article wmc001239

Article ID: WMC001239 2046-1690

Palatal ObturatorCorresponding Author:Dr. Narendra Kumar,professor, institute of dental studies and technologies, 60154 - India

Submitting Author:Dr. Reema Gupta,Sr. Lecturer, College of Dentistry - India

Previous Article Reference: http://www.webmedcentral.com/article_view/555

Article ID: WMC001239

Article Type: Original Articles

Submitted on:29-Nov-2010, 06:52:49 AM GMT Published on: 29-Nov-2010, 08:32:17 PM GMT

Article URL: http://www.webmedcentral.com/article_view/1239

Subject Categories:DENTISTRY

Keywords:maxillary carcinoma, palatal obtuator

How to cite the article:Kumar N . Palatal Obturator . WebmedCentral DENTISTRY 2010;1(11):WMC001239

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Palatal ObturatorAuthor(s): Kumar N

Abstract

Carcinoma of maxillary sinus is a common sinonasaltract tumor. Malignant tumors of Sinonasal tractconstitutes less than 1% of all malignancies in thebody and about 3% of head and neck cancers.Thiscase report describes the case of carcinoma ofmaxillary sinus, which is rehabilitated with obturator.

Introduction

Patient with cariconoma of maxillary sinus usuallypresents with pain and swelling in the maxilla.Treatment of malignant neoplasm of hard palateinvolves surgical resection followed by rehabilitationwith prosthesis.The rehabilitation of patient with carcinoma ofmaxillary sinus involving underlying maxilla requirescoordination of interdisciplinary medical team. Palatalobturators may be used alone or in combination,integrating plastic reconstructive surgery.3 One of themain problems with an obturator maxillary prosthesisis its weight.In extensive cases, the defects over a certain size, theforce of gravity prevails over the capacity of retentionof the substructures.This article reports the management of a patient withmaxillary resection, rehabilitated with a obturator.

Methods

A 65-year-old woman reported to the dental clinic withchief complaint of pain in upper right back teeth regionsince 6 weeks. Patient was diagnosed having carcinoma of maxillarysinus. Treatment was planned with the team ofsurgeons and prosthodontist. Tumour was surgicallyresected (figure-2)with involved underlying maxillarybone.2weeks after maxillary resection, wound had startedepithelizing. The palatal prosthesis given at this stagewas without teeth as mucous membrane was veryfragile. This delay of adding the teeth reduced thechances of irritation that could affect the surgicalhealing site. After 2 months wound was almost healed. Palatalprosthesis was fabricated in combination with soft

tissue mask on buccal side for retentive purpose andstability of the obturator.(figure-5,6)Prosthesis was inserted into patients mouth with anadequate peripheral seal.

Discussion

A maxillary-palatal defect may have seriousconsequences as far it concerns the relationshipbetween form and function: inability to chew andswallow, disorders in phonation and importantpsychological implications.Resection is the treatment for neoplasm, bone graftingis not recommended because the blood supply to thegraft area is compromised. Hence, in these patients,obturators are the favoured method for filling thedefect.Fabrication of an obturator prosthesis depends on theapplication of basic prosthodontic principles that areused in the treatment of patients without maxillarydefects.The defect, in conjunction with the remainingstructures, must be used to provide support, retention,and stability of an obturator prosthesis. The retentivedesign is critical in the sub-total maxillectomy patientwho has lost extensive supportive and retentivestructures in resection procedure.In dentate patients, primary retention, support, andstability of an obturator depends on the number anddistribution of remaining teeth.With resection of the hard tissue, the weight of theobturator is balanced bilaterally by providing acrylicresin mask on the contralateral side of the defect.

Conclusion(s)

The treatment achieved restoration of the lostfunctions which satisfied the patient, restoring his selfconfidence and enhancing hisquality of life. Applyingthe obturator was successful and may be consideredas an alternative to more complicated surgicaltechnique.

Reference(s)

1. RAMARAJU A V, SAJJAN S, REDDY N.ProstheticRehabilitation Of A Maxillary Defect With Hollow Bulb



Obturator Retained By A Combination Of A CastClasp And Zest Anchor Type Radicular BallAttachment- A Case Report. Journal Of Clinical AndDiagnostic Research2010: 599-933.2. Ahmed Abdulrahman Abass.Light Weight ObturatorFor A Patient With Unilateral Maxillectomy.Rev. Cln.Pesq. Odontol. 2007 : 3(3):195-198.3. Desjardins RP. Obturator prosthesis design foracquired maxillary defects. J Prosthet Dent1978;39(4): 424-435.



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