Abstract

Maxillofacial prosthetics is among the foremost rapidly growing areas of dentistry. It has become a key area, especially when it involves rehabilitation of postsurgical cases. 1-5% of oral lesions are malignant tumors that commonly affect the hard and soft palate and the gingiva. Squamous cell carcinoma accounts for 60% of the tumors that affect these areas. Most of those carcinomas are diagnosed very late i.e., when there is bone invasion. Treatment modalities of choice for removal of SCC are: alveolectomy, palatectomy or maxillectomy which could either be partial or total resection. The rehabilitation of such patients may be a daunting task. Rehabilitating patients with maxillofacial defects are among the foremost difficult therapies of the stomatognathic system and requires a multidisciplinary approach including surgery, radio/chemotherapy, phonetic rehabilitation, physiotherapy and prosthetic treatment. The defect/deformity characteristics, the number of teeth present and the amount of supporting structures determine the management of maxillary defects. Unfavorable characteristics of the defect can negatively affect the prosthetic management and treatment outcome. Good prognosis of the prosthesis requires adequate retention, light in weight and has to be comfortable to the patient and the surrounding tissues holding it. This article describes a case of a rhino-oral defect (Aramany class VI resection) whereby an acrylic hollow bulb obturator and an acrylic nasal prosthesis attached to spectacle were used for case rehabilitation.

Keywords: Acrylic Obturator; Aramany Class VI; Hollow Bulb Obturator Prosthesis; Prosthetic Rehabilitation; Prosthetic Nose; SCC

