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Reconstructive Surgery. J Oral Maxillofac Surg 2023; 81:E263-E299. [PMID: 37833026 DOI: 10.1016/j.joms.2023.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Alqarni H, Alfaifi M, Ahmed WM, Almutairi R, Kattadiyil MT. Classification of maxillectomy in edentulous arch defects, algorithm, concept, and proposal classifications: A review. Clin Exp Dent Res 2023; 9:45-54. [PMID: 36600487 PMCID: PMC9932229 DOI: 10.1002/cre2.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 11/08/2022] [Accepted: 12/15/2022] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Aramany's classification of postsurgical maxillectomy defects was introduced for partially edentulous situations, and has been widely used for education and effective communication among practitioners. Numerous classifications of maxillofacial defects, based on surgical procedure, resultant defects, or prosthodontist's perspective after rehabilitation, exist in the literature. However, no single classification has incorporated all these factors. The purpose of this review was to highlight the classification systems and describe a pragmatic classification series for edentulous maxillary arch defects (maxillectomy) by applying the Aramany classification criteria, to enhance treatment outcomes and communication among practitioners. MATERIAL AND METHODS An electronic search of the literature published in English was conducted using the PubMed/MEDLINE and Google Scholar database. Keywords used were "maxillectomy classification" AND "surgical resection," "maxillectomy classification" AND "complete edentulous." In addition, a manual search was also performed followed the same criteria in the following journals: Journal of Prosthetic Dentistry and Journal of Prosthodontics. RESULTS Several classification systems for partial dentition were found in terms of size, location, dentition, and extension of the defect (isolated or communication defects). The findings revealed a variety of maxillectomy defect classifications for partially dentate, considering surgical factors and rehabilitation. However, no study or classification system exist for the edentulous arch defects. CONCLUSIONS Different classification systems for maxillectomy defects exist in the literature, only for partially dentate patients. To the authors best knowledge, no classification system for completely edentulous maxillary arch defects have been proposed till date. A simple classification system with clear characteristics for edentulous maxillectomy dental arch defects has been proposed. This classification was modeled after Aramany classification for easier memorization and application.
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Affiliation(s)
- Hatem Alqarni
- Department of Restorative and Prosthetic Dental Sciences, College of DentistryKing Saud Bin Abdulaziz University for Health SciencesRiyadhSaudi Arabia
- King Abdullah International Medical Research CenterRiyadhSaudi Arabia
| | - Mohammed Alfaifi
- Department of Prosthtic Dental Sciences, King Khalid University College of Dentistry, Abha, Saudi Arabia; Fellow in Advanced Digital Prosthodontics and Implant Dentistry, Department of ProsthodonticsLoma Linda University School of DentistryLoma LindaCaliforniaUSA
| | - Walaa Magdy Ahmed
- Department of Restorative Dentistry, Faculty of DentistryKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Rania Almutairi
- Prosthodontic ResidentKing Saud UniversityRiyadhSaudi Arabia
| | - Mathew T. Kattadiyil
- Advanced Education Program in ProsthodonticsLoma Linda University School of DentistryLoma LindaCaliforniaUSA
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Wang Y, Hattori M, Liu R, Sumita YI. Digital acoustic analysis of the first three formant frequencies in patients with a prosthesis after maxillectomy. J Prosthet Dent 2022:S0022-3913(22)00654-0. [PMID: 36460491 DOI: 10.1016/j.prosdent.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 11/30/2022]
Abstract
STATEMENT OF PROBLEM Prosthetic rehabilitation with an obturator can help to restore or improve the intelligibility of speech in patients after maxillectomy. The frequency of formants 1 and 2 as well as their ranges were initially reported in patients with maxillary defects in 2002, and the evaluation method that was used is now applied in clinical evaluation. However, the details of formant 3 are not known and warrant investigation because, according to speech science, formant 3 is related to the pharyngeal volume. Clarifying the formant frequency values of formant 3 in patients after maxillectomy would enable prosthodontists to refer to these data when planning treatment and when assessing the outcome of an obturator. PURPOSE The purpose of this clinical study was to determine the acoustic characteristics of formant 3, together with those of formants 1 and 2, by using a digital acoustic analysis during maxillofacial prosthetic treatment. The utility of determining formant 3 in the evaluation of speech in patients after maxillectomy was also evaluated. MATERIAL AND METHODS Twenty-six male participants after a maxillectomy (mean age, 63 years; range, 20 to 93 years) were included, and the 5 Japanese vowels /a/, /e/, /i/, /o/, and /u/ produced with and without a definitive obturator prosthesis were recorded. The frequencies of the 3 formants were determined, and their ranges were calculated by using a speech analysis system (Computerized Speech Lab CSL 4400). The Wilcoxon signed rank test was used to compare the formants between the 2 use conditions (α=0.05). RESULTS Significant differences were found in the frequencies and ranges of all 3 formants between the use conditions. The ranges of all 3 formants produced with the prosthesis were significantly greater than those produced without it. CONCLUSIONS Based on the findings, both the first 2 formants and the third formant were changed by wearing an obturator prosthesis. Because formant 3 is related to the volume of the pharynx, evaluation of this formant and its range can reflect the effectiveness of the prosthesis to seal the oronasal communication and help reduce hypernasality, suggesting the utility of formant 3 analysis in prosthodontic rehabilitation.
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Affiliation(s)
- Yujia Wang
- Graduate student, Department of Maxillofacial Prosthetics, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Mariko Hattori
- Assistant Professor, Department of Maxillofacial Prosthetics, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
| | - Rongguang Liu
- Clinical Staff, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yuka I Sumita
- Associate Professor, Department of Maxillofacial Prosthetics, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Petrides GA, Dunn M, Charters E, Venchiarutti R, Cheng K, Froggatt C, Mukherjee P, Wallace C, Howes D, Leinkram D, Singh J, Nguyen K, Hubert Low TH, Ch'ng S, Wykes J, Clark JR. Health-related quality of life in maxillectomy patients undergoing dentoalveolar rehabilitation. Oral Oncol 2022; 126:105757. [PMID: 35121398 DOI: 10.1016/j.oraloncology.2022.105757] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Surgical resection of the maxilla impairs aesthetics, speech, swallowing, and mastication. Maxillary reconstruction is increasingly performed with virtual surgical planning (VSP) to enhance functional dental rehabilitation with a conventional denture or osseointegrated implants. The aim of this study was to determine whether dental status and VSP is associated with health-related quality of life (HRQOL) and function in patients who have undergone maxillectomy. MATERIALS AND METHODS A cross-sectional study was conducted among patients who underwent free flap reconstruction or obturation of the maxilla between July 2009 and December 2020. The FACE-Q Head and Neck Cancer (FACE-Q) module, M.D. Anderson Dysphagia Inventory (MDADI), and Speech Handicap Index (SHI) were used to evaluate HRQOL. RESULTS Forty-three patients (response rate 59%) completed questionnaires and 48% underwent dental rehabilitation. In Okay Class II and III defects, adjusting for the effect of radiotherapy and time from surgery, there was a positive association between denture status and FACE-Q smiling (p = 0.020), eating (p = 0.012), smiling (p = 0.015), and MDADI global (p = 0.015), emotional (p = 0.027), functional (p = 0.028), and composite (p = 0.029) scores. VSP was associated with FACE-Q swallowing (p = 0.005), drooling (p = 0.030), eating (p = 0.008), smiling (p = 0.021), MDADI global (p = 0.017), emotional (p = 0.041), functional (p = 0.040), composite (p = 0.038), and SHI total scores (p = 0.042). CONCLUSIONS Dentoalveolar rehabilitation and VSP were associated with higher HRQOL scores relating to eating and drinking, smiling, and speaking.
