Clinical Longevity of Obturators in Patients with Jaw Defects: a Retrospective Cohort Study

OBJECTIVES

The primary objective of the present retrospective clinical study was to determine the survival time of obturators while analyzing possible influencing factors.

MATERIALS AND METHODS

This retrospective clinical cohort study analyzed the influence of various clinical factors on the survival probability of obturators and their follow-up outcomes using Kaplan‒Meier analysis.

RESULTS

A total of 76 patients with 115 obturators were included in the study (47 men and 29 women, mean age 58.1 ± 18.1 years). The mean observation time was 3.0 ± 4.5 years (maximum 26.3 years). A total of 40.9% (47) of all obturators observed had to be replaced. The survival rate after 5 years was 79.5% for telescopic-crown-retained tooth-supported obturators, 86.9% for telescopic-crown-retained implant-supported obturators, 58.8% for removable full denture obturators, 22.1% for clasp-retained obturators and 0.0% for splints. The type of attachment, attendance at a regular follow-up and defect cause significantly influenced the survival of the obturators (p < .05).

CONCLUSIONS

The findings obtained in this study support the recommendation of using implant-supported obturators. Telescopic-crown attachments, either tooth- or implant-supported, seem to be favorable in terms of survival time. Attendance at a strict follow-up program seems to have a major influence on the longevity of the obturators.

CLINICAL RELEVANCE

The use of implant-supported obturators to cover permanent oral and maxillofacial defects is highly recommended. Additionally, the use of telescopic-crown attachments seems to be favorable in terms of survival time. Clasp-retained obturators and surgical splints should be used primarily for temporary restorations due to their shorter survival times.

Emergency transabdominal preperitoneal (TAPP) repair of a strangulated obturator hernia: A literature review and video vignette

Obturator hernia (OH), a rare and potentially life-threatening condition, presents diagnostic and therapeutic challenges. This review article comprehensively delves into the clinical features, diagnosis, and management of OH, with a particular emphasis on the pivotal role of computed tomography (CT) in timely and accurate diagnosis. Delays, particularly in contrast-enhanced CT, dramatically increase mortality due to potential bowel strangulation. To illustrate the challenges and complexities surrounding OH, we present a video vignette of a 74-year-old female patient who presented with symptoms suggestive of bowel obstruction (BO) secondary to a strangulated left-sided OH. This patient case complements the theoretical framework established in the review, serving as a practical example for healthcare professionals. Her presentation included abdominal pain, absence of flatus and bowel movements, and abdominal distension. Laboratory tests demonstrated a mildly elevated white blood cell count and C-reactive protein. CT imaging confirmed the diagnosis of a strangulated OH with an ischemic small bowel. An emergency laparoscopy was undertaken, and the hernia was repaired using the transabdominal preperitoneal approach. A portion of the ischemic small bowel was resected through a 5-cm extension of the umbilical port, and an anastomosis was performed using a modified Barcelona technique. The surgery was successfully completed without immediate or long-term complications. This case highlights the crucial role of timely CT diagnosis and minimally invasive surgical management in achieving improved outcomes in acute BO secondary to OH, particularly when facilitated by pre-operative CT planning.

Case report: Incarcerated obturator hernia, initially presenting as right hip pain!

INTRODUCTION

An incarcerated Obturator herniation is a rare external abdominal hernia. Abdominal CT-scanning is the first choice for the diagnosis of such an incarcerated Obturator hernia. Since intestinal incarceration leads to acute necrosis. Therefore emergency surgical treatment is required. However, due to the lack of specificity of the clinical manifestations of incarcerated Obturator hernia, a delay in adequate diagnostics may be higher than expected.

PRESENTATION OF CASE

An 82 year woman was admitted to the hospital because of right hip joint pain. She was initially evaluated and admitted by orthopedics team for suspected arthritis. A CT-scan with contrast was ordered, which showed an intestinal ischemic obstruction in a right sided obturator hernia, an acute laparotomy was carried out.

DISCUSSION

This case is important and differs from the well-known similar cases through the emergency admission at the orthopedic department because of the clear right hip pain and clinical history from the patient. An Obturator herniation (OH) is a rare external abdominal hernia accounting for only 0.07 %-1 % of all hernia cases. Because the female pelvis is wider which can lead to herniation of abdominal contents. The Howship-Romberg sign should be checked during physical examination.

CONCLUSION

Obturator hernia is very rare and difficult to diagnose. Moreover when elderly women suffer from long-term chronic diseases, a very thin body, or a history of multiple deliveries. Howship-Romberg sign should be checked in these situations during physical examination. Early diagnosis and treatment significantly reduces the occurrence of intestinal perforation, necrosis, sepsis and/or other severe adverse events, thereby, a significant prognostic improvement of patients.

Early Combination of an Obturator with a Free Flap to Prevent Palatal Dehiscence Following Oral Cancer Surgery: Technique and Indications

Introduction

In the Indian subcontinent where tobacco chewing is rampant, composite 'bite' defects are common after oral cancer ablation, which comprise buccal mucosa, maxilla and mandible with or without skin. These are often reconstructed with soft tissue flaps like anterolateral thigh flaps, which provide ample soft tissue replacement. A common problem is palatal dehiscence where these flaps are inset, due to the dynamics of speaking and chewing, as well as the gravitational pull on the flap.

Materials and Methods

We describe our technique of combining an early custom obturator for these patients in the post operative period, which helps support the palatal inset and prevent dehiscence. We describe in detail the indications and workflow for this technique, mechanism of action and outcomes.

Results

We show the successful result of use in a single patient with an early dehiscence and how it can be incorporated into standard workflow in selected patients at risk of dehiscence.

Conclusions

This is a useful technique to prevent dehiscence in patients undergoing extensive buccal resections involving the maxilla. It allows for early oral intake and function while preventing dehiscence and dealyed wound healing, which is often costly.

