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Nirunrungrueng P, Virarat P, Techalertpaisarn P, Ungvijanpunya N. Nasolabial morphological changes in patients with unilateral cleft lip and palate using a Korat-modified nasoalveolar moulding appliance with primary correction. Orthod Craniofac Res 2024; 27 Suppl 1:80-89. [PMID: 38305564 DOI: 10.1111/ocr.12765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE The objective of this study is to measure the morphological changes of the nose and lip in patients with unilateral cleft lip and palate before and after cheiloplasty with primary rhinoplasty (primary correction) in conjunction with Korat-NAM usage. DESIGN Longitudinal cohort study. SETTING Cleft Center Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand. SUBJECTS Twenty-six patients with unilateral cleft lip and palate. INTERVENTIONS Control group: only active obturator before primary correction. Experimental group: an active obturator and Korat-NAM I before primary correction. A customized endotracheal tube was retained in the nostril for 3 weeks before switching to Korat-NAM II for 1 year. MAIN OUTCOME MEASURES Six measurements comprising nostril rim length, nostril height, nostril sill width, columella angle, vertical lip height, and horizontal lip length were measured from the patients' photographs. All measurements, except the columella angle, were reported as the cleft side/non-cleft side value ratio. Measurements were taken at the initial appointment, immediately before, 3 weeks after, and 1 year after primary correction. RESULTS Nostril rim length ratio, nostril height ratio, nostril sill width ratio, columella angle on the cleft side, and vertical lip height ratio were improved using Korat-NAM before and 3 weeks after primary correction. Nostril rim length and height ratios were significantly better than the control group. CONCLUSIONS Korat-NAM improved nose and lip morphology before primary correction. An overcorrection improved the nose and lip morphology on the cleft side. The nostril rim length and vertical lip height on the cleft side also improved with Korat-NAM II 1 year after primary correction.
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Affiliation(s)
| | - Pongjai Virarat
- Cleft Center Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand
| | | | - Nicha Ungvijanpunya
- Department of Orthodontics, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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Goker F, Bonaso M, Grecchi E, Grivetto F, Stefanelli LV, Brucoli M, Donati G, Kisnisci R, Del Fabbro M, Grecchi F. Quality of life in oncologic patients after maxillectomy operations: clinical case series on different rehabilitation protocols. Eur Rev Med Pharmacol Sci 2024; 28:2710-2723. [PMID: 38639511 DOI: 10.26355/eurrev_202404_35900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVE The study's purpose was to compare the quality of life (QoL) in oncologic patients treated with different rehabilitation protocols following maxillary tumor resections. PATIENTS AND METHODS The patients were divided into three groups. Group A: 18 Patients with maxillary obturator prosthesis. Group B: 17 Patients with simultaneous autologous tissue reconstruction. Group C: 12 Patients with prosthesis on zygomatic implants. The post-operative QoL was compared using standard questionnaires, investigating items like pain, mood, social relations, and specific functions that could potentially compromise the post-operative QoL. A secondary analysis compared reconstructed vs. non-reconstructed patients. RESULTS Most questionnaire items did not show significant differences among groups. Statistically significant outcomes were found in two parameters (social contact and sexuality), in which patients treated with zygomatic implants had the best satisfaction, and patients with obturator prostheses showed the lowest satisfaction. Patients belonging to the non-reconstructed group showed better moods than those in the reconstructed group, while taste problem complaints and pain were lower in the reconstructed group. CONCLUSIONS Although the type of reconstruction procedure depends on the type of maxillectomy to be performed and on the general health situation of each patient, the impact of the rehabilitation protocol on the patients' QoL should be accounted for when planning the treatment.
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Affiliation(s)
- F Goker
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, Milan, Italy.