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Affiliation(s)
- George A Petrides
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Masako Dunn
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Emma Charters
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Rebecca Venchiarutti
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Kai Cheng
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Catriona Froggatt
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Payal Mukherjee
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, NSW 2050, Australia
| | - Christine Wallace
- Department of Oral Restorative Sciences, Westmead Centre for Oral Health, Corner of Hawkesbury Road and, Darcy Road, Westmead NSW 2145, Australia
| | - Dale Howes
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; School of Dentistry, Faculty of Medicine and Health, University of Sydney, 2 Chalmers St, Surry Hills, NSW 2010, Australia
| | - David Leinkram
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Jasvir Singh
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Kevin Nguyen
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia
| | - Tsu-Hui Hubert Low
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Anderson Stuart Building, The University of Sydney, Camperdown, NSW 2050, Australia; Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Sydney Ch'ng
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Anderson Stuart Building, The University of Sydney, Camperdown, NSW 2050, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, NSW 2050, Australia; Department of Plastic Surgery, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, NSW 2050, Australia
| | - James Wykes
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Anderson Stuart Building, The University of Sydney, Camperdown, NSW 2050, Australia
| | - Jonathan R Clark
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, 119-143 Missenden Road, Camperdown, NSW 2050, Australia; Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Anderson Stuart Building, The University of Sydney, Camperdown, NSW 2050, Australia; Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Camperdown, NSW 2050, Australia.
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Corsalini M, Barile G, Catapano S, Ciocia A, Casorelli A, Siciliani R, Di Venere D, Capodiferro S. Obturator Prosthesis Rehabilitation after Maxillectomy: Functional and Aesthetical Analysis in 25 Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312524. [PMID: 34886250 PMCID: PMC8657009 DOI: 10.3390/ijerph182312524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/30/2022]
Abstract
The number of patients undergoing a surgical resection of the maxilla for oncological reasons is constantly increasing, the most common complication of which remains the communication between oral and nasal cavities. On the basis of data arising from the literature regarding the treatment options of maxillary oncological post-surgical defects, obturator prosthesis remains the most used worldwide. We studied 25 patients (with at least 1-year follow up) rehabilitated by obturator prosthesis after maxillary resection leading to oro-nasal communication, providing data on the objective/subjective evaluation of such rehabilitation and mastication performance measured by a two-color chewing gum test. The type of defect was classified according to the classification system proposed by Aramany. Among the patients in our study, 72% rated a higher score for either stability and retention than for aesthetic appearance, as confirmed by the Kapur score rated by clinicians. The two-color chewing gum test shows similar results as only one patient had insufficient chewing function. Interestingly, we found no correlation between the masticatory function and residual denture, confirming that the maxillary obturator remains a predictable solution in such patients regardless of the anatomical alterations following surgery.
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Affiliation(s)
- Massimo Corsalini
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.B.); (A.C.); (A.C.); (R.S.); (D.D.V.)
- Correspondence: (M.C.); (S.C.)
| | - Giuseppe Barile
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.B.); (A.C.); (A.C.); (R.S.); (D.D.V.)
| | - Santo Catapano
- Dental Clinic, Dental School, University of Ferrara, 44121 Ferrara, Italy;
| | - Annamaria Ciocia
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.B.); (A.C.); (A.C.); (R.S.); (D.D.V.)
| | - Assunta Casorelli
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.B.); (A.C.); (A.C.); (R.S.); (D.D.V.)
| | - Rosaria Siciliani
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.B.); (A.C.); (A.C.); (R.S.); (D.D.V.)
| | - Daniela Di Venere
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.B.); (A.C.); (A.C.); (R.S.); (D.D.V.)
| | - Saverio Capodiferro
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.B.); (A.C.); (A.C.); (R.S.); (D.D.V.)
- Correspondence: (M.C.); (S.C.)
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Grover R, Jurel SK, Agarwal B, Rao J, Kapoor S, Mishra N, Singh BP. Speech intelligibility, nasal resonance, and swallowing ability of maxillectomy patients with customized obturator: A non randomized controlled study. J Indian Prosthodont Soc 2021; 21:249-255. [PMID: 34380811 PMCID: PMC8425377 DOI: 10.4103/jips.jips_98_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aim: To compare speech intelligibility (SI), nasal resonance, and swallowing ability in maxillectomy patients with a customized obturator to the conventional obturator. Settings and Design: Non-randomized controlled study. Materials and Methods: Forty-eight maxillectomy patients were recruited and assessment of SI, nasal resonance, and swallowing ability was done at three situations: without obturator, with conventional obturator, and with customized obturator. Recordings of unrehearsed conversation, counting from number 1–20 and four sets of Chapel Hill Multilingual Intelligibility Test in the Hindi language were used to assess SI and nasal resonance. SI was evaluated by untrained listeners and graded according to a 6-point scale. Nasal resonance was evaluated by speech pathologists on a 7-point scale of severity. Swallowing ability was evaluated by water drinking test. Statistical Analysis Used: One-way ANOVA, Post hoc Bonferroni and Chi square test. Results: SI and nasal resonance showed a statistically significant difference between any two groups (P < 0.001). Water drinking time was significantly different between without obturator and with customized obturator (P < 0.001), but the difference was not statistically significant between without obturator and with obturator (P < 0.004). Conclusion: SI, nasal resonance, and swallowing ability improved with customized obturator in comparison to the conventional obturator.
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Affiliation(s)
- Rohan Grover
- Department of Prosthodontics, Crown and Bridge, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sunit Kumar Jurel
- Department of Prosthodontics, Crown and Bridge, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Bhaskar Agarwal
- Department of Prosthodontics, Crown and Bridge, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Jitendra Rao
- Department of Prosthodontics, Crown and Bridge, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Saumya Kapoor
- Department of Prosthodontics, Crown and Bridge, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Niraj Mishra
- Department of Prosthodontics, Crown and Bridge, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Balendra Pratap Singh
- Department of Prosthodontics, Crown and Bridge, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
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Nagatsuka H, Kawakami S, Kuwahara M, Kubota C, Kodama N, Minagi S. Newly designed flat surface artificial tongue system for speech improvement in glossectomy patients: A preliminary study. J Prosthodont Res 2021; 66:87-92. [PMID: 34261846 DOI: 10.2186/jpr.jpr_d_20_00230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE To design an efficient tongue prosthesis with reproducibility and to objectively evaluate improvement in speech function. METHODS A silicon anatomical artificial tongue (AT) and a flat surface artificial tongue system (FTS) were used in our study. Twenty healthy participants (10 males and 10 females, 26.3 ± 1.8 years) were fitted with a tongue movement suppression appliance (TSA) that fit the dental arch to simulate the glossectomy condition. TSA, TSA + FTS, and TSA + AT simulated the state of glossectomy patients without artificial tongue, with normal artificial tongue, and newly designed artificial tongue, respectively. Three speech intelligibility tests were performed for each of the following conditions: pronouncing 100 Japanese monosyllables, 40 Japanese words, and reading a short story. One-way ANOVA, Wilcoxon signed-rank test, and Tukey-Kramer post-hoc test were used for statistical analyses. RESULTS Significant differences were observed for 100 Japanese monosylla bles and 40 Japanese words between the TSA + FTS, TSA, and TSA + AT conditions (p ‹ 0.05). Regarding the speech intelligibility test for reading a short story, the TSA + FTS condition resulted in a significantly higher speech intelligibility than the TSA and TSA + AT conditions (p ‹ 0.05). CONCLUSIONS A flat surface artificial tongue system contributed to the improvement in speech function. This structure can be easily used in cases where conventional artificial tongue are applicable, regardless of variation in the oral condition; thus, making it a widely applicable treatment option for glossectomy patients.