Dental Perspective on Mucormycosis in COVID-19: a Literature Review

PURPOSE OF REVIEW

The purpose of this paper is to gain an understanding of existing knowledge and attain familiarity on mucormycosis for early diagnosis and treatment. It highlights the systematic factors, signs and symptoms, diagnostic tests and treatment procedure for mucormycosis from dentistry point of view. PubMed/ Medline, Scopus, Web of Science were the search engine used. Study selection encompassed systematic reviews, critical reviews and case reports related to mucormycosis in COVID-19 patients and only mucormycosis. 19 articles were selected between Years 2001 to 2021. Analysis was done based on patient's comorbidity, site of mucormycosis infection, use of steroids and its effect on people with COVID -19 infection.

RECENT FINDINGS

Rhino-orbito-cerebral mucormycosis is the most common of all systemic manifestations of mucormycosis. Diabetes mellitus and long-term corticosteroid therapy are the leading risk factors with pre-existing diabetes mellitus accounting for almost 80% cases.  Elements that facilitate the growth of mucor in COVID-19 patients are the presence of low oxygen levels, high blood glucose levels, acidic media, high levels of iron, immunosuppression, and episodes of prolonged hospitalization. Mucormycosis is heterogenic in nature. Its management requires an individualized plan that considers the immunity status of the host, stage of the infection, systemic disease, early diagnosis and susceptibility to anti-fungal agents. Supervised use of corticosteroids and betadine gargle prevent the occurance of mucormycosis.

SUMMARY

The paper sheds some light on the warning signs and diagnostic tests that can help in early identification of infection by a dentist. This enables the timely implementation of therapy resulting in good prognosis of the treatment.

Prospective Clinical Pilot Study to Evaluate the Effect of Prosthodontic Rehabilitation on Psychological Status and Quality of Life in Maxillectomy Patients: An Indian Experience

Abstract

The purpose of the study was to assess psychological status (PS) and quality of life (QOL) before surgical resection of maxilla (T0), 2 weeks after resection (T1), 2 weeks after use of intermediate obturator (T2), before (T3) and 12 weeks after use of definitive obturator (T4). 20 participants, planned for resection of maxilla and subsequent prosthodontic rehabilitation were enrolled. Assessment was done using Hospital Anxiety and Depression Scale (HADS) (HADS-A: anxiety and HADS-D: depression) for PS, World Health Organization Quality of Life BREF (WHOQOL-BREF) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire- Head and Neck Module (EORTC QLQ- H&N35) for QOL, and obturator functioning scale (OFS) for obturator functioning. Six cases were dropped out. Highest HADS-A score was observed presurgically (18.7 ± 1.1) and highest HADS-D score at T1 (18.5 ± 1.8). After rehabilitation, HADS-A and HADS-D decreased significantly (P < 001). Least WHOQOL-BREF score was observed at T1, followed by a consistent, significant rise after rehabilitation at all time intervals (P < 001). Highest EORTC QLQ-H&N 35 score was observed at T1, with significant reduction (P < 0.001) after rehabilitation for all questions, except those related to sexual wellness (P = 1). Highest OFS were observed at T2 (3.1 ± 10.3) and least at T4 (1.9 ± 0.2). QOL and PS decline after maxillectomy. Patient education and rehabilitation with obturator leads to improvement in QOL and PS probably due to restored oral functions, and improved health of soft tissue. Both parameters improved with enhanced obturator quality and time.

Registration at Clinical Trials Registry - India ICMR-NIMS

Reg. No. CTRI/2018/04/013164 http://ctri.nic.in/Clinicaltrials/regtrial.php?modid=1&compid=19&EncHid=67729.89030.

An unusual case of early-stage obturator hernia causing bowel obstruction and strangulation

Obturator hernia is rare, contributing to less than 2% of the total incidence of small bowel obstructions. The diagnosis of obturator hernia is still a big challenge today. Abdominopelvic Computed Tomography scans have better diagnostic value preoperatively, showing the bowel loop between the pectineus and obturator externus muscle. We report an unusual case of a 77-year-old woman who presented to the emergency ward with an acute abdominal pain. Plain abdominal radiography showed small bowel obstruction. However, a computed tomography scan only showed signs of closed-loop obstruction and strangulation with bulging of the peritoneum through the obturator foramen. Exploration by laparotomy allowed complete evaluation of the obturator canal and confirmed the diagnosis of obturator hernia as a cause of bowel obstruction and strangulation.

Infected Radicular Cyst of Deciduous Second Molar Mimicking Dentigerous Cyst of Second Premolar in a Young Child: A Rare Entity

Radicular cysts are the most common cystic lesions in the oral cavity. Radicular cysts have a rare occurrence in the primary dentition. Radicular cysts arising from deciduous teeth are reported to occur in the age range of 3–19 years with a male predominance. The etiological factor is long-standing dental caries and dental trauma. The present case report describes the inflammatory radicular cyst involving the deciduous mandibular second molar. Surgical management includes enucleation of the cyst along with mandibular second premolar in a 5-year-old female patient. The surgical cavity was closed by an obturator appliance to maintain the patency. Eventful healing was seen after 3 months of follow-up.

How to cite this article: Kajjari S, Gowtham A, Meharwade P, et al. Infected Radicular Cyst of Deciduous Second Molar Mimicking Dentigerous Cyst of Second Premolar in a Young Child: A Rare Entity. Int J Clin Pediatr Dent 2021;14(3):434–437.

Laparotomy with suture repair is the most common treatment for obturator hernia: a scoping review

BACKGROUND

Obturator hernias are rare and associated with high mortality. However, the optimal surgical approach remains unknown. We aimed to investigate the available evidence and examine the surgical details regarding obturator hernia defect closure as well as the recurrence rates of the different approaches.

METHODS

We reported this scoping review according to the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analysis Extension for Scoping Reviews) and registered the protocol online. A comprehensive literature search in five different databases was conducted. The population was patients undergoing surgery for obturator hernia. Articles were included for data charting if the management of the hernia defect was reported. Data regarding surgical details, and hernia recurrence were extracted.

