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Table of Contents
CASE REPORTS
Year : 2022  |  Volume : 6  |  Issue : 2  |  Page : 107-109

Re-establishment of quality of life and dietary habits after resection of a carcinomatous lesion: A case report


1 Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai, India
2 Department of Prosthodontics, Tamil Nadu Government Dental College, Chennai, Tamil Nadu, India

Date of Submission08-Feb-2022
Date of Decision16-Apr-2022
Date of Acceptance22-Apr-2022
Date of Web Publication12-Jul-2022

Correspondence Address:
Ahila Singaravel Chidambaranathan
Department of Prosthodontics, SRM Dental College, Ramapuram, Chennai, Tamil Nadu 600089
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/SDJ.SDJ_8_22

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  Abstract 

Background: Defects can be a congenital, developmental, or acquired one. Trauma or neoplasms, including malignant tumors of the maxilla treated with a maxillectomy, are frequent causes of acquired disfigurement of the orofacial region. Obturators fitted after a maxillectomy affect mastication, deglutition, phonation, and esthetic appearance, leading to loss of confidence post-surgery. Rehabilitation using a surgical obturator can restore confidence of patients particularly. Case Report: This case report describes a patient with a stage III adenocarcinoma in the center of the posterior aspect of the maxilla, which was classified as Aramony’s class III type of acquired palatal defect, in which a surgical obturator was placed immediately after surgery. Conclusion: The surgical obturator restored the patient’s confidence and quality of life (QoL) immediately after surgery of the palate by closing the defect that aids in phonetics and mastication and by easy maintenance.

Keywords: Obturator, palatal defect, PMMA resin, surgical obturator


How to cite this article:
Chidambaranathan AS, Thulasingam C. Re-establishment of quality of life and dietary habits after resection of a carcinomatous lesion: A case report. Sci Dent J 2022;6:107-9

How to cite this URL:
Chidambaranathan AS, Thulasingam C. Re-establishment of quality of life and dietary habits after resection of a carcinomatous lesion: A case report. Sci Dent J [serial online] 2022 [cited 2022 Aug 19];6:107-9. Available from: https://www.scidentj.com/text.asp?2022/6/2/107/350762




  Background Top


Palatal deformities may be congenital or the result of trauma, infectious diseases, radiation burns, or surgery.[1] The usual treatment plan for a maxillary neoplasm is surgical excision of the tumor. Resection surgery generally results in an oronasal deformity, which results in functional problems such as difficulty in chewing, swallowing, mastication, and phonetics. It also gives rise to esthetic concerns.[2] An oronasal deformity requires a special prosthesis known as an obturator to restore the oronasal seal.[3] An alternative prosthesis is required immediately after surgery to close oronasal deformities, restore normal function, and improve quality of life (QoL).[4],[5]

An obturator placed after a maxillectomy facilitates oncological surveillance of the graft area, as the excision area is easily inspected by removing the obturator, allowing any recurrence to be easily identified.[6] The excision area is easily inspected after detachment of the obturator and cancerous lesion, and recurrence may be identified during this time.[7] To ensure the outcome of a healthy clinical condition, the patients should be fully informed about the treatment pre-surgery and provided with adequate psychological care and phonetic therapy post-surgery.[8] According to a previous study, global QoL after prosthodontic therapy with obturator prostheses was 64% (±22.9).[9] Other research reported that a properly designed and fabricated obturator can have a positive impact on a patient’s QoL.[9] We should strive to ensure that all patients have as near as possible to a normal QoL, after surgical removal of maxillae without functional impairment or psychological trauma. This case report describes a simple and economic way of fabricating a surgical obturator for a stage III adenocarcinoma of the palate after surgery.


  Case Report Top


A 40-year-old male patient presented to the Department of Prosthodontics, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu with a palatal defect. On examination, the patient had a stage III adenocarcinoma of the palate, which was classified as Aramony’s class III type of acquired palatal defect (defects that involve hard palate but not the tooth-bearing alveolus) [Figure 1].[10] The treatment plan was surgical excision, with a surgical obturator immediately after the surgery. The defect was closed successfully, and retention was obtained using Adams clasps on the remaining natural teeth. The aim of the prosthesis was to seal the oroantral fistula and to restore masticatory function and speech following surgery.
Figure 1: Intraoral defect

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A maxillary arch impression was made using an irreversible hydrocolloid impression material (Zelgan Plus Alginate Impression Material; Dentsply International, Inc., New York, USA) [Figure 2]. The impression was poured with dental stone (Golden Stone, Golden Stone Ramaraju Traders, Chennai, Tamil Nadu, India) [Figure 3], and the tumor area on the cast was marked with an indelible pencil and filled with wax up to the palatal contour. The wax pattern of the surgical obturator was fabricated using modeling wax (Hindustan Dental Products, Hyderabad, India). Adams clasps were added to the first molar tooth on both sides for retention, as the defect in the midportion of the palate was small. For fabrication of the surgical obturator, heat-activated polymethylmethacrylate resin (Heat Cure; DPI, Mumbai, India) was used [Figure 4]. Immediately after the surgery, the prosthesis was inserted into the oral cavity [Figure 5]. The prosthesis is simple, lightweight, easy to fabricate and place, and cost-effective. Maintenance of the prosthesis is very easy, and the prosthesis aids phonetics and mastication. Thus, the prosthesis improves QoL.
Figure 2: Diagnostic impression