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Affiliation(s)
- Hiroaki Nagatsuka
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Shigehisa Kawakami
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Miho Kuwahara
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Chie Kubota
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Naoki Kodama
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
| | - Shogo Minagi
- Department of Occlusal and Oral Functional Rehabilitation, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama
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Buurman DJM, Speksnijder CM, Engelen BHBT, Kessler P. Masticatory performance and oral health-related quality of life in edentulous maxillectomy patients: A cross-sectional study to compare implant-supported obturators and conventional obturators. Clin Oral Implants Res 2020; 31:405-416. [PMID: 31944417 PMCID: PMC7319476 DOI: 10.1111/clr.13577] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/05/2019] [Accepted: 01/08/2020] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of this cross-sectional study was to compare the masticatory performance and oral health-related quality of life (OHRQoL) of edentulous maxillectomy patients with and without implant-supported obturator prostheses. MATERIAL AND METHODS Nineteen edentulous maxillectomy patients with completed prosthetic obturator treatment in the upper jaw participated in this study. In nine patients, the obturator prosthesis was supported by implants in the remaining bone of the midface and/or skull base to improve retention. Masticatory performance was measured objectively by the mixing ability test (MAT) and subjectively by three OHRQoL questionnaires: (a) the Oral Health Impact Profile for EDENTulous people (OHIP-EDENT), (b) the Obturator Function Scale (OFS), and (c) the Dutch Liverpool Oral Rehabilitation Questionnaire version 3 (LORQv3-NL). The independent t test and the Mann-Whitney U test were used to test for differences in outcomes of patients with and without implant-retention of their obturator prostheses. RESULTS Patients with implant-supported obturator prostheses had significantly better masticatory and oral function, reported fewer chewing difficulties, and had less discomfort during food intake than did patients with a conventional obturator. CONCLUSION Supporting prosthetic obturators after maxillectomy with implants improve oral functioning, chewing, and eating comfort. This treatment modality is a viable technique to improve the functionality of prosthetic rehabilitation in patients who have undergone maxillectomy.
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Affiliation(s)
- Doke J M Buurman
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Caroline M Speksnijder
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Head and Neck Surgical Oncology, University Medical Center Utrecht Cancer Center, Utrecht University, Utrecht, The Netherlands.,Julius Center Sciences, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Britt H B T Engelen
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Peter Kessler
- Department of Cranio-Maxillofacial Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
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9
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Olsson AB, Dillon J, Kolokythas A, Schlott BJ. Reconstructive Surgery. J Oral Maxillofac Surg 2019; 75:e264-e301. [PMID: 28728733 DOI: 10.1016/j.joms.2017.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Dalkiz M, Dalkiz AS. The Effect of Immediate Obturator Reconstruction after Radical Maxillary Resections on Speech and other Functions. Dent J (Basel) 2018; 6:dj6030022. [PMID: 29933554 PMCID: PMC6162668 DOI: 10.3390/dj6030022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 05/18/2018] [Accepted: 05/24/2018] [Indexed: 11/18/2022] Open
Abstract
Objective: Maxillectomy often results in a high level of morbidity with significant psychological and functional implications for patients. The aims of the present study were to assess the effectiveness of the maxillary obturator as a speech rehabilitation aid, to examine the influence of dentition on speech intelligibility, to restore patients’ regular daily activity as soon as possible, and to maintain patients’ psychological well-being throughout the treatment. Patients and Methods: Forty-one palatomaxillary immediate obturator and definitive reconstruction patient treatments were reviewed at a clinic (Ankara, Turkey). Patients aged between 20 and 73 years with surgically acquired partial maxillary defects were included in this study. All patients were rehabilitated with immediate and definitive obturators. The patients were given immediate surgical obturators which were adjusted to the defect area with a tissue conditioner. By employing this procedure and relining with the tissue conditioner weekly, immediate obturators were used in the interim stage of the treatment. As interim obturators, prostheses were used for two to three months until healing and resorption were found satisfactory, after which the definitive obturators were fabricated. Results: The speech intelligibility test (SIT) was employed for the evaluation of the speech ability. Significant improvements were found in the mean speech intelligibility test score (SITS), from 0.02% in patients without prosthetic obturation to 94.10% in patients with immediate obturation on the second day, 95.60% in patients with immediate obturation on the 20th day, and 95.97% in patients with definitive obturation.
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Affiliation(s)
- Mehmet Dalkiz
- Private Practice 1, Boulevard Sylvain Dupuis 235-10, 1070 Brussels, Belgium.
| | - Ahmed Suat Dalkiz
- Private Practice 2, Boulevard Sylvain Dupuis 235-10, 1070 Brussels, Belgium.
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11
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Obturators versus flaps after maxillary oncological ablation: A systematic review and best evidence synthesis. Oral Oncol 2018; 82:152-161. [PMID: 29909890 DOI: 10.1016/j.oraloncology.2018.05.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/02/2018] [Accepted: 05/25/2018] [Indexed: 02/05/2023]
Abstract
Maxillary defects can be resolved by prosthetic obturation, autologous tissue reconstruction, or a combination of both. However, there is still controversy in the selection of the optimal approach. Therefore, the aim of this study was to systematically review evidences comparing the performance of obturators and flaps in patients after maxillary oncological ablation. Both electronic and manual searching approaches were conducted to identify eligible evidence. Two reviewers independently assessed the risk of bias. In addition, the same reviewers independently extracted the data. Meta-analyses were performed using Revman 5.3, and best evidence synthesis was performed. Sixteen studies were included and a total of 528 participants were analyzed. All studies were assessed at low quality. Results of this meta-analysis showed weak evidence in the difference between obturators and flaps on the outcome regarding word intelligibility (P = 0.004) and masticatory efficiency (P = 0.002). However, no differences were detected regarding speech intelligibility and nasalance. All studies were compiled into the best evidence synthesis. The sum of 31 evidences was considered. Twelve evidences were evaluated at a moderate level, such as speech, mastication, pain, salivation, taste sensations, and mouth opening. Except the outcomes of word intelligibility, masticatory efficiency, and mouth pain, other moderate evidences showed no difference between obturators and flaps. In conclusion, both obturators and flaps might be effective in patients' rehabilitation functions after maxillary ablation. However, some advantages were observed when using surgical reconstruction over prosthetic rehabilitation. Additional high-quality studies are needed to provide more solid evidence before applying these results into clinical practice.
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Ali MM, Khalifa N, Alhajj MN. Quality of life and problems associated with obturators of patients with maxillectomies. Head Face Med 2018; 14:2. [PMID: 29329558 PMCID: PMC5795281 DOI: 10.1186/s13005-017-0160-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/22/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Maxillary defects predispose patients to different undesirable effects. The aim of this study was to assess the quality of life (QoL) of patients with maxillary defects (acquired/congenital) wearing obturators. METHODS The study comprised 30 patients aged between 16 and 78 years. Interviews were conducted to collect information pertaining to patients; sociodemographic, self-reported function of obturator using Obturator Functioning Scale (OFS), self-evaluation of general health using Visual Analogue Scale (VAS), radiotherapy treatment, salivary gland removal, reconstructive surgery, neck dissection and length of time obturators were worn. Clinical examination included type of maxillectomy, Aramany classification of the defect, and evaluation of obturator function using the Kapur retention and stability scoring system. RESULT Quality of life was affected significantly by marital status (P = 0.026). Married patients had better quality of life 61.3%, followed by divorced patients 38.8%, widowed 37.3% and the least QoL was detected in single patients 36.5%. Significant association between the type of maxillectomy and QoL was detected (P = 0.002). Retention of obturator prosthesis had a highly significant association with QoL (P < 0.001). Type of maxillectomy had a significant relation with obturator retention (P = 0.005). Stability had a significant correlation with QoL (P = 0.022). Obturator wearers who were treated with radiotherapy had lower QoL than those who were not treated with radiotherapy. CONCLUSION Rehabilitation of patients with maxillary defects using obturator prosthesis is an appropriate and not invasive treatment modality. Results support that good obturators contribute to a better life quality.
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Affiliation(s)
- Marwa Mohammed Ali
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
| | - Nadia Khalifa
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan.,Department of Preventive and Restorative Dentistry, Faculty of Dental Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - Mohammed Nasser Alhajj
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan. .,Department of Prosthodontics, Faculty of Dentistry, Thamar University, Dhamar, Yemen.