RESULTS

A total of 1299 patients from 313 articles were included. In total, 937 patients underwent open obturator hernia repair, in which 992 hernias were repaired (including some bilateral obturator hernias). A total of 295 patients underwent laparoscopic repair for 341 obturator hernias, and for the remaining 67 patients, type of surgery was not reported. For open surgery, suture repair was the most common method of repair (n = 508, 51%) with a recurrence rate of 10%. For laparoscopic surgery, the most common repair of the defect was mesh repair (n = 299, 88%) with no reported recurrences.

CONCLUSION

Open surgery with primary suture repair is the most common method of repair for obturator hernia but is associated with a recurrence rate of 10%. Laparoscopic mesh repair is becoming more common and have seemingly very low recurrence rates and may be a better method of repair.

The relevance of extra-nodal natural killer/T-cell lymphoma to the oral health care providers- A clinical review with case report

Lymphomas are the second most common malignancy in the oral cavity after squamous cell carcinoma. Non-specific clinical presentation of lymphoma mimics the other common oral pathologies thereby; delaying its diagnosis, ensuing definitive treatment, and leading to a guarded prognosis. The present clinical review and accompanying case report highlights the clinical presentation, diagnostic challenges, progression, manifestations, and holistic management of a rare extra-nodal, nasal variant of Natural Killer T-cell lymphoma and underscores the importance of interdisciplinary coordination in the overall management of this aggressive tumor.

Implant-Prosthetic Rehabilitation of a Patient with Squamous Cell Carcinoma: A Case Report

Patients who have undergone maxillary resection procedures are rehabilitated with dental obturators or microvascular reconstruction. This case report describes implant-supported prosthetic rehabilitation of a patient who underwent maxillary resection due to squamous cell carcinoma. After maxillectomy surgery, the patient was rehabilitated using a surgical obturator for one week followed by an interim obturator until the surgical field was completely healed. For definitive prosthesis, different treatment options were presented from which the patient selected an implant-supported maxillofacial prosthesis and a removable mandibular partial prosthesis. Under general anesthesia, two zygomatic implants and four conventional implants to the posterior maxilla were inserted. After a healing period, the bar-retained maxillofacial prosthesis and removable mandibular partial denture were fabricated. The patient was satisfied with regard to function, esthetics, speech, and swallowing. No problems, except slight discoloration of the prosthesis were noted at the 6-month follow-up. Implant-supported maxillofacial prostheses are a valuable treatment option to improve   quality of life after maxillary resection.

A maxillofacial prosthetic obturator using precision attachments

The majority of maxillary defects can be rehabilitated with pedicled flaps. However, when there are very large resections of the maxilla and flap success is questionable, then the defect may be obturated with a conventional hollow bulb clasp retained obturator or implant retained obturator prosthesis. However, inadequate retention, stability and support may be associated with the use of a conventional obturator and in case of recurrence the success of implant is questionable. A precision attachment becomes the silver lining. They have been used to retain obturator for some time. The use of precision attachments in a dentate maxillectomy patient can yield significant functional improvement while maintaining the obturator's aesthetic advantages. This clinical report describes the successful prosthetic rehabilitation of maxillary defects with an obturator retained using two different extracoronal resilient precision attachments. Attachment retained prosthesis provides a successful closure for the defect but also better esthetics, retention, better tolerability and better mastication and speech.

PROSTHODONTIC REHABILITATION OF MAXILLOFACIAL DEFECTS IN A NIGERIAN TEACHING HOSPITAL: A 9-YEAR REVIEW

OBJECTIVE

The objective was to review patients treated with maxillofacial prostheses in a Nigerian teaching hospital to assess the types of prostheses provided for them.

METHODOLOGY

This was a retrospective study of patients treated with maxillofacial prostheses over a period of nine years. The socio-demographic data of the patients, types of defect, causes of defects, location of defect, types of maxillofacial prostheses and the indications for prostheses were obtained from the patients' case records. Case records with incomplete information were excluded. All data generated were analysed using the IBM SPSS version 20. Fisher's exact test was used to test for statistical significance.

RESULTS

Case records of eighty-two patients treated with maxillofacial prostheses were reviewed. Forty-three (52.4%) of the patients were males while 39 (47.6%) were females. The age ranged from 6 to 76 years with the mean age being of 38.76 (SD±18.3) years. The majority, 58 (70.7%) of the patients were of lower social-economic class. Sixty-six (80.5%) patients had prostheses for maxillary defects, while only one (1.2%) patient had prosthesis for nasal defect. Twenty (30.3%) of the 66 patients that had maxillary defects had definitive obturators, while only three (4.5%) had all the three types of obturator. Surgical recession of tumours of the jaw was the major cause (85.4%) and mastication (70.7%) was the major indication for the prescription of obturators.

CONCLUSION

The majority of the patients were of the lower social class and maxillary obturator was the major form of maxillofacial prostheses provided for patients in this study. Most of the defects are caused by surgical recession of tumours of the jaw and mastication was the major indication for the prescription of obturators.

Postpartum Polyneuropathy in a Mare: A Case Report

Obstetric paralysis is a generic term used to describe postpartum locomotor alterations resulting from nerve damage, widely reported in cattle, but rare in equines. The aim of this study is to report a case of a peripheral polyneuropathy in a primiparous mare, 3 years old, of Mangalarga Marchador breed, after a dystocia lasting approximately 12 hours. At the time of delivery, the head of the fetus was exposed in the vulva and there was flexion of the thoracic limbs. These events culminated in a framework of extreme abduction of the pelvic limbs, thus generating functional impotence and leading the animal to adopt a frog anddecubitus position. After three days of treatment with no improvement in the clinical framework, the animal was euthanized. In the postmortem examination, perineural hemorrhagic lesions were observed in the obturator and sciatic nerves, characterizing the diagnosis of obstetric paralysis. It is possible the outcome of the case would have been satisfactory if there had been an early fetotomy or postpartum treatment had been more prolonged; however, these measures depend on the availability of equipment, conditions of care, and consideration of the owner.