References

1. National Cancer Institute. Head and neck cancers (2021).
2. Lewis JS. “Sinonasal Squamous Cell Carcinoma: A Review with Emphasis on Emerging Histologic Subtypes and the Role of Human Papillomavirus”. Head and Neck Pathology 10 (2016): 60-67.
3. Turner JH and Reh DD. “Incidence and survival in patients with sinonasal cancer: A historical analysis of population-based data”. Head Neck6 (2012): 877-885.
4. Jain S., et al. “Prognostic Factors in Paranasal Sinus Squamous Cell Carcinoma and Adenocarcinoma: A SEER Database Analysis”. Journal of Neurological Surgery Part B: Skull Base3 (2019): 258-263.
5. Chigurupati R., et al. “Quality of life after maxillectomy and prosthetic obturator rehabilitation”. Journal of Oral and Maxillofacial Surgery8 (2013): 1471-1478.
6. Goiato MC., et al. “Patient satisfaction with maxillofacial prosthesis. Literature review”. Journal of Plastic, Reconstructive and Aesthetic Surgery2 (2009): 175-180.
7. Lapointe HJ., et al. “Comparison of maxillectomy patients with immediate versus delayed obturator prosthesis placement”. Journal of Otolaryngology5 (1996): 308-312.
8. Hagio M., et al. “Maxillofacial prosthetic treatment factors affecting oral health-related quality of life after surgery for patients with oral cancer”. Journal of Prosthetic Dentistry4 (2018): 663-670.
9. Hou Y., et al. “Inflatable hollow obturator prostheses for patients undergoing an extensive maxillectomy: a case report”. International Journal of Oral Science 4 (2012): 114-118.
10. Aramany MA. “Basic principles of obturator design for partially edentulous patients. Part II: Design principles”. Journal of Prosthetic Dentistry6 (2001): 562-568.
11. Parr GR., et al. “Prosthodontic principles in the framework design of maxillary obturator prostheses”. Journal of Prosthetic Dentistry5 (2005): 405-411.
12. Aramany MA. “Basic principles of obturator design for partially edentulous patients. Part I: Classification”. Journal of Prosthetic Dentistry6 (2001): 559-561.
13. Shaker KT. “A Simplified Technique for Construction of an Interim Obturator for a Bilateral Total Maxillectomy Defect”. The International Journal of Prosthodontics2 (2000): 166-168.
14. Davis DM., et al. “The emotional effects of tooth loss: A preliminary quantitative study”. The British Dental Journal9 (2000): 503-506.
15. Pigno MA. “Conventional prosthetic rehabilitation after free flap reconstruction of a maxillectomy defect: A clinical report”. Journal of Prosthetic Dentistry6 (2001): 578-581.
16. Shrivastava KJ., et al. “Prosthetic rehabilitation of large mid-facial defect with magnet-retained silicone prosthesis”. The Journal of the Indian Prosthodontic Society3 (2015): 276-280.
17. Ali MM., et al. “Quality of life and problems associated with obturators of patients with maxillectomies”. Head and Face Medicine2 (2018): 1-9.
18. Phasuk K and Haug SP. “Maxillofacial Prosthetics”. Oral and Maxillofacial Surgery Clinics of North America4 (2018): 487-497.
19. El Mahdy AS. “Processing a hollow obturator”. Journal of Prosthetic Dentistry6 (1969): 682-686.
20. Parel SM and LaFuente H. “Single-visit hollow obturators for edentulous patients”. Journal of Prosthetic Dentistry 4 (1978): 426-429.
21. Elliott DJ. “The hollow bulb obturator: its fabrication using one denture flask”. Quintessence of Dental Technology 1 (1983): 13-14.
22. Schneider A. “Method of fabricating a hollow obturator”. Journal of Prosthetic Dentistry 3 (1978): 351.
23. Grossmann Y and Savion I. “The use of a light-polymerized resin-based obturator for the treatment of the maxillofacial patient”. Journal of Prosthetic Dentistry 3 (2005): 289-292.
24. Cordeiro PG and Santamaria E. “A classification system and algorithm for reconstruction of maxillectomy and midfacial defects”. Plastic and Reconstructive Surgery 7 (2000): 2331-2346.
25. Oh WS and Roumanas ED. “Optimization of maxillary obturator thickness using a double-processing technique”. Journal of Prosthodontics 1 (2008): 60-63.
26. Tetteh S., et al. “Maxillofacial prostheses challenges in resource constrained regions”. Disability and Rehabilitation3 (2019): 348-356.
27. Farook TH., et al. “A systematic review of the computerized tools and digital techniques applied to fabricate nasal, auricular, orbital and ocular prostheses for facial defect rehabilitation”. Journal of Stomatology Oral and Maxillofacial Surgery3 (2020): 268-277.
28. Goiato MC., et al. “Positioning magnets on a multiple/sectional maxillofacial prosthesis”. The Journal of Contemporary Dental Practice7 (2007): 101-107.
29. Williams RJ., et al. “Use of CAD/CAM technology to fabricate a removable partial denture framework”. Journal of Prosthetic Dentistry2 (2006): 96-99.
30. Williams RJ., et al. “A technique for fabricating patterns for removable partial denture frameworks using digitized casts and electronic surveying”. Journal of Prosthetic Dentistry1 (2004): 85-88.
31. Pan S and Liu B. “Research progress on 3D printing metal powders used in cranio-maxillofacial prosthesis”. West China Journal of Stomatology4 (2019): 438-442.
32. Thota KK., et al. “A Prosthodontic Rehabilitation of a Partial Maxillectomy Patient with Hollow Bulb Obturator”. Indian Journal of Dental Advancements4 (2010): 383-386.
33. Lethaus B., et al. “Surgical and prosthetic reconsiderations in patients with maxillectomy”. Journal of Oral Rehabilitation2 (2010): 138-142.
34. Evan B Rosen., et al. “The Role of Maxillofacial Prosthetics for the Surgically Treated Patient at NCI-Designated Comprehensive Cancer Centers”. Laryngoscope2 (2019): 409-414.
35. Tasopoulos T., et al. “Fabrication of a 3D Printing Definitive Obturator Prosthesis: a Clinical Report”. Acta Stomatologica Croatica1 (2017): 53-59.
36. Cheah C-M., et al. “Integration of laser surface digitizing with CAD/CAM techniques for developing facial prostheses. Part 2: Development of molding techniques for casting prosthetic parts”. The International Journal of Prosthodontics 16.5 (2003): 543-548.