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Figure 3: Working cast

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Figure 4: Surgical obturator

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Figure 5: Intraoral rehabilitation with surgical obturator

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  Discussion Top


The primary treatment aim of prosthetic obturation for maxillectomy defects is to close the opening in the oral cavity. Prosthetic obturation plays a crucial role in the restoration of oral function after a maxillectomy.[1] Due to the design of surgical obturators, they cannot be modified post-operatively but must fit properly at the time of surgery and be functional immediately after surgery.[11] Basic design principles for obturators include maximum coverage to furnish support and engage the maximum number of teeth with clasps for maximum retention. The majority of maxillectomy patients limits social contacts post-surgery, as well as subsequent visits to the dentist. Hence, a simple prosthesis without a try-in procedure would be useful.[12] The advantages of placing a surgical obturator immediately after surgical resection are that it provides a scaffold upon which to support the surgical dressing that supports the facial flap and maintains pressure on the skin graft placed over the denuded internal surface of the flap. It also provides a barrier between the surgical dressing and the oral cavity. As a result, the patient is not aware of the defect during the initial healing period. In addition, it reduces oral contamination of the wound during the immediate post-surgical period and thus decreases the incidence of oral infection. By reproducing normal palatal contours, it facilitates deglutition and normal speech. Finally, a surgical obturator minimizes the initial feelings of tissue loss for 1–2 weeks and the duration of hospitalization.[13]

According to the literature, patients with the highest levels of education rated that their QoL after surgery would be better than those with low levels of education because of better awareness and understanding of care instructions, manipulation methods, and limitations of maxillary obturators.[8]


  Conclusion Top


Rehabilitation of maxillectomy patients with surgical obturators is similar to that of patients with conventional prostheses. However, treatment planning in maxillectomy cases must be tailored to each patient, and additional care must be taken when making impressions and fitting the obturator. In addition to ensuring adequate function immediately after surgery, the obturator described in the present case has the advantages like easy maintenance and aids phonetics and mastication. Thus, the prosthesis improves QoL.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

The authors declare that there are no conflicts of interest.



 
  References Top

1.
Keyf F. Obturator prostheses for hemimaxillectomy patients. J Oral Rehabil 2001;28:821-9.  Back to cited text no. 1
    
2.
Desjardins RP. Early rehabilitative management of the maxillectomy patient. J Prosthet Dent 1977;38:311-8.  Back to cited text no. 2
    
3.
Rieger J, Wolfaardt J, Seikaly H, Jha N. Speech outcomes in patients rehabilitated with maxillary obturator prostheses after maxillectomy: A prospective study. Int J Prosthodont 2002;15:139-44.  Back to cited text no. 3
    
4.
Newton JT, Fiske J, Foote O, Frances C, Loh IM, Radford DR. Preliminary study of the impact of loss of part of the face and its prosthetic restoration. J Prosthet Dent 1999;82:585-90.  Back to cited text no. 4
    
5.
Lethaus B, Lie N, de Beer F, Kessler P, de Baat C, Verdonck HW. Surgical and prosthetic reconsiderations in patients with maxillectomy. J Oral Rehabil 2010;37:138-42.  Back to cited text no. 5
    
6.
Moreno MA, Skoracki RJ, Hanna EY, Hanasono MM. Microvascular free flap reconstruction versus palatal obturation for maxillectomy defects. Head Neck 2010;32:860-8.  Back to cited text no. 6
    
7.
Riaz N, Warriach RA. Quality of life in patients with obturator prostheses. J Ayub Med Coll Abbottabad 2010;22:121-5.  Back to cited text no. 7
    
8.
Depprich R, Naujoks C, Lind D, Ommerborn M, Meyer U, Kübler NR, et al. Evaluation of the quality of life of patients with maxillofacial defects after prosthodontic therapy with obturator prostheses. Int J Oral Maxillofac Surg 2011;40:71-9.  Back to cited text no. 8
    
9.
Irish J, Sandhu N, Simpson C, Wood R, Gilbert R, Gullane P, et al. Quality of life in patients with maxillectomy prostheses. Head Neck 2009;31:813-21.  Back to cited text no. 9
    
10.
Okay DJ, Genden E, Buchbinder D, Urken M. Prosthodontic guidelines for surgical reconstruction of the maxilla: A classification system of defects. J Prosthet Dent 2001;86:352-63.  Back to cited text no. 10
    
11.
Beumer J, Curtis T, Marunick M. Maxillofacial Rehabilitation: Prosthodontic and Surgical Considerations. St. Louis: Ishiyaku Euro America, Inc. Publishers; 1996. p. 240-85.  Back to cited text no. 11
    
12.
Ullah Khan MW, Shah AA, Fatima A. Single-step fabrication of a new maxillary obturator prosthesis. J Dent Oral Disord Ther 2015;3:1-4.  Back to cited text no. 12
    
13.
Desjardins RP. Obturator prosthesis design for acquired maxillary defects. J Prosthet Dent 1978;39:424-35.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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