Fabrication technique of obturator-type sports mouthguard for a patient who had undergone maxillectomy and its speech intelligibility assessment:A case report

PURPOSE

Wearing a sports mouthguard is not only recommended in collision sports, such as American football, boxing, and rugby football, but also in low-contact sports, such as basketball, handball, and soccer. It is recommended to remove oral prosthetic devices while playing sports to avoid the risk of fracturing the device. However, players with maxillectomy must wear obturator-type prosthetic devices for speech, breathing, and deglutition even while playing sports. Therefore, there is a need for an oral appliance to prevent dental injury while playing sports without the risk of fracturing the device for players who have undergone maxillectomy.In this case, we fabricated and proposed overlay-type and obturator-type customized sports mouthguards for a patient who had undergone maxillectomy and assessments of satisfaction, speech intelligibility, nasopharyngeal closure function, and swallowing function while playing soccer.

RESULTS

The patient was only satisfied with the obturator-type mouthguard, and the results of the speech intelligibility, nasopharyngeal closure function, and swallowing tests using the obturator-type mouthguard showed no differences compared to those associated with the previously used prosthetic device.

CONCLUSIONS

This case may help highlight the importance of providing obturator-type mouthguards for players who have undergone maxillectomy to prevent dental injury and physical and mental discomfort.

Obturator hernias: a systematic review of the literature

PURPOSE

Obturator hernias (OH) are extremely rare hernias, accounting for 0.07-1% of all hernias. This is the first systematic review investigating their presentation, imaging, treatment outcomes, and recurrence rate.

METHODS

After a detailed search in electronic search engines, 74 studies matched our criteria. A review of these reports was conducted and the full texts were examined.

RESULTS

A total of 146 patients with a mean age of 78.8 years were included in our analysis, with 40.1%, 29.9%, and 25.2% of patients suffering from either a right, a left or bilateral OH, respectively. OH were associated with non-specific symptoms and signs; bowel obstruction being the most common. Howship-Romberg sign was present in 56.2% of patients. Computed tomography (CT) scan was the most frequently used diagnostic modality, inversely associated with perioperative mortality. Mesh repair demonstrated a significantly improved perioperative morbidity rate, compared with non-mesh repair. Approximately 30% of patients underwent a laparoscopic operation, which was associated with significantly decreased morbidity and mortality rate as well as length of hospital stay, compared with the open repair.

CONCLUSION

OHs are not associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair.

Single-visit Feeding Obturator Fabrication in Infants with Cleft Lip and Palate: A Case Series and Narrative Review of Literature

Cleft lip and palate (CLP) is one of the most common craniofacial anomaly affecting newborns. In the early years of life to survive baby requires nutrition from the mother. Lip seal of infant is affected because of cleft palate and thereby feeding is greatly compromised. As there is communication between nasal cavity and oral cavity there are more chances of aspiration of milk into the lungs. The main role of pedodontist is to fabricate a palatal obturator which facilitates feeding. In this article we have discussed fabrication of feeding obturator in single visit in infants with cleft palate.

Designing 3D prosthetic templates for maxillofacial defect rehabilitation: A comparative analysis of different virtual workflows

OBJECTIVE

To design and compare the outcome of commercial (CS) and open source (OS) software-based 3D prosthetic templates for rehabilitation of maxillofacial defects using a low powered personal computer setup.

METHOD

Medical image data for five types of defects were selected, segmented, converted and decimated to 3D polygon models on a personal computer. The models were transferred to a computer aided design (CAD) software which aided in designing the prosthesis according to the virtual models. Two templates were designed for each defect, one by an OS (free) system and one by CS. The parameters for analyses were the virtual volume, Dice similarity coefficient (DSC) and Hausdorff's distance (HD) and were executed by the OS point cloud comparison tool.

RESULT

There was no significant difference (p > 0.05) between CS and OS when comparing the volume of the template outputs. While HD was within 0.05-4.33 mm, evaluation of the percentage similarity and spatial overlap following the DSC showed an average similarity of 67.7% between the two groups. The highest similarity was with orbito-facial prostheses (88.5%) and the lowest with facial plate prosthetics (28.7%).

CONCLUSION

Although CS and OS pipelines are capable of producing templates which are aesthetically and volumetrically similar, there are slight comparative discrepancies in the landmark position and spatial overlap. This is dependent on the software, associated commands and experienced decision-making. CAD-based templates can be planned on current personal computers following appropriate decimation.

Finite element analysis of displacement with single and two piece hollow bulb obturator prosthesis

Background

Rehabilitation of hemi-maxillectomy defects is difficult and challenging when there is displacement of obturator prosthesis. The literature lacks data on the displacement of different types of obturators. The intent of the study was to evaluate the differences in displacement between the single and two piece hollow bulb obturator prosthesis in Aramany Class I maxillectomy defect.

Methods

Finite element (FE) model of Aramany Class I maxillectomy defect restored with single and two piece closed bulb obturator was fabricated based on patient computed tomography (CT) scan. Finite element analysis (FEA) with three different load applications was done to measure the displacement of the obturator. Graphical and numerical values of displacement were obtained and the results were tabulated.

Results

The results were obtained as displacement colour images and the numerical displacement values. The displacement of two piece obturator was 4.779e-8, 6.372e-8, 7.965e-8 compared to single piece obturator 4.509e-8, 6.012e-8, and 7.5151e-8. There was marginal numerical increase in magnitude of displacement in two piece obturator compared to single piece obturator.

Conclusion

The study observed no significant difference in displacement between the obturator. The numerical difference in displacement is more in two piece obturator compared to the single piece obturator.

Long-term impact of living with an obturator following a maxillectomy: A qualitative study

OBJECTIVES

To explore the long-term impact for patients living with an obturator prosthesis, following a maxillectomy for a head and neck neoplasm.

METHODS

A qualitative approach was employed, using semi-structured interviews. A purposive sample of eight men and four women, living with an obturator prosthesis for at least five years, were recruited. Interviews were digitally recorded and transcribed. Using thematic analysis, two researchers analysed the data.

