting prosthesis has enhanced stability and retention, since the impression material more efficiently engages the remaining tissue undercuts.…”

“…15 There are several case reports in the literature, mainly from India, presenting the prosthodontic rehabilitation of post-COVID-19 mucormycosis maxillary defects with interim obturator prostheses. [16][17][18][19][20][21] The aim of this clinical report is to present the surgical and prosthodontic management of a challenging COVID-19 related mucormycosis maxillectomy defect, raise awareness regarding this emerging during the pandemic clinical condition, and highlight the role of the maxillofacial prosthodontist in alleviating this severe COVID-19 associated morbidity by restoring patient's wellbeing.…”

“…Since the prevalence of diabetes mellitus is dramatically increasing in low‐ and middle‐income countries, and the world continues to strive against the COVD‐19 pandemic, the associated number of cases of maxillofacial mucormycosis is anticipated to increase presenting therefore, significant diagnostic and therapeutic challenges for the oral and maxillofacial surgeon and the maxillofacial prosthodontist 15 . There are several case reports in the literature, mainly from India, presenting the prosthodontic rehabilitation of post‐COVID‐19 mucormycosis maxillary defects with interim obturator prostheses 16‐21 . The aim of this clinical report is to present the surgical and prosthodontic management of a challenging COVID‐19 related mucormycosis maxillectomy defect, raise awareness regarding this emerging during the pandemic clinical condition, and highlight the role of the maxillofacial prosthodontist in alleviating this severe COVID‐19 associated morbidity by restoring patient's well‐being.…”