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Over LM, Dierks E. Interdisciplinary prosthetic rehabilitation following bilateral maxillectomy with total upper lip and unilateral zygoma resection: A clinical report. J Prosthet Dent 2024; 131:341-345. [PMID: 35610086 DOI: 10.1016/j.prosdent.2022.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/17/2022] [Accepted: 03/18/2022] [Indexed: 10/18/2022]
Abstract
This clinical report describes the design and fabrication of an implant-retained and soft-tissue-supported obturator prosthesis and a magnetic retained midfacial prosthesis for a patient with a midfacial defect following bilateral total maxillectomy, removal of the left zygoma, and excision of the entire upper lip. The patient underwent multiple head and neck surgeries for 4 separate primary oral cancers, 1 recurrence, and 1 pulmonary metastasis. The definitive obturator prosthesis was retained by 1 zygomatic implant with soft-tissue support and retention. The midfacial prosthesis was attached to the obturator prosthesis with magnets, improving appearance and the recovery of significant aspects of the patient's speech and swallowing. Some improvement in mastication was observed.
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Affiliation(s)
- Larry Michael Over
- Private practice, Eugene, Ore; Adjunct Professor, School of Medicine, Department of Otolaryngology, OHSU, Portland, Ore; Adjunct Professor, Department of Restorative Dentistry, OHSU School of Dentistry, Portland, Ore.
| | - Eric Dierks
- Private practice, Portland, Ore; Adjunct Professor, Department of Oral and Maxillofacial Surgery, OHSU, Portland, Ore
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Özcivelek T, Kılıçarslan MA. Full digital workflow of a 2-piece obturator with polyetherketoneketone in a patient with maxillectomy and trismus: A clinical and laboratory report. J Prosthet Dent 2024; 131:346-351. [PMID: 37487802 DOI: 10.1016/j.prosdent.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 07/26/2023]
Abstract
The computer-aided design and computer-assisted manufacturing of a 2-piece definitive palatal obturator 3D printed from polyetherketoneketone and 2 acrylic resins with a fully digital workflow are presented for a patient who was diagnosed with adenoid cystic carcinoma and who developed severely limited mouth opening after surgery and radiotherapy. The 18-month follow-up period revealed satisfactory function, tissue compatibility, retention, and esthetics for this patient with a maxillectomy and severe trismus.
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Affiliation(s)
- Tuğgen Özcivelek
- Assistant Professor, Department of Prosthodontics, Gülhane Faculty of Dentistry, Health Sciences University, Ankara, Turkey.
| | - Mehmet Ali Kılıçarslan
- Professor, Department of Prosthodontics and Medical Design Application and Research Center (MEDITAM), Faculty of Dentistry, Ankara University, Ankara, Turkey
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5
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Benli M. The Effect of the Wall Thickness of 3D-Printed Obturator Bulbs on Masticatory Function in Patients with Aramany Class I Defects: A Randomized Crossover Clinical Trial. INT J PROSTHODONT 2023; 36:681-688. [PMID: 38109388 DOI: 10.11607/ijp.8084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
PURPOSE To evaluate the effect of obturator bulb thickness on the masticatory performance and weight of obturator prostheses in edentulous hemimaxillectomy patients. MATERIALS AND METHODS A randomized, single-blind, three-period crossover trial was conducted with 17 edentulous patients. Each patient was provided with three definitive 3D-printed obturator prostheses. Obturators were divided into three groups: group 1 (G1; 1-mm bulb); group 2 (G2; 2-mm bulb); and group 3 (G3; 3-mm bulb). After fabrication, the weight of each obturator was measured with a digital analytical balance. The patients used each obturator for a period of 2 weeks without a passive period (ie, they did not stop using the obturator). The masticatory function of each obturator was evaluated with an adapted Sato questionnaire and the sieve test. Data were analyzed using one-way ANOVA and Pearson correlation analysis (α = .05). RESULTS According to the results of the Sato questionnaire and sieve test, G1 demonstrated the highest masticatory function scores (70.88 ± 9.39; 1.06 ± 0.06), while G3 exhibited the lowest scores (48.23 ± 7.69; 0.92 ± 0.05; P < .001). The weight of the obturators was significantly different between groups (G1 = 31.58 ± 1.09 g; G2 = 33.99 ± 1.21 g; G3 = 36.57 ± 1.13 g; P < .001). The correlation between masticatory function and the weight of the obturator was significant (P < .05). CONCLUSIONS This study revealed that 1-mm obturator bulb thickness was an effective fabrication method for improving masticatory function and reducing the weight of obturator prostheses in edentulous hemimaxillectomy patients.