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Wu S, Huang X, Wang J, Hong N, Li Y. Evaluation of speech improvement following obturator prostheses for patients with palatal defect. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2018; 143:202. [PMID: 29390771 DOI: 10.1121/1.5020781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Palatal defect is a common maxillofacial defect after maxillectomy that can be repaired by obturator prostheses, which can effectively improve patients' speech. However, comprehensive evaluation methods for speech recovery are still controversial and remain undefined. A prospective cohort study on 34 patients with palatal defect and 34 healthy controls was performed. Patients received obturator prostheses and their speech was recorded without and then with obturators. Participants pronounced six Chinese vowels and 100 syllables for recording. This paper evaluated the recovery of speech function of patients through the combination of subjective and objective assessment methods. Recruited listeners evaluated the speech intelligibility (SI) of 100 syllables. Vowel formant frequency and quantified vowel nasalization were measured using analysis software. The SI of patients improved significantly after wearing obturators. F2 values of six vowels in patients with obturators were higher than patients without obturators and close to the corresponding values in normal controls. The differences in F2 of /i/ and /u/, (A1-P1) of /i/ and /u/ for patients without and with obturator use were significant. Patients' ability to control the pronunciation of /i/ and /u/ improved greatly with obturators. These provide clinical evidence of the treatment outcomes in patients with palatal defect who received obturators.
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Affiliation(s)
- Shuyi Wu
- Department of Prosthodontics, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, No. 56 Lingyuan West Road, Guangzhou, 510055, China
| | - Xiaoqiong Huang
- Department of Prosthodontics, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, No. 56 Lingyuan West Road, Guangzhou, 510055, China
| | - Junjie Wang
- Department of Prosthodontics, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, No. 56 Lingyuan West Road, Guangzhou, 510055, China
| | - Nanrui Hong
- Department of Prosthodontics, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, No. 56 Lingyuan West Road, Guangzhou, 510055, China
| | - Yan Li
- Department of Prosthodontics, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, No. 56 Lingyuan West Road, Guangzhou, 510055, China
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Elbashti ME, Sumita YI, Hattori M, Aswehlee AM, Taniguchi H. Digitized Speech Characteristics in Patients with Maxillectomy Defects. J Prosthodont 2017; 28:649-655. [PMID: 29210525 DOI: 10.1111/jopr.12705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Accurate evaluation of speech characteristics through formant frequency measurement is important for proper speech rehabilitation in patients after maxillectomy. This study aimed to evaluate the utility of digital acoustic analysis and vowel pentagon space for the prediction of speech ability after maxillectomy, by comparing the acoustic characteristics of vowel articulation in three classes of maxillectomy defects. MATERIALS AND METHODS Aramany's classifications I, II, and IV were used to group 27 male patients after maxillectomy. Digital acoustic analysis of five Japanese vowels-/a/, /e/, /i/, /o/, and /u/-was performed using a speech analysis system. First formant (F1) and second formant (F2) frequencies were calculated using an autocorrelation method. Data were plotted on an F1-F2 plane for each patient, and the F1 and F2 ranges were calculated. The vowel pentagon spaces were also determined. One-way ANOVA was applied to compare all results between the three groups. RESULTS Class II maxillectomy patients had a significantly higher F2 range than did Class I and Class IV patients (p = 0.002). In contrast, there was no significant difference in the F1 range between the three classes. The vowel pentagon spaces were significantly larger in class II maxillectomy patients than in Class I and Class IV patients (p = 0.014). CONCLUSION The results of this study indicate that the acoustic characteristics of maxillectomy patients are affected by the defect area. This finding may provide information for obturator design based on vowel articulation and defect class.
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Affiliation(s)
- Mahmoud E Elbashti
- Department of Maxillofacial Prosthetics, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Yuka I Sumita
- Department of Maxillofacial Prosthetics, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Mariko Hattori
- Department of Maxillofacial Prosthetics, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Amel M Aswehlee
- Department of Maxillofacial Prosthetics, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hisashi Taniguchi
- Department of Maxillofacial Prosthetics, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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15
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Sumita YI, Hattori M, Murase M, Elbashti ME, Taniguchi H. Digitised evaluation of speech intelligibility using vowels in maxillectomy patients. J Oral Rehabil 2017; 45:216-221. [PMID: 29205443 DOI: 10.1111/joor.12595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2017] [Indexed: 11/28/2022]
Abstract
Among the functional disabilities that patients face following maxillectomy, speech impairment is a major factor influencing quality of life. Proper rehabilitation of speech, which may include prosthodontic and surgical treatments and speech therapy, requires accurate evaluation of speech intelligibility (SI). A simple, less time-consuming yet accurate evaluation is desirable both for maxillectomy patients and the various clinicians providing maxillofacial treatment. This study sought to determine the utility of digital acoustic analysis of vowels for the prediction of SI in maxillectomy patients, based on a comprehensive understanding of speech production in the vocal tract of maxillectomy patients and its perception. Speech samples were collected from 33 male maxillectomy patients (mean age 57.4 years) in two conditions, without and with a maxillofacial prosthesis, and formant data for the vowels /a/,/e/,/i/,/o/, and /u/ were calculated based on linear predictive coding. The frequency range of formant 2 (F2) was determined by differences between the minimum and maximum frequency. An SI test was also conducted to reveal the relationship between SI score and F2 range. Statistical analyses were applied. F2 range and SI score were significantly different between the two conditions without and with a prosthesis (both P < .0001). F2 range was significantly correlated with SI score in both the conditions (Spearman's r = .843, P < .0001; r = .832, P < .0001, respectively). These findings indicate that calculating the F2 range from 5 vowels has clinical utility for the prediction of SI after maxillectomy.
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Affiliation(s)
- Y I Sumita
- Department of Maxillofacial Prosthetics, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - M Hattori
- Department of Maxillofacial Prosthetics, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - M Murase
- Department of Maxillofacial Prosthetics, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - M E Elbashti
- Department of Maxillofacial Prosthetics, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - H Taniguchi
- Department of Maxillofacial Prosthetics, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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GASTALDI G, PALUMBO L, MORESCHI C, GHERLONE E, CAPPARÉ P. Prosthetic management of patients with oro-maxillo-facial defects: a long-term follow-up retrospective study. ORAL & IMPLANTOLOGY 2017; 10:276-282. [PMID: 29285330 PMCID: PMC5735392 DOI: 10.11138/orl/2017.10.3.276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION The aim of this study is to determine the outcome of maxillofacial prosthetic rehabilitation after oncological resections, including both intra- and extra-oral prosthetic devices. METHODS In this study were included 72 patients, who have undergone an intra or extra-oral maxillofacial prosthetic rehabilitation after an oncologic resection. Tumors on the head and neck were analyzed and the defects of these resections have been divided in two different groups: intra and extra-oral defects. RESULTS 72 participants were treated with maxillofacial prosthesis, 3 of which with post-traumatic wounds and 69 with resections of tumors on the head and neck. Of the 69 treated for neoplastic disease, 43 received an intraoral prosthesis (palatal obturator) and 29 with an extraoral epithesis (18 with nasal prostheses, 8 with orbital implants and 3 with ear implants). The group included patients with different types of tumors. All the patients were evaluated in terms of aesthetic appearance after the construction of the prostheses and the results were satisfactory. CONCLUSION Within the limitations of this study, after the use of maxillofacial protheses patients feel more confident and self-assured. Maxillofacial protheses are a good solution in order to improve the life's quality in patients with tumors resections: prostheses are easy to handle and provide a satisfying social interaction for the patients.
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Affiliation(s)
| | | | | | | | - P. CAPPARÉ
- Correspondence to: Dr. Paolo Capparé, Department of Dentistry, IRCCS San Raffaele Hospital, Via Olgettina 48, 20132 Milan, Italy, Phone: 0039 0226433619; fax 0039 0226432953;, E-mail:
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Alam D, Ali Y, Klem C, Coventry D. The Evolution of Complex Microsurgical Midface Reconstruction. Facial Plast Surg Clin North Am 2016; 24:593-603. [DOI: 10.1016/j.fsc.2016.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Abu-Serriah M, Wong L, Richardson S, Fasanmade A, Wiesenfeld D, Martin IC. The SECONDI MAPZ(©) system: new approach for the classification of oncological defects of the midface. Br J Oral Maxillofac Surg 2016; 54:422-9. [PMID: 26907930 DOI: 10.1016/j.bjoms.2015.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
Abstract
The appearance and function of the midface are crucial physiologically, psychologically, and aesthetically, and defects in the region can be devastating. Most of these defects are caused by operations for cancer, for which surgical access and rehabilitation can be challenging. Clinical evidence in midfacial ablative surgery is limited because differences between existing classifications do not allow a uniform approach to data recording, which makes comparison difficult. We explore the history of the classification of midfacial and maxillary defects, we analyse the shortcomings of those currently in use, and propose a new system that enables defects to be mapped simply, logically, and accurately.
