Rehabilitation of Oncology Patients with Hard Palate Defects Part 2: Principles of Obturator Design

Pathways for the rehabilitation of resection defects in the maxilla

Oral rehabilitation of head and neck cancer patients is an integral component of the care pathway. Maxillectomy procedures can cause significant defects, such as oronasal fistulas, loss of support for the cheek and lip, aesthetic defects in the middle third of the face and functional impairments. Orofacial rehabilitation plays a fundamental role in restoring aesthetics and functional capabilities, such as speech, mastication and deglutition.Rehabilitation of maxillectomy patients poses a challenge for both clinicians and patients. This paper utilises case examples to demonstrate the treatment options for the oral rehabilitation of these patients. We will summarise the treatment pathways for conventional obturators, delayed (secondary) implant retained fixed rehabilitation following composite free flap and early rehabilitation using a zygomatic implant perforated flap technique. This paper aims to highlight the challenges in treatment planning and the importance of a multidisciplinary approach in improving patient outcomes.

A Palatal Speech Bulb—A Case Study

Palatal defects of the oral cavity can be either congenital or acquired following trauma or surgical excision of malignant disease. Palatal defects can greatly affect function and subsequent quality of life. Rehabilitation using a removable obturator can be a preferable treatment option as it allows regular review post-surgery. This case study reports on the design and construction of a removable “speech bulb” obturator. A 50-year-old female patient presented complaining of nasal regurgitation and looseness of her current palatal obturator. She had previously undergone wide surgical excision of her soft palate under general anaesthesia due to adenoid cystic carcinoma. Treatment consisted of the provision of a new removable obturator, paying careful attention to the design of the “speech bulb” itself. The design of the “speech bulb” is crucial to optimise function, and the method of prosthesis fabrication is fully described. This case highlights the impact of obturator fit on a patient’s quality of life and will be of benefit to clinicians from many disciplines including dentists, oral and maxillofacial surgeons, Ear, Nose & Throat (ENT) surgeons and speech and language therapists.

An Implant-Retained Obturator – A Case Study

This case describes the oral rehabilitation of a patient following maxillary hemi-section due to squamous cell carcinoma of the palate. Planned treatment was construction of a maxillary implant-supported obturator. Two dental implants were placed in his maxilla to aid the support and retention of an obturator. However, owing to bone availability, their angulation was suboptimal and compromised the retention of the obturator. This case describes alternative implant attachments to aid the retention and stability of implant-retained dentures constructed in cases with suboptimal implant placement. Clinical relevance: This case highlights the importance of careful planning for implant placement, and reinforces the need to plan the prostheses before implant surgery. This case highlights possible difficulties that can arise if implants are non-ideally angulated, and how to adapt restorations to manage such difficulties in cases with maxillary removable prostheses.