RESULTS

The data were categorised into four themes: 1. Preparedness for living with an obturator, 2. Impact of living with an obturator - what changes to expect, 3. Stability and retention of the obturator, and 4. Coping strategies to aid adjustment. Long-term effects of living with an obturator spanned many aspects of life to include: chewing and eating, speaking, dealing with nasal leakage and altered body image, employment and intimacy issues, along with embarrassment during social encounters. Optimal retention and stability of the obturator, as perceived by the patient, lead to improved social confidence and engagement. The emotional impact varied greatly on peoples' lives.

CONCLUSIONS

Patients experiencing the greatest long-term challenges had larger defects, were of employment age and had not returned to work. Gaining an improved understanding of the psychology of coping overtime is clearly important, as this can inform interventions to facilitate adjustment for those who are emotionally struggling. Furthermore, the findings of this study could inform the design of a communication tool to facilitate shared-decision making and aid preparedness for living with an obturator following a maxillectomy.

CLINICAL SIGNIFICANCE

The multidisciplinary head and neck team should provide patients with detailed pre-operative information, including potential effects on social, work and personal relationships. The restorative dentistry team has a pivotal role in the long-term management of these patients, as obturators have a finite lifespan with ongoing maintenance necessary to promote optimal retention and stability.

Radiographic and surgical findings of type I obturator hernias in patients with refractory groin pain

Groin pain is a common complaint in the general population, with an underlying etiology that may be difficult to diagnose. Although uncommon, type I obturator hernias may be a significant source of chronic or refractory groin pain. In this review, we discuss the commonly missed findings of type I obturator hernias at CT and MRI, as well as correlate these findings with images obtained at the time of laparoscopic repair.

The Role of Polyether Ether Ketone (Peek) in Dentistry - A Review

This study is aimed to review the applications of Polyether Ether Ketone (PEEK) in dentistry. The increased demand for aesthetics, legislation in some developed countries, few drawbacks with existing materials and clinicians shifting their paradigms towards metal free restorations led space for the metal-free restorations in today's dental practice. An electronic literature search was conducted through Medline via PubMed, Wiley Online library, EBSCOhost, Science Direct, as well as the Google Scholar between January 2010 and March 2018 using the keywords: PEEK, modified PEEK, PEEK and Dental, advantages of PEEK, applications of PEEK in dentistry and PEEK Implants. A total of 103 articles were found in the literature search and out of these, 18 were not related to our study and hence were excluded. Finally, 85 articles were found to be relevant. PEEK has been explained for a number of applications in dental practice. The literature showed that the PEEK material has superior mechanical properties with different uses in various specialties of dentistry.

Left sided Richter type obturator hernia causing intestinal obstruction: A case report

Introduction

Although relatively rare, an obturator hernia is a significant cause of intestinal obstruction. It usually occurs in emaciated elderly females. Computed tomography is the imaging modality of choice to diagnose obturator hernias.

Case report

In this report we present a case of an elderly female who presented to the emergency department with features suggesting bowel obstruction. The patient was admitted to the hospital and was initially managed conservatively. Two days later the patient underwent an exploratory laparotomy and was diagnosed with a left sided Richter type obturator hernia. The hernia was successfully reduced and the necrotic bowel was resected with end to end anastomosis.

Discussion

An obturator hernia is a rare type of abdominal hernias which often occurs in very thin old females. Patients with obturator hernias usually present with symptoms of acute or intermittent small bowel obstruction. Mild symptoms without abdominal pain may be due to incomplete obstruction or Richter type hernia. Computed tomography is considered the gold standard diagnostic modality for obturator hernias. An early surgical intervention is the treatment of choice.

Conclusion

The clinical diagnosis of an obturator hernia is often difficult due to its nonspecific symptoms and infrequent signs. Yet early diagnosis is mandatory because its delay contributes to bowel necrosis and to the poor prognosis in these patients. Surgery remains the only effective management of this condition.

•

Obturator hernias are a rare cause of intestinal obstruction.

•

An obturator hernia usually occurs in very thin elderly females.

•

Obturator hernias present with symptoms of intestinal obstruction.

•

Computed tomography is the imaging modality of choice to diagnose obturator hernias.

•

The only management of this condition is surgery through either laparotomy or laparoscopy.

Prosthetic versus surgical rehabilitation in patients with maxillary defect regarding the quality of life: systematic review

PURPOSE

To assess the ability of prosthetic rehabilitation versus surgical rehabilitation in improving the QOL for patients with maxillary defects.

MATERIAL AND METHODS

A systematic search of PubMed, Scopus data base, Cochrane database, Ovid database, and Latin America & Caribbean database for articles published before September 2017 was performed by two independent reviewers. A manual search of articles published from January 2000 to September 2017 was also conducted. Only English studies were included which evaluate the QoL in patients with head and neck cancers. Any confusion between the two independent reviewers was resolved by means of a moderated discussion between the reviewers.

RESULTS

Five studies fulfilled the inclusion criteria for this study. Many parameters were used regarding evaluation of QOL as the EORTC Head and Neck 35 assessment, UW-QOL, OHIP-14, VAS, OFS, MHI, HAD, Body Satisfaction Scale, Oral symptom check list, Swallowing, Diet consist, Pain control, Postoperative complication, and Speech. Two studies supported the surgical line of treatment for improving the QOL as compared to the prosthetic one; another two studies showed a statistically insignificant improvement in the patients' QOL with the surgical line, while only one revealed insignificant difference in QoL with both lines of treatment.

CONCLUSIONS

Surgical rehabilitation provides a better line of treatment in improving the QOL for patients with maxillary defects. On the other hand, prosthetic has proved effectiveness in the immediate post-surgical times as temporary strategy, and it has represented a good alternative when the surgical obturation is compromised.

Fabrication of a 3D Printing Definitive Obturator Prosthesis: a Clinical Report

INTRODUCTION

Digital technologies related to imaging and manufacturing provide the clinician with a wide variety of treatment options. Stereolithography (SLA) offers a simple and predictable way for an accurate reconstruction of congenital or acquired defects.