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Affiliation(s)
- Muammar Abu-Serriah
- Department of Oral and Maxillofacial Surgery, Manchester Head and Neck Centre, Manchester Royal Infirmary, Central Manchester Foundation Trust, Manchester, UK.
| | - Lilia Wong
- Department of Oral and Maxillofacial Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Sophia Richardson
- Department of Oral and Maxillofacial Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Adekunmi Fasanmade
- The Head and Neck Surgery Supra-regional Unit, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - David Wiesenfeld
- Department of Surgery, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Ian C Martin
- Department of Oral and Facial Surgery, Sunderland Royal Hospital, Sunderland, UK
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Abu-Serriah M, Wong L, Richardson J, Richardson S. The SECONDI MAPZ(©) system: a practical guide and proof of concept. Br J Oral Maxillofac Surg 2016; 54:430-7. [PMID: 26898518 DOI: 10.1016/j.bjoms.2015.12.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 12/08/2015] [Indexed: 11/27/2022]
Abstract
The SECONDI MAPZ(©) system is a new, simple, and logical classification of oncological defects of the midface that combines regional anatomy, 3-dimensional visualisation, and the hierarchy of functional priorities. In this paper, we provide clinical and radiographic examples of defects of varying complexity to illustrate the application of the system, to highlight its versatility, and to give practical clinical and radiological guidance on its use. We hope that its introduction will result in better communication of information, and the collection of more uniform data with which to compare outcomes, and ultimately will facilitate evidence-based practice in head and neck oncology.
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Affiliation(s)
- Muammar Abu-Serriah
- Department of Oral and Maxillofacial Surgery, Manchester Head and Neck Centre, Manchester Royal Infirmary, Central Manchester Foundation Trust, Manchester, UK.
| | - Lilia Wong
- Department of Oral and Maxillofacial Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Jeremy Richardson
- Department of Plastic and Reconstructive Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Sophia Richardson
- Department of Oral and Maxillofacial Surgery, the Head and Neck Surgery Supra-regional Unit, Churchill Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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20
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Tripathi A, Gupta A, Arora V. Effect of Prosthodontic Rehabilitation of Maxillary Defects on Hypernasality of Speech. J Prosthodont 2015. [PMID: 26215582 DOI: 10.1111/jopr.12309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To establish a correlation between the effective internal diameter of the maxillary defect, the resonating frequency, and the effectiveness of the definitive obturator in reducing the percentage nasality. MATERIALS AND METHODS Twenty-nine patients who underwent maxillectomy confined only to the hard palate (Aramany's class I and class II defect) and were wearing a definitive obturator for at least 3 months were included. The percentage nasality and resonating frequency were calculated with the help of Praat software. The patients were asked to read out a "Rainbow" passage and also to phonate and articulate vowels. Both parameters were assessed with and without the obturator prosthesis. RESULTS Following obturator use, a mean change of 1.07 ± 0.83 kHz was observed in the resonating frequency (p < 0.001). The percentage change in resonating frequency was found to be 27.48 ± 4.99% following obturator use (p < 0.001). The effective internal diameter of the maxillary defect was calculated with the help of a Vernier calliper. The correlation between absolute and percentage values of resonating frequency and nasality before and after obturator use was found to be negative. CONCLUSION This study found that efficacy of the obturator prosthesis in reducing nasality was greater in smaller defects than in large defects.
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Affiliation(s)
- Arvind Tripathi
- Postgraduate Studies and Research, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India
| | - Ashutosh Gupta
- Department of Prosthodontics, Saraswati Dental College and Hospital, Lucknow, Uttar Pradesh, India
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Elbashti ME, Hattori M, Sumita YI, Taniguchi H. Evaluation of articulation simulation system using artificial maxillectomy models. J Oral Rehabil 2015; 42:678-84. [PMID: 25975670 DOI: 10.1111/joor.12306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2015] [Indexed: 10/23/2022]
Abstract
Acoustic evaluation is valuable for guiding the treatment of maxillofacial defects and determining the effectiveness of rehabilitation with an obturator prosthesis. Model simulations are important in terms of pre-surgical planning and pre- and post-operative speech function. This study aimed to evaluate the acoustic characteristics of voice generated by an articulation simulation system using a vocal tract model with or without artificial maxillectomy defects. More specifically, we aimed to establish a speech simulation system for maxillectomy defect models that both surgeons and maxillofacial prosthodontists can use in guiding treatment planning. Artificially simulated maxillectomy defects were prepared according to Aramany's classification (Classes I-VI) in a three-dimensional vocal tract plaster model of a subject uttering the vowel /a/. Formant and nasalance acoustic data were analysed using Computerized Speech Lab and the Nasometer, respectively. Formants and nasalance of simulated /a/ sounds were successfully detected and analysed. Values of Formants 1 and 2 for the non-defect model were 675.43 and 976.64 Hz, respectively. Median values of Formants 1 and 2 for the defect models were 634.36 and 1026.84 Hz, respectively. Nasalance was 11% in the non-defect model, whereas median nasalance was 28% in the defect models. The results suggest that an articulation simulation system can be used to help surgeons and maxillofacial prosthodontists to plan post-surgical defects that will be facilitate maxillofacial rehabilitation.
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Affiliation(s)
- M E Elbashti
- Department of Maxillofacial Prosthetics, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - M Hattori
- Department of Maxillofacial Prosthetics, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Y I Sumita
- Department of Maxillofacial Prosthetics, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - H Taniguchi
- Department of Maxillofacial Prosthetics, Graduate School, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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22
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Thoma A, Gupta M, Archibald S. Maxillary reconstruction. Plast Reconstr Surg 2015. [DOI: 10.1002/9781118655412.ch27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Costa H, Zenha H, Sequeira H, Coelho G, Gomes N, Pinto C, Martins J, Santos D, Andresen C. Microsurgical reconstruction of the maxilla: Algorithm and concepts. J Plast Reconstr Aesthet Surg 2015; 68:e89-e104. [PMID: 25778873 DOI: 10.1016/j.bjps.2014.12.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 12/04/2014] [Accepted: 12/06/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The main purpose of this article is to highlight free tissue transfers as the first-choice method for three-dimensional (3D) maxillary reconstruction, particularly in providing enough bone for palate and maxillary arch reconstruction and consequently an implant-retained prosthesis. To achieve this, the myosseous free iliac crest was selected whenever possible as the first choice inside the reconstructive algorithm and free flap armamentarium. A new maxillectomy classification and algorithm reconstruction are proposed. Technical modifications and improvements accomplished over time are discussed, considering palate, dental implants and prosthesis, nasal sidewall, cranial base and dura, as well as recipient vessels. We present functional and aesthetic outcomes of the senior author's past 24-year experience (H. C.) with complex midface reconstructions. MATERIAL AND METHODS The authors report and analyse a 24-year experience with 57 midface defects in 54 patients (30 males and 24 females). A total of 57 maxillary defects - classified as Class I (limited maxillectomy) = 12, Class II (subtotal maxillectomy) = 15, Class III (total maxillectomy) = 19 and Class IV (orbitomaxillectomy) = 11 - were analysed regarding sex, age, tumour recurrence, free flap, reconstruction and necrosis. In addition, functional outcomes were evaluated regarding diet, speech, globe position and vision, while aesthetic outcomes were evaluated by patient and surgeon scores. RESULTS A total of 52 free flaps were performed in 47 patients; three patients were operated upon twice; and two other patients needed two sequentially linked flow-through flaps. The free flap survival was 96% with two total flap losses (4%). The other seven patients were fitted with a soft tissue-retained obturator prosthesis. CONCLUSIONS Microsurgical vascularised osteomyocutaneous free flaps are actually the gold standard for reconstruction of complex defects following maxillectomy. This algorithm is based on the anatomofunctional defect of the maxilla and it facilitates flap selection, which is a must.