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Lyons KM, Cannon RD, Beumer J, Bakr MM, Love RM. Microbial Analysis of Obturators During Maxillofacial Prosthodontic Treatment Over an 8-Year Period. Cleft Palate Craniofac J 2023; 60:1426-1441. [PMID: 35642284 DOI: 10.1177/10556656221104940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of the study was to investigate the microbial colonization (by Candida species, anaerobic and facultative anaerobic bacteria) of maxillary obturators used for the restoration of maxillary defects, including during radiotherapy. Retrospective cohort study. Fifteen patients requiring a maxillary obturator prosthesis had swabs of their obturators and adjacent tissues taken at different stages of their treatment over a period of 8 years. Identification of microbial species from the swabs was carried out using randomly amplified polymorphic DNA polymerase chain reaction (RAPD PCR) analysis, checkerboard DNA-DNA hybridization, CHROMagar Candida chromogenic agar, and DNA sequencing. Candida species were detected in all patients and all patients developed mucositis and candidiasis during radiotherapy which was associated with an increase in colonization of surfaces with Candida spp., particularly C albicans. Microbial colonization increased during radiotherapy and as an obturator aged, and decreased following a reline, delivery of a new prosthesis, or antifungal treatment during radiotherapy. Microbial colonization of maxillary obturators was related to the stage of treatment, age of the obturator material, radiotherapy and antifungal medications, and antifungal treatment may be recommended if C albicans colonization of palatal tissues is greater than 105 colony-forming units per cm2 following the first week of radiotherapy.
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Affiliation(s)
- Karl M Lyons
- Department of Oral Rehabilitation and Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Richard D Cannon
- Department of Oral Sciences and Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - John Beumer
- Division of Advanced Prosthodontics, School of Dentistry, University of California, Los Angeles, CA, USA
| | - Mahmoud M Bakr
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Robert M Love
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
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Chaturvedi A, Deepika K, Gupta R. Intraoral customized Z-spring-retained delayed surgical obturator for rare cases of bilateral subtotal maxillectomy. J Indian Prosthodont Soc 2022; 22:405-409. [PMID: 36511076 PMCID: PMC9709873 DOI: 10.4103/jips.jips_530_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/22/2022] [Accepted: 06/17/2022] [Indexed: 11/30/2022] Open
Abstract
While dealing with a grave second wave of ongoing pandemic COVID-19, India also saw a surge in cases of COVID-19-associated mucormycosis, a systematic fungal infection caused by the Mucorales species. Mucormycosis is a highly angioinvasive, rapidly spreading fungal infection. In numerous cases of mucormycosis, bilateral subtotal maxillectomy was performed due to unpredictable and indefinable advancement of fungus clinically. Effective obturation of bilateral maxillectomy defect is a difficult task and as this is a relatively uncommon surgical problem, insufficient data are available on the construction of delayed surgical obturator for such cases. The aim of this article is to discuss the design of Z-spring-retained delayed surgical obturator which is easy to fabricate, easy to rectify, cost-effective, and comfortable for the patients compared to previous spring-retained obturators. This surgical obturator is retained through Z-spring made of 1.02 mm thick wire. Due to the thick gauge, this spring counters postsurgery trismus and develops the seal between the acrylic plate and dorsum of the tongue during deglutition thus helps the patient in taking a soft diet initially. Novelty in this case is the design of the spring, which makes it beneficial for both patient and prosthodontist.