CLINICAL CASE

A 65-years old cancer patient with non- keratinized squamous cell carcinoma of left maxillary sinus came for a prosthetic clinical evaluation. A bilateral maxillectomy was performed and the treatment plan included definite obturator prosthesis for the upper arch. CT data and 3D planning software were used to create a 3D printing plastic model of the defect. A wax pattern of the hollow bulb was fabricated and cured with heat-cured silicone soft liner. A final impression was obtained with the hollow bulb placed intraorally. The master cast was duplicated and the new cast was invested and reflasked. The flasks were opened, wax was boiled out and some space was created in the internal part of the obturator. Transparent heat cured acrylic resin was sandwiched with, at the inner part of the bulb, improving the retention between the acrylic denture base and the silicone based soft lining material. The patient was then placed on a 6-month recall. The five-year follow up consists of a chair side relining, when needed, of the definite removable prostheses.

CONCLUSION

Maxillofacial surgery patients may develop postoperative complications such as trismus and pain. In these cases, the combination of digital technology and conventional techniques provide an accurate prosthetic restoration.

[Case report: Occlusion and intestinal necrosis by obturator hernia]

BACKGROUND

Obturator hernia is a rare variety of abdominal hernia, it accounts for 0.07%-1.0% of all hernias, and occurs most often in women of advanced age and multiparous.

CLINICAL CASE

A 78-year-old female was admitted to the Emergency Department due to nausea, vomiting, complaints of abdominal discomfort and obstipation for the last 7 days. Abdominal CT scan showed dilated small bowel loops and multiple air-fluid levels near to a small bowel loop obturator hernia, between external obturator and pectineus muscle. Emergency laparotomy was performed and during the surgery, loop of small intestine was revealed herniated into the obturator foramen, 130cm from the angle of Treitz. Necrosis of small intestine was found, without perforation. Resection of the 10cm affected jejunal segment was performed and a side-to-side bowel anastomosis was fashioned. Also simple suture closure of obturator foramen was performed.

CONCLUSION

Obturator hernia is relatively rare. However physicians should keep it in mind and have clinical suspicion for obturator hernia as a cause of intestinal obstruction in female, elderly and multiparous patients in order to make an appropriate diagnosis and avoid bowel ischaemia.

Transobturator Bypass Utilizing Fluoroscopic Guidance

Introduction

Transobturator bypass is an older and less frequently performed revascularization of the lower extremity that is useful in the setting of multiple failed lower extremity bypasses usually due to groin sepsis and infection(s). It can be a technically challenging operation due to anatomic constraints.

Report

We describe a successful transobturator bypass utilizing fluoroscopy for passage of bypass tunneler and graft through the obturator foramen.

Discussion

Live fluoroscopy is a versatile technique and in conjunction with our described surgical technique of lower extremity bypass should help increase the technical success rates of this procedure.

Implant-prosthetic rehabilitation of hemimaxillectomy defects with CAD/CAM suprastructures

BACKGROUND

Patients with hemimaxillectomy defects after tumor surgery can alternatively be rehabilitated with dental obturators or microvascular flaps. When general medical or oncologic conditions do not permit microvascular surgery, dental obturators are the only solution, yet retention for edentulous patients is often poor. The aim of this study was to evaluate whether CAD/CAM suprastructures supported by implants placed in both residual alveolar ridges and contralateral zygomatic bone could enhance obturator stability and improve functional outcomes.

MATERIALS AND METHODS

Five edentulous patients with class IId hemimaxillectomy defects were included in the study. Implant-retained reconstructions were planned to support cross-arch CAD/CAM milled suprastructures. Patients had to rate their restorations on a 100-mm visual analogue scale before and after treatment. Additional evaluation was performed using the Oral Health Impact Profile (OHIP-EDENT) questionnaire.

RESULTS

In the 5 patients, 7 conventional implants were placed in the remaining zygomatic bone and 16 in the remaining contralateral alveolar ridge. After 4 months of submerged healing, CAD/CAM suprastructures were fabricated that connected all respective implants with each other. All of the prosthetic restorations were removable and bar-retained. They all achieved good defect closure and showed significant improvements concerning general satisfaction (p = 0.0343), stability (p < 0.0001), ability to chew (p = 0.0077), esthetics (p = 0.0173) and foreign body sensation (p = 0.0207). According to the OHIP-EDENT questionnaire (p = 0.0036) the improvements were significant. During the observation period of 29.4 months, no mechanical or biological complications occurred.

CONCLUSION

The CAD/CAM suprastructures improved retention in all treated patients without any complications.

Wispy Prosthesis: A Novel Method in Denture Weight Reduction

INTRODUCTION

Stability and retention of the denture becomes at stake with the increase in weight of the denture prosthesis. As a consequence, different materials and methods have been introduced to overcome these issues but denture weight reduction still remains to be a cumbersome and strenuous procedure.

AIM

To introduce a novel technique for the fabrication of denture prosthesis where in the weight of the denture will not affect the retention and stability of the denture.

MATERIALS AND METHODS

Four groups with a sample size of 10 each, were included where in one group was control and other three were study groups. The control group samples were made completely solid and the study group samples were packed with materials like bean balls, cellulose balls and polyacrylic fibers. The weight of all the samples of each study group was measured and compared with the control group. The observations were analyzed statistically by paired t-test.

RESULTS

It was observed that the bean balls group produced a weight reduction of 31.3%, cellulose balls group 27.4% and polyacrylic fibers group 24.5% when compared to that of the control group.

CONCLUSION

This novel technique will eliminate the problems that were associated in creating hollowness and at the same time will reduce the weight of the prosthesis and among all the study groups, bean balls group were found to reduce maximum weight of the prosthesis.

Assessment of swallowing and masticatory performance in obturator wearers: a clinical study

PURPOSE

To assess function by identifying changes in swallowing and masticatory performance in maxillary obturator prosthesis wearers.