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Affiliation(s)
- Horácio Costa
- Plastic Reconstructive Craniomaxillofacial and Microsurgical Unit, Centro Hospitalar de Gaia, I.C.B.A.S. - Faculty of Medicine - Oporto University, Rua Conceição Fernandes, s/n, 4434-502 Gaia, Portugal.
| | - Horácio Zenha
- Plastic Reconstructive Craniomaxillofacial and Microsurgical Unit, Centro Hospitalar de Gaia, I.C.B.A.S. - Faculty of Medicine - Oporto University, Rua Conceição Fernandes, s/n, 4434-502 Gaia, Portugal
| | - Hugo Sequeira
- Plastic Reconstructive Craniomaxillofacial and Microsurgical Unit, Centro Hospitalar de Gaia, I.C.B.A.S. - Faculty of Medicine - Oporto University, Rua Conceição Fernandes, s/n, 4434-502 Gaia, Portugal
| | - Gustavo Coelho
- Plastic Reconstructive Craniomaxillofacial and Microsurgical Unit, Centro Hospitalar de Gaia, I.C.B.A.S. - Faculty of Medicine - Oporto University, Rua Conceição Fernandes, s/n, 4434-502 Gaia, Portugal
| | - Nuno Gomes
- Plastic Reconstructive Craniomaxillofacial and Microsurgical Unit, Centro Hospitalar de Gaia, I.C.B.A.S. - Faculty of Medicine - Oporto University, Rua Conceição Fernandes, s/n, 4434-502 Gaia, Portugal
| | - Cristina Pinto
- Plastic Reconstructive Craniomaxillofacial and Microsurgical Unit, Centro Hospitalar de Gaia, I.C.B.A.S. - Faculty of Medicine - Oporto University, Rua Conceição Fernandes, s/n, 4434-502 Gaia, Portugal
| | - João Martins
- Plastic Reconstructive Craniomaxillofacial and Microsurgical Unit, Centro Hospitalar de Gaia, I.C.B.A.S. - Faculty of Medicine - Oporto University, Rua Conceição Fernandes, s/n, 4434-502 Gaia, Portugal
| | - Diana Santos
- Plastic Reconstructive Craniomaxillofacial and Microsurgical Unit, Centro Hospitalar de Gaia, I.C.B.A.S. - Faculty of Medicine - Oporto University, Rua Conceição Fernandes, s/n, 4434-502 Gaia, Portugal
| | - Carolina Andresen
- Plastic Reconstructive Craniomaxillofacial and Microsurgical Unit, Centro Hospitalar de Gaia, I.C.B.A.S. - Faculty of Medicine - Oporto University, Rua Conceição Fernandes, s/n, 4434-502 Gaia, Portugal
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Measurement of voice onset time in maxillectomy patients. ScientificWorldJournal 2014; 2014:925707. [PMID: 24574934 PMCID: PMC3918378 DOI: 10.1155/2014/925707] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 11/07/2013] [Indexed: 12/04/2022] Open
Abstract
Objective speech evaluation using acoustic measurement is needed for the proper rehabilitation of maxillectomy patients. For digital evaluation of consonants, measurement of voice onset time is one option. However, voice onset time has not been measured in maxillectomy patients as their consonant sound spectra exhibit unique characteristics that make the measurement of voice onset time challenging. In this study, we established criteria for measuring voice onset time in maxillectomy patients for objective speech evaluation. We examined voice onset time for /ka/ and /ta/ in 13 maxillectomy patients by calculating the number of valid measurements of voice onset time out of three trials for each syllable. Wilcoxon's signed rank test showed that voice onset time measurements were more successful for /ka/ and /ta/ when a prosthesis was used (Z = −2.232, P = 0.026 and Z = −2.401, P = 0.016, resp.) than when a prosthesis was not used. These results indicate a prosthesis affected voice onset measurement in these patients. Although more research in this area is needed, measurement of voice onset time has the potential to be used to evaluate consonant production in maxillectomy patients wearing a prosthesis.
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Kumar P, Jain V, Thakar A, Aggarwal V. Effect of varying bulb height on articulation and nasalance in maxillectomy patients with hollow bulb obturator. J Prosthodont Res 2013; 57:200-5. [PMID: 23809296 DOI: 10.1016/j.jpor.2013.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 01/31/2013] [Accepted: 02/19/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the effect of bulb height of hollow bulb obturator prosthesis on articulation and nasalance. METHOD A total of 10 patients, who were to undergo maxillectomy falling under Aramany class-I and II, with normal speech and hearing pattern were selected for the study. They were provided 2 maxillary obturators, one extending full height of the defect and other with bulb height approximately up to inferior nasal concha. The patients were asked to wear each obturator for 6 weeks and the speech analysis was done to measure changes in articulation and nasalance at 6 different stages of treatment i.e. preoperative, postoperative (after complete healing), 24h and 6 weeks after providing full bulb height obturator and reduced bulb height obturator. Articulation was measured objectively for distortion, addition, substitution and omission by speech pathologist and nasalance was measured by Dr. SPEECH software. RESULT Comparison between full and reduced bulb height for nasalance and articulation, showed that there was no statistical significant difference (P>0.05) between the two for both the parametres. CONCLUSION Articulation and nasality improves after providing obturator. Articulation and nasalance both are independent of bulb height.
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Affiliation(s)
- Pravesh Kumar
- Department of Maxillofacial Prosthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Nanda A, Jain V, Nafria A. Light is Right—Various Techniques to Fabricate Hollow Obturators. Cleft Palate Craniofac J 2013; 50:237-41. [DOI: 10.1597/11-134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Management of malignancies and abnormal growths in maxillary sinus often include ablative surgeries. The closure of the resulting anatomical defect can be achieved with an obturator prosthesis. Reduction in weight of the obturator is an important consideration in improving the retention and stability of the prosthesis. Hollowing the bulb of the obturator (extension of the prosthesis into the defect) is an effective method of reducing the weight of the prosthesis. Such obturators can be one piece or two pieces. Of the many methods to make an obturator hollow, four techniques are described here. Along with the pros and cons of each, the method of fabrication is detailed as well. It is the discretion of the operator to apply these techniques aptly for fabrication of either an interim or a definitive prosthesis.
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Affiliation(s)
- Aditi Nanda
- Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Veena Jain
- Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Anil Nafria
- Maulana Azad Institute of Dental Sciences, New Delhi, India
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Kumar P, Jain V, Thakar A. Speech rehabilitation of maxillectomy patients with hollow bulb obturator. Indian J Palliat Care 2013; 18:207-12. [PMID: 23440022 PMCID: PMC3573476 DOI: 10.4103/0973-1075.105692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aim: To evaluate the effect of hollow bulb obturator prosthesis on articulation and nasalance in maxillectomy patients. Materials and Methods: A total of 10 patients, who were to undergo maxillectomy, falling under Aramany classes I and II, with normal speech and hearing pattern were selected for the study. They were provided with definitive maxillary obturators after complete healing of the defect. The patients were asked to wear the obturator for six weeks and speech analysis was done to measure changes in articulation and nasalance at four different stages of treatment, namely, preoperative, postoperative (after complete healing, that is, 3-4 months after surgery), after 24 hours, and after six weeks of providing the obturators. Articulation was measured objectively for distortion, addition, substitution, and omission by a speech pathologist, and nasalance was measured by Dr. Speech software. Results: The statistical comparison of preoperative and six weeks post rehabilitation levels showed insignificance in articulation and nasalance. Comparison of post surgery complete healing with six weeks after rehabilitation showed significant differences in both nasalance and articulation. Conclusion: Providing an obturator improves the speech closer to presurgical levels of articulation and there is improvement in nasality also.