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Affiliation(s)
- Anandmayee Chaturvedi
- Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Kumari Deepika
- Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
| | - Rekha Gupta
- Department of Prosthodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India
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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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Jamayet NB, Farook TH, Al-Oulabi A, Johari Y, Patil PG. Digital workflow and virtual validation of a 3D-printed definitive hollow obturator for a large palatal defect. J Prosthet Dent 2021; 129:798-804. [PMID: 34635339 DOI: 10.1016/j.prosdent.2021.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/31/2021] [Accepted: 08/02/2021] [Indexed: 11/19/2022]
Abstract
This clinical report describes how a hollow obturator prosthesis was designed and fabricated for an 82-year-old partially edentulous patient with a large palatal defect. Computer-aided design (CAD) was used to design, articulate, and align the mandibular denture with the obturator prosthesis. The prosthesis was printed, adjusted chairside, rescanned, and made hollow by using a CAD software program. The prosthesis was printed in resin with a dental 3D printer. Quantitative evaluations of clinical (prosthesis dimensions, rest, and occlusal vertical dimensions) and virtual (surface area, volume, weight, interpoint mismatches, spatial overlap) parameters found that the 3D-printed prosthesis required an additional 5% chairside modification. The greatest differences in volume (24.7% less) and weight (22.2% less) were observed when the modified obturator bulb was made hollow via CAD. Hollowing the bulb, therefore, reduced the spatial overlap in volume by 16.8%.
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Affiliation(s)
- Nafij Bin Jamayet
- Senior Lecturer in Prosthodontics, Division of Restorative Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.
| | - Taseef Hasan Farook
- Research Fellow, Maxillofacial Prosthetic Service, Prosthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Ayman Al-Oulabi
- Clinical Fellow, Prosthodontic Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Yanti Johari
- Senior Lecturer in Prosthodontics, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Pravinkumar G Patil
- Senior Lecturer in Prosthodontics, Division of Restorative Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
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Artopoulou II, Karademas EC, Perisanidis C, Polyzois G. Quality of life in patients with soft palate resection: The relationship between reported functional prosthetic outcomes and the patient's psychological adjustment. J Prosthet Dent 2021; 128:1387-1397. [PMID: 34119321 DOI: 10.1016/j.prosdent.2021.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 11/19/2022]
Abstract
STATEMENT OF PROBLEM Tumors of the soft palate and the adjacent tissues often create considerable soft palate defects that are challenging for the maxillofacial prosthodontist. Soft palate obturator prostheses can usually address functional and esthetic concerns; however, the effectiveness of the prosthetic rehabilitation in improving the patient's well-being and overall quality of life (QOL) has not been extensively researched. PURPOSE The purpose of the present research was to evaluate the function of the prosthesis, to review the interrelation between sociodemographic, medical, and treatment (SMT) characteristics, QOL, and prosthesis functioning, and to analyze the role of the prosthesis in how the patient represents the illness and the psychological coping response. MATERIAL AND METHODS Thirty-three patients who underwent resection of the soft palate and had been using a technically successful soft palate obturator prosthesis for at least 1 year were interviewed by means of 5 questionnaires: European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30), Head and Neck Cancer Module (QLQ-HN35), Obturator Functioning Scale (OFS), Illness Perceptions Questionnaire (IPQ-R), and Mental Adjustment to Cancer Scale (MAC). Data analysis was performed at α=.01. RESULTS The QOL (r=-0.53, P=.001), personal control (r=-0.53, P=.001), negative adjustment to cancer (r=0.47, P=.005), treatment control (r=-0.55, P=.001), consequences (r=0.62, P<.001), and emotional representations (r=0.30, P=.009) were significantly related to prosthesis functioning. Better QOL was significantly related to prosthesis functioning (P=.006), age (P=.001), sex (P=.011), and type of soft palate defect (P=.009). The most important predictors of favorable soft palate obturator functioning were age (P<.001) and type of soft palate defect (P=.01). CONCLUSIONS A patient-perceived effective soft palate obturator prosthesis was a significant predictor for advanced QOL, better adjustment to illness and illness-related disabilities, as well as the overall coping response to cancer.