MATERIALS AND METHODS

Sixty subjects were recruited for the study, of which 20 were obturator wearers, 20 were completely dentulous and 20 had removable partial/complete dentures with similar Eichner's Index. Swallowing ability was evaluated with and without obturator using the "Water Drinking Test"; Masticatory performance was evaluated with the Sieve test; and maximum occlusal force was recorded with the help of a digital bite sensor. The data was analyzed using the Statistical Package for Social Science version 15.0 with a confidence level at 95%.

RESULTS

Profile, behavior of drinking and time taken to drink were significantly improved (P<.001) in subjects after wearing obturator. Masticatory performance was not significantly different (P=.252) in obturator wearer when compared with dentulous or removable partial/complete denture wearer, but significantly (P<.001) high inter group difference in maximum occlusal force existed. Correlation between masticatory performance and maximum occlusal force was not significant (P=.124).

CONCLUSION

Swallowing ability was significantly improved after wearing obturator but masticatory performance was not significantly different from those having similar occlusal support zone in their dentition.

A Novel Obturator Device for Management of Dilated Trachea-esophageal Puncture Tract Fistulas

Voice rehabilitation in laryngectomized patients by tracheoesophageal puncture is a time tested technique. In some patients the tracheoesophageal puncture gets inordinately dilated leading to leakage around the prosthesis. Most of these fistulas are managed by a variety of conservative treatments like temporary removal of prosthesis, placement of silastic ring over the prosthesis, placement of nasogastric tube and airway protection by a cuffed tracheostomy tube. Intractable fistulas are tackled by surgical closure but are fraught with failures. We hereby suggest a novel temporary obturator that can be can be easily made at a very low cost in any hospital having prosthetic rehabilitation services and obviates the need for a tracheostomy tube, nasogastric tube and repeated hospital visits.

Obturator dislocation of the hip with ipsilateral femoral neck fracture: A case report

Obturator dislocation of the hip associated with ipsilateral femoral neck fracture is an unusual injury. We report a case of a 40-year-old man with such a combination of injuries which was treated with an open reduction and internal fixation. He has a good follow-up result. There was no evidence of avascular necrosis on radiographs after 3 years.

Obturator hernia: A case report and review of the literature

INTRODUCTION

An obturator hernia is a rare condition but is associated with the highest mortality of all abdominal wall hernias. Early surgical intervention is often hindered by clinical and radiological diagnostic difficulty. The following case report highlights these diagnostic difficulties, and reviews the current literature on management of such cases.

PRESENTATION OF CASE

We present the case of an 86-year-old lady who presented with intermittent small bowel obstruction, clear hernial orifices, and right medial thigh pain. Pre-operative CT imaging was suggestive of an obstructed right femoral hernia. However, intra-operatively the femoral canal was clear and an obstructed hernia was found passing through the obturator foramen lying between the pectineus and obturator muscles in the obturator canal.

DISCUSSION

Obturator hernias are notorious for diagnostic difficulty. Patients often present with intermittent bowel obstruction symptoms due to a high proportion exhibiting Richter's herniation of the bowel. Hernial sacs can irritate the obturator nerve within the canal, manifesting as medial thigh pain, and often no hernial masses can be detected on clinical examination. Increasing speed of diagnosis through early CT imaging has been shown to reduce the morbidity and mortality associated with obturator hernias. However, over-reliance on CT findings should be cautioned, as imaging and operative findings may not always correlate.

CONCLUSION

A high suspicion for obturator hernia should be maintained when assessing a patient presenting with bowel obstruction particularly where intermittent symptoms or medial thigh pain are present. Rapid clinical and appropriate radiological assessment, followed by early surgery is critical to successful treatment.

Closed hollow bulb obturator--one-step fabrication: a clinical report

A method is described for the fabrication of a closed hollow bulb obturator prosthesis using a hard thermoforming splint material and heat-cured acrylic resin. The technique allowed the thickness of the thermoformed bulb to be optimized for weight reduction, while the autopolymerized seal area was covered in heat-cured acrylic resin, thus eliminating potential leakage and discoloration. This technique permits the obturator prosthesis to be processed to completion from the wax trial denture without additional laboratory investing, flasking, and processing.

Rehabilitation of a patient with an intra oral prosthesis and an extra oral orbital prosthesis retained with magnets

This clinical case report deals with a rehabilitation of a patient with an extensive maxillary and orbital defect using an intra oral prosthesis obturating the maxillary defect and extra oral orbital prosthesis retained with rare-earth magnets for secondary retention; primary retention was derived by snug fit of the prosthesis to underlying and adjacent tissues. The rehabilitation resulted in improved function, esthetics and comfort to the patient thus enabling him to lead a normal life.

Speech rehabilitation of maxillectomy patients with hollow bulb obturator

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.

Management of Oro-Nasal Fistula Using Andrew's Bridge: A Case Report

Oro-nasal fistula is the most common complication following the surgical closure of the cleft palate. Retention is the paramount factor in the successful prosthodontic habilitation of cleft palate patients. Various precision attachments have provided us with the opportunity to make the prosthesis fixed removable type; giving a double advantage to the patient i.e. comfort through fixed type and easy maintenance through removal type. This case report describes a case of oro-nasal fistula habilitated with an obturator attached to Andrew's bridge, which had good retention and esthetics.

Magnet retained intraoral-extra oral combination prosthesis: a case report

Facial prosthesis is generally considered over surgical reconstruction to restore function and appearance in patients with facial defects that resulted from cancer resection. Retention of the prosthesis is challenging due to its size and weight. Retention can be achieved by using medical grade adhesives, resilient attachments, clips and osseointegrated implants. It can also be connected to obturator by magnets. This clinical report highlights the rehabilitation of a lateral midfacial defect with a two piece prosthesis that included an extra oral facial prosthesis and an intraoral obturator with the use of magnets.