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Affiliation(s)
- Pravesh Kumar
- Department of Maxillofacial Prosthodontics, Centre for Dental Education and Research, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Bidra AS, Jacob RF, Taylor TD. Classification of maxillectomy defects: a systematic review and criteria necessary for a universal description. J Prosthet Dent 2012; 107:261-70. [PMID: 22475469 DOI: 10.1016/s0022-3913(12)60071-7] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
STATEMENT OF PROBLEM Maxillectomy defects are complex and involve a number of anatomic structures. Several maxillectomy defect classifications have been proposed with no universal acceptance among surgeons and prosthodontists. Established criteria for describing the maxillectomy defect are lacking. PURPOSE This systematic review aimed to evaluate classification systems in the available literature, to provide a critical appraisal, and to identify the criteria necessary for a universal description of maxillectomy and midfacial defects. MATERIAL AND METHODS An electronic search of the English language literature between the periods of 1974 and June 2011 was performed by using PubMed, Scopus, and Cochrane databases with predetermined inclusion criteria. Key terms included in the search were maxillectomy classification, maxillary resection classification, maxillary removal classification, maxillary reconstruction classification, midfacial defect classification, and midfacial reconstruction classification. This was supplemented by a manual search of selected journals. After application of predetermined exclusion criteria, the final list of articles was reviewed in-depth to provide a critical appraisal and identify criteria for a universal description of a maxillectomy defect. RESULTS The electronic database search yielded 261 titles. Systematic application of inclusion and exclusion criteria resulted in identification of 14 maxillectomy and midfacial defect classification systems. From these articles, 6 different criteria were identified as necessary for a universal description of a maxillectomy defect. Multiple deficiencies were noted in each classification system. Though most articles described the superior-inferior extent of the defect, only a small number of articles described the anterior-posterior and medial-lateral extent of the defect. Few articles listed dental status and soft palate involvement when describing maxillectomy defects. CONCLUSIONS No classification system has accurately described the maxillectomy defect, based on criteria that satisfy both surgical and prosthodontic needs. The 6 criteria identified in this systematic review for a universal description of a maxillectomy defect are: 1) dental status; 2) oroantral/nasal communication status; 3) soft palate and other contiguous structure involvement; 4) superior-inferior extent; 5) anterior-posterior extent; and 6) medial-lateral extent of the defect. A criteria-based description appears more objective and amenable for universal use than a classification-based description.
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Affiliation(s)
- Avinash S Bidra
- Department of Reconstructive Sciences, University of Connecticut Health Center, Farmington, CT, USA
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Morimata J, Otomaru T, Murase M, Haraguchi M, Sumita Y, Taniguchi H. Investigation of factor affecting health-related quality of life in head and neck cancer patients. Gerodontology 2012; 30:194-200. [DOI: 10.1111/j.1741-2358.2012.00662.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Andrades P, Militsakh O, Hanasono MM, Rieger J, Rosenthal EL. Current strategies in reconstruction of maxillectomy defects. ACTA ACUST UNITED AC 2011; 137:806-12. [PMID: 21844415 DOI: 10.1001/archoto.2011.132] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To outline a contemporary review of defect classification and reconstructive options. DESIGN Review article. SETTING Tertiary care referral centers. RESULTS Although prosthetic rehabilitation remains the standard of care in many institutions, the discomfort of wearing, removing, and cleaning a prosthesis; the inability to retain a prosthesis in large defects; and the frequent need for readjustments often limit the value of this cost-effective and successful method of restoring speech and mastication. However, flap reconstruction offers an option for many, although there is no agreement as to which techniques should be used for optimal reconstruction. Flap reconstruction also involves a longer recovery time with increased risk of surgical complications, has higher costs associated with the procedure, and requires access to a highly experienced surgeon. CONCLUSION The surgeon and reconstructive team must make individualized decisions based on the extent of the maxillectomy defect (eg, the resection of the infraorbital rim, the extent of palate excision, skin compromise) and the need for radiation therapy.
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Affiliation(s)
- Patricio Andrades
- Division of Plastic and Maxillofacial Surgery, Department of Surgery, University of Chile Clinical Hospital and Hospital del Trabajador de Santiago, Santiago, Chile
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Kwon HB. Gender difference in speech intelligibility using speech intelligibility tests and acoustic analyses. J Adv Prosthodont 2010; 2:71-6. [PMID: 21165272 PMCID: PMC2994697 DOI: 10.4047/jap.2010.2.3.71] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 09/13/2010] [Accepted: 09/16/2010] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The purpose of this study was to compare men with women in terms of speech intelligibility, to investigate the validity of objective acoustic parameters related with speech intelligibility, and to try to set up the standard data for the future study in various field in prosthodontics. MATERIALS AND METHODS Twenty men and women were served as subjects in the present study. After recording of sample sounds, speech intelligibility tests by three speech pathologists and acoustic analyses were performed. Comparison of the speech intelligibility test scores and acoustic parameters such as fundamental frequency, fundamental frequency range, formant frequency, formant ranges, vowel working space area, and vowel dispersion were done between men and women. In addition, the correlations between the speech intelligibility values and acoustic
variables were analyzed. RESULTS Women showed significantly higher speech intelligibility scores than men and there were significant difference between men and women in most of acoustic parameters used in the present study. However, the correlations between the speech intelligibility scores and acoustic parameters were low. CONCLUSION Speech intelligibility test and acoustic parameters used in the present study were effective in differentiating male voice from female voice and their values might be used in the future studies related patients involved with maxillofacial prosthodontics. However, further studies are needed on the correlation between speech intelligibility tests and objective acoustic parameters.
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Affiliation(s)
- Ho-Beom Kwon
- Department of Prosthodontics, School of Dentistry, Seoul National University, Seoul, Korea
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Kwon HB, Chang SW, Lee SH. The effect of obturator bulb height on speech in maxillectomy patients. J Oral Rehabil 2010; 38:185-95. [PMID: 20819135 DOI: 10.1111/j.1365-2842.2010.02139.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to compare the speech function of low height bulb obturators with that of high height bulb obturators. Thirteen maxillectomy patients, who underwent post-operative prosthodontic rehabilitations, were included. Two obturators of the same design except for different bulb heights were fabricated for each maxillectomy patient. One of the two obturators had high bulb design and the other had low bulb design. After one of the obturators was used for a period of 3 weeks, the patient's speaking functions were evaluated by measuring nasalance scores, formant frequencies, and vowel working space areas. The same procedures were repeated with the second obturator following another 3-week period of usage. In addition, the effect of delivery sequence and anatomic conditions related to maxillectomy were analysed. The results demonstrated that the nasalance scores with the low bulb obturators were significantly higher than those with the high bulb obturators. There were no significant differences in formant frequencies based on the bulb height of the obturators. The vowel working spaces for the two obturators were similar in shape and there were no significant differences between the vowel working space areas created by the two obturators. The delivery sequence affected the results. However, there were no significant differences related to the other anatomical variables. Although low bulb obturators might function similarly with high bulb obturators in terms of the articulation of speech, they would exhibit a difficulty in controlling hypernasality in maxillectomy patients.
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Affiliation(s)
- H B Kwon
- Department of Prosthodontics, School of Dentistry, Seoul, Korea
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New simple evaluation method of the monosyllable /sa/ using a psychoacoustic system in maxillectomy patients. J Prosthodont Res 2010; 55:7-11. [PMID: 20483679 DOI: 10.1016/j.jpor.2010.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2009] [Revised: 04/14/2010] [Accepted: 04/22/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE An objective assessment of speech would benefit the prosthetic rehabilitation of maxillectomy patients. This study aimed to establish a simple, objective evaluation of monosyllable /sa/ utterances in maxillectomy patients by using a psychoacoustic system typically used in industry. MATERIALS AND METHODS This study comprised two experiments. Experiment 1 involved analysis of the psychoacoustic parameters (loudness, sharpness and roughness) in monosyllable /sa/ utterances by 18 healthy subjects (9 males, 9 females). The utterances were recorded in a sound-treated room. The coefficient of variation (CV) for each parameter was compared to identify the most suitable parameter for objective evaluation of speech. Experiment 2 involved analysis of /sa/ utterances by 18 maxillectomy patients (9 males, 9 females) with and without prosthesis, and comparisons of the psychoacoustic data between the healthy subjects and maxillectomy patients without prosthesis, between the maxillectomy patients with and without prosthesis, and between the healthy subjects and maxillectomy patients with prosthesis. RESULTS The CV for sharpness was the lowest among the three psychoacoustic parameters in both the healthy males and females. There were significant differences in the sharpness of /sa/ between the healthy subjects and the maxillectomy patients without prosthesis (but not with prosthesis), and between the maxillectomy patients with and without prosthesis. CONCLUSION We found that the psychoacoustic parameters typically adopted in industrial research could also be applied to evaluate the psychoacoustics of the monosyllable /sa/ utterance, and distinguished the monosyllable /sa/ in maxillectomy patients with an obturator from that without an obturator using the system.