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Affiliation(s)
- Ioli Ioanna Artopoulou
- Assistant Professor, Department of Prosthodontics, National and Kapodistrian University of Athens, School of Dentistry, Athens, Greece; Maxillofacial Prosthodontist, Former Fellow, The University of Texas, M.D. Anderson Cancer Center, Houston, Texas.
| | | | - Christos Perisanidis
- Professor and Chief, Department of Oral and Maxillofacial Surgery, National and Kapodistrian University of Athens, "Evaggelismos" General Hospital, Athens, Greece
| | - Gregory Polyzois
- Professor and Chief, Department of Prosthodontics, National and Kapodistrian University of Athens, School of Dentistry, Athens, Greece
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Abstract
Maxillectomy is done for a variety of disease conditions. Reconstruction following maxillectomy is done to restore the form and function. One of the important goals that are to be achieved in reconstruction is the separation of the oral and nasal cavities. In this article, we report the use of palatal flap by preserving the descending palatine artery during bilateral inferior partial maxillectomy, for separating the nasal cavity from the oral cavity. This technique eliminates the need for an obturator or another free or local flap for this purpose.
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Affiliation(s)
| | - Pranay Gaikwad
- Department of General Surgery Unit 1, Christian Medical College and Hospital Vellore Department of Physiology, Vellore, Tamil Nadu, India
| | - Jagadish Ebenezer
- Department of Dental and Oral Surgery, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
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12
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Leberfinger AN, Jones CM, Mackay DR, Samson TD, Henry CR, Ravnic DJ. Computer-Aided Design and Manufacture of Intraoral Splints: A Potential Role in Cleft Care. J Surg Res 2021; 261:173-178. [PMID: 33444946 DOI: 10.1016/j.jss.2020.11.085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 10/30/2020] [Accepted: 11/16/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nasoalveolar molding is a nonsurgical modality for the treatment of cleft lip and palate that uses an intraoral splint to align the palatal shelves. Repeated impressions are needed for splint modification, each carrying risk of airway obstruction. Computer-aided design and manufacturing (CAD/CAM) has the ability to simplify the process. As a precursor to CAD/CAM splint fabrication, a proof-of-concept study was conducted to compare three-dimensional splints printed from alginate impressions versus digital scans. We hypothesized that intraoral digital scanning would compare favorably to alginate impressions for palate registration and subsequent splint manufacture, with decreased production times. METHODS Alginate and digital impressions were taken from 25 healthy teenage volunteers. Digital impressions were performed with a commercially available intraoral scanner. Plaster casts made from alginate impressions were converted to Standard Triangle Language files. Patient-specific matched scans were evaluated for total surface area with the concordance correlation coefficient. Acrylic palatal splints were three-dimensionally printed from inverse digital molds. Subjective appliance fit was assessed using a five-point scale. RESULTS A total of 23 participants were included. Most subjects preferred digital impression acquisition. Impression methods showed moderate agreement (concordance correlation coefficient 0.93). Subjects rated splints from digital impressions as having a more precise fit (4.4 versus 3.9). The digital approach decreased impression phase time by over 10-fold and overall production time by 28%. CONCLUSIONS CAD/CAM has evolved extensively over the past two decades and is now commonplace in medicine. However, its utility in cleft patients has not been fully realized. This pilot study demonstrated that CAD/CAM technologies may prove useful in patients requiring intraoral splints.