Obturator hernia - MRI image

Obturator hernia although considered a rare entity is the most frequently encountered pelvic floor hernia. Since the first published report in the 18th century, their unusual and unfamiliar clinical presentation still represents a diagnostic dilemma for the modern day clinician. A detailed history and clinical examination in our thin, elderly female patient who presented with intermittent small bowel obstruction and symptoms of right obturator nerve compression with a positive Howship-Romberg sign was crucial in establishing a diagnosis. Sophisticated radiologic modalities such as MRI as shown below in the case of our patient can reliably confirm the diagnosis of obturator hernia.

Clinical considerations for prosthodontic rehabilitation of intermediate form of osteopetrosis: A report of two cases

INTRODUCTION

Osteopetrosis is a rare autosomal hereditary disorder characterized by abnormal functioning of osteoclasts, which leads to delayed wound healing. Hence chances of infection are increased even after minor surgical procedures. This paper aims to describe clinical features, and prosthodontic management of two patients who presented with clinical features of intermediate form of osteopetrosis and missing teeth.

CASE REPORT

A 27-year-old patient having intermediate osteopetrosis presented with difficulty in chewing food and swallowing, due to edentulous maxillary and mandibular arches with large antral cavities, which developed secondary to tooth extraction. Another case discussed is a 25-year-old female patient who reported with chief complaints of difficulty in chewing due to resected left side of lower jaw. In these case reports, importance of avoiding extractions, preservation of remaining teeth and conservative management with minimum number of patients' visits has been emphasized.

CONCLUSION

Efforts should be made to avoid dental extraction in such cases as chances of bone infection and fracture are more. If patient is partially or completely edentulous only removable type of prosthesis is advisable as bones are hypocalcified and maintenance of oral hygiene is easy with removable prosthesis.

Prosthetic rehabilitation of a patient with a large mid face defect secondary to Basal cell carcinoma

The art of maxillofacial prosthetics restores esthetics and function in patients with gross developmental or acquired defects of face and helps them to restore hope and ambition to lead a useful life. This valuable service provided by maxillofacial prosthodontist lifts the morale of the patient and thus aids in physical well being and quality of life. Diagnosis and treatment planning should include attention to each detail prior to rehabilitation process. This paper describes a clinical case of mid face defect due to basal cell carcinoma, rehabilitated with facial prosthesis and intraoral obturator.

Rehabilitation of a One-day-Old Neonate with Cleft Lip and Palate using Palatal Obturator: A Case Report

Feeding a neonate with a complete cleft lip and palate is difficult pursuit due to communication between oral cavity and nasal cavity. A multidisciplinary approach is required to manage the complex problems involved in case of such neonates and their families. Present case is of a 1-day-old neonate having complete bilateral cleft lip and palate for which palatal obturator was constructed. A stepwise simple, easy and uncomplicated procedure for making accurate impressions, maxillary cast and fabrication of palatal obturator in infants with cleft lip and palate has been presented. The objective to present this case report is to emphasize the fact that how these palatal obturators /plates help in feeding, speech/language development, presurgical orthopedics and prevent other associated otorhinolaryngeal problems. How to cite this article: Bansal R, Pathak AK, Bhatia B, Gupta S, Gautam KK. Rehabilitation of a One-day Old Neonate with Cleft Lip and Palate using Palatal Obturator: A Case Report. Int J Clin Pediatr Dent 2012;5(2):145-147.

Enhanced retention of a maxillofacial prosthetic obturator using precision attachments: Two case reports

The majority of maxillary defects can be rehabilitated with conventional simple obturator prosthesis. However, inadequate retention, stability and support may be associated with the use of an obturator. Precision attachments have been used to retain obturators for some time. The use of precision attachments in a dentate maxillectomy patient can yield significant functional improvement while maintaining the obturator's aesthetic advantages. This clinical report describes the prosthetic rehabilitation of two maxillary defects with an obturator retained using extracoronal resilient precision attachments.

Hybrid maxillofacial prosthesis: a case report

The role of a prosthodontist in the management of cleft lip & palate patients is pertinent involving restoration of mastication, facial harmony, dental harmony and phonation. This article presents the prosthodontic rehabilitation of a congenitally bilateral cleft lip and palate patient with a unique method which fulfilled the patient's needs, esthetics and psychological well being.

Speech therapy with obturator

Rehabilitation of speech is tantamount to closure of defect in cases with velopharyngeal insufficiency. Often the importance of speech therapy is sidelined during the fabrication of obturators. Usually the speech part is taken up only at a later stage and is relegated entirely to a speech therapist without the active involvement of the prosthodontist. The article suggests a protocol for speech therapy in such cases to be done in unison with a prosthodontist.

An alternative approach to combine orbital prosthesis and obturator: a case report

This report describes a different approach for diminishing the movements of orbital prosthesis during mimic movements and chewing function. Mechanical devices such as magnets are used to enhance the retention in case lack of the implants. However rigid fixation of obturator and orbital prosthesis can result in movements of the orbital prosthesis during mastication. In this case obturator and orbital prosthesis are combined by magnets. However this combination is not rigid because of an active part which provides movement. This active part allows movements in a space constructed in the acrylic base of orbital prosthesis. Thus, the movements that may occur on orbital prosthesis during chewing can be diminished by this simple mechanism. Due to the fact that designing such a mechanism that minimizes the movements of the orbital prosthesis contributes patient's comfort.

A simple technique to fabricate a surgical obturator restoring the defect in original anatomical form

Oral cancer treatment involves the surgical removal of all or part of the maxilla, leaving the patient with a defect that compromises the integrity and function of the oral cavity. The postoperative restoration of esthetics, deglutition, and speech shortens recovery time in the hospital and expedites the patient's return to the community as a functioning member. The surgical obturator is the proven treatment option in such situations. This article describes a simple technique to fabricate a surgical obturator that restores patient's original dentition and facial and palatal tissue form. The obturator fabricated with this technique utilizes the vacuum formed index of patient's original tissue form and duplicated partly in heat and partly in auto polymerizing acrylic resin. Duplication of the original tissue form helps patient to minimize the immense physiological trauma immediately after the surgical resection. The obturator fabricated with this technique supports soft tissues after surgery and minimizes scar contracture and disfigurement, and thus may have a positive effect on the patients' psychology.