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Hattori M, Sumita YI, Kimura S, Taniguchi H. Application of an automatic conversation intelligibility test system using computerized speech recognition technique. J Prosthodont Res 2010; 54:7-13. [DOI: 10.1016/j.jpor.2009.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2009] [Revised: 07/02/2009] [Accepted: 07/29/2009] [Indexed: 10/20/2022]
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de Carvalho-Teles V, Pegoraro-Krook MI, Lauris JRP. Speech evaluation with and without palatal obturator in patients submitted to maxillectomy. J Appl Oral Sci 2009; 14:421-6. [PMID: 19089242 PMCID: PMC4327294 DOI: 10.1590/s1678-77572006000600007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2006] [Accepted: 10/10/2006] [Indexed: 11/21/2022] Open
Abstract
Most patients who have undergone resection of the maxillae due to benign or malignant tumors in the palatomaxillary region present with speech and swallowing disorders. Coupling of the oral and nasal cavities increases nasal resonance, resulting in hypernasality and unintelligible speech. Prosthodontic rehabilitation of maxillary resections with effective separation of the oral and nasal cavities can improve speech and esthetics, and assist the psychosocial adjustment of the patient as well. The objective of this study was to evaluate the efficacy of the palatal obturator prosthesis on speech intelligibility and resonance of 23 patients with age ranging from 18 to 83 years (Mean = 49.5 years), who had undergone inframedial-structural maxillectomy. The patients were requested to count from 1 to 20, to repeat 21 words and to spontaneously speak for 15 seconds, once with and again without the prosthesis, for tape recording purposes. The resonance and speech intelligibility were judged by 5 speech language pathologists from the tape recordings samples. The results have shown that the majority of patients (82.6%) significantly improved their speech intelligibility, and 16 patients (69.9%) exhibited a significant hypernasality reduction with the obturator in place. The results of this study indicated that maxillary obturator prosthesis was efficient to improve the speech intelligibility and resonance in patients who had undergone maxillectomy.
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Affiliation(s)
- Viviane de Carvalho-Teles
- Rehabilitation Department, Fundação Oncocentro de São Paulo and Cancer Institute Arnaldo Vieira de Carvalho, Oscar Freire - São Paulo, Brazil.
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Örtorp A. Three tumor patients with total maxillectomy rehabilitated with implant-supported frameworks and maxillary obturators: a follow-up report. Clin Implant Dent Relat Res 2009; 12:315-23. [PMID: 19438940 DOI: 10.1111/j.1708-8208.2009.00164.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Few reports are available on treatment using implant-supported frameworks with maxillary obturators after total maxillectomy on tumor patients. PURPOSE To describe, evaluate, and report the clinical and radiographic performance of implant-supported frameworks and maxillary obturators after maxillectomy during the first years of function. MATERIALS AND METHODS Three patients with cancer in the maxillary region treated by total maxillectomy were rehabilitated. Seventeen dental and two craniofacial implants were installed, and the patients each received implant-supported, screw-retained, three-unit frameworks with a U-shaped bar and obturators retained by four magnetic attachments. Clinical and radiographic data were collected up to 7 years of follow-up. RESULTS The frequency of complications was low. Two craniofacial implants and one dental implant were loose and removed at abutment connection. No implants were lost after framework connection, and the mean marginal bone loss was small. CONCLUSION Within the limitations of this report, dental implants are useful for rehabilitation of total maxillectomy patients, and a three-unit, screw-retained, implant-supported framework with maxillary obturator retained by magnetic attachment is a successful treatment concept for this patient group.
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Affiliation(s)
- Anders Örtorp
- Department of Prosthetic Dentistry/Dental Materials Science, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
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Oh WS, Roumanas ED. Optimization of maxillary obturator thickness using a double-processing technique. J Prosthodont 2007; 17:60-3. [PMID: 17931364 DOI: 10.1111/j.1532-849x.2007.00249.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Preservation of remaining structures is a primary goal of prosthetic rehabilitation. Continuously applied stresses on the remaining tissues from a large, heavy obturator jeopardize the health of the tissues, compromise the function of the prosthesis, and affect patient comfort. Various techniques have been described for hollowing the bulb of an obturator after processing to reduce its weight; however, access to the inner aspects of the bulb is limited, preventing adequate control of thickness of the walls. This article describes a double-processing technique for an obturator to optimize the weight and thickness of the bulb.
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Affiliation(s)
- Won-suck Oh
- Division of Prosthodontics, Department of Biologic & Materials Sciences, University of Michigan School of Dentistry, 1011 N. University, Ann Arbor, MI 48109, USA.
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Oh WS, Roumanas E. Alternate technique for fabrication of a custom impression tray for definitive obturator construction. J Prosthet Dent 2006; 95:473-5. [PMID: 16765162 DOI: 10.1016/j.prosdent.2006.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Won-Suck Oh
- Department of Advanced Prosthodontics, Biomaterials and Hospital Dentistry, University of California, Los Angeles, School of Dentistry, 90095, USA.
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Uckan S, Oguz Y, Uyar Y, Ozyesil A. Reconstruction of a Total Maxillectomy Defect With a Zygomatic Implant-Retained Obturator. J Craniofac Surg 2005; 16:485-9. [PMID: 15915122 DOI: 10.1097/01.scs.0000157306.54667.68] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Treatment options of maxillary fibrous dysplasia are surgical recontouring or total or partial maxillectomy depending on the site and behavior of the lesion. Among the reconstruction procedures, which include many surgical options, reconstruction using a maxillary obturator is the least invasive one. This report describes a case of aggressive maxillary fibrous dysplasia that was treated with a total maxillectomy and reconstructed with a malar implant-retained maxillary obturator.
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Affiliation(s)
- Sina Uckan
- Department of Oral and Maxillofacial Surgery, Baskent University Faculty of Dentistry, Ankara, Turkey.
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Materials and techniques in maxillofacial prosthodontic rehabilitation. Oral Maxillofac Surg Clin North Am 2002; 14:73-93. [DOI: 10.1016/s1042-3699(02)00018-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
BACKGROUND At present no widely accepted classification exists for the maxillectomy defect suitable for surgeons and prosthodontists. An acceptable classification that describes the defect and indicates the likely functional and aesthetic outcome is needed. METHODS The classification is made on the basis of the assessment of 45 consecutive maxillectomy patients derived prospectively from the database (September 1992) and retrospectively from 1989. RESULTS The classification of the vertical component is as follows: Class 1, maxillectomy without an oro-antral fistula; Class 2, low maxillectomy (not including orbital floor or contents); Class 3, high maxillectomy (involving orbital contents); and Class 4, radical maxillectomy (includes orbital exenteration); Classes 2 to 4 are qualified by adding the letter a, b, or c. The horizontal or palatal component is classified as follows: a, unilateral alveolar maxillectomy; b, bilateral alveolar maxillectomy; and c, total alveolar maxillary resection. CONCLUSION This practical classification attempts to relate the likely aesthetic and functional outcomes of a maxillectomy to the method of rehabilitation.
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Affiliation(s)
- J S Brown
- Regional Centre for Maxillofacial Surgery, University Hospital Aintree, Longmoor Lane, Liverpool L7 4AL UK
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