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Affiliation(s)
- Ashley N Leberfinger
- Division of Plastic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Christine M Jones
- Division of Plastic Surgery, Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Donald R Mackay
- Division of Plastic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Thomas D Samson
- Division of Plastic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Cathy R Henry
- Division of Plastic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Dino J Ravnic
- Division of Plastic Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
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13
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Villefort RF, Tribst JPM, Dal Piva AMDO, Borges AL, Binda NC, Ferreira CEDA, Bottino MA, von Zeidler SLV. Stress distribution on different bar materials in implant-retained palatal obturator. PLoS One 2020; 15:e0241589. [PMID: 33125441 PMCID: PMC7598468 DOI: 10.1371/journal.pone.0241589] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022] Open
Abstract
Implant-retained custom-milled framework enhances the stability of palatal obturator prostheses. Therefore, to evaluate the mechanical response of implant-retained obturator prostheses with bar-clip attachment and milled bars, in three different materials under two load incidences were simulated. A maxilla model which Type IIb maxillary defect received five external hexagon implants (4.1 x 10 mm). An implant-supported palatal obturator prosthesis was simulated in three different materials: polyetheretherketone (PEEK), titanium (Ti:90%, Al:6%, V:4%) and Co-Cr (Co:60.6%, Cr:31.5%, Mo:6%) alloys. The model was imported into the analysis software and divided into a mesh composed of nodes and tetrahedral elements. Each material was assumed isotropic, elastic and homogeneous and all contacts were considered ideal. The bone was fixed and the load was applied in two different regions for each material: at the palatal face (cingulum area) of the central incisors (100 N magnitude at 45°); and at the occlusal surface of the first left molar (150 N magnitude normal to the surface). The microstrain and von-Mises stress were selected as criteria for analysis. The posterior load showed a higher strain concentration in the posterior peri-implant tissue, near the load application side for cortical and cancellous bone, regardless the simulated material. The anterior load showed a lower strain concentration with reduced magnitude and more implants involving in the load dissipation. The stress peak was calculated during posterior loading, which 77.7 MPa in the prosthetic screws and 2,686 με microstrain in the cortical bone. For bone tissue and bar, the material stiffness was inversely proportional to the calculated microstrain and stress. However, for the prosthetic screws and implants the PEEK showed higher stress concentration than the other materials. PEEK showed a promising behavior for the bone tissue and for the integrity of the bar and bar-clip attachments. However, the stress concentration in the prosthetic screws may represent an increase in failure risk. The use of Co-Cr alloy can reduce the stress in the prosthetic screw; however, it increases the bone strain; while the Titanium showed an intermediate behavior.
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Affiliation(s)
- Regina Furbino Villefort
- Biotechnology Program, Federal University of Espírito Santo, Rede Nordeste de Biotecnologia (RENORBIO), Vitória, Espírito Santo, Brazil
| | - João Paulo Mendes Tribst
- Post-Graduate Program in Restorative Dentistry (Prosthodontic), Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp/SJC), São José dos Campos, SP, Brazil
| | - Amanda Maria de Oliveira Dal Piva
- Post-Graduate Program in Restorative Dentistry (Prosthodontic), Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp/SJC), São José dos Campos, SP, Brazil
| | - Alexandre Luiz Borges
- Post-Graduate Program in Restorative Dentistry (Prosthodontic), Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp/SJC), São José dos Campos, SP, Brazil
| | - Nívia Castro Binda
- Biotechnology Program, Federal University of Espírito Santo, Rede Nordeste de Biotecnologia (RENORBIO), Vitória, Espírito Santo, Brazil
| | | | - Marco Antonio Bottino
- Post-Graduate Program in Restorative Dentistry (Prosthodontic), Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University (Unesp/SJC), São José dos Campos, SP, Brazil
| | - Sandra Lúcia Ventorim von Zeidler
- Biotechnology Program, Federal University of Espírito Santo, Rede Nordeste de Biotecnologia (RENORBIO), Vitória, Espírito Santo, Brazil
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Brucoli M, Boffano P, Pezzana A, Corio C, Benech A. The use of optical scanner for the fabrication of maxillary obturator prostheses. Oral Maxillofac Surg 2020; 24:157-161. [PMID: 32147758 DOI: 10.1007/s10006-020-00836-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 02/26/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Maxillectomy following tumors or, more rarely, traumatic injuries may result in maxillary defects that may determine physical dysfunctions and functional impairment of speech and swallowing. The aim of our study was to present our experience in the management of post-maxillectomy patients by the use of obturator prostheses that were obtained by 3D digital casts via an intraoral scanner. METHODS Patients with maxillary defects following maxillary and/or palatal resection or maxillary traumatic avulsion were selected for this clinical study between 2015 and 2018. Five to 6 months after surgery, a definitive obturator prosthesis was fabricated thanks to an intraoral scanner. The following parameters of clinical outcome were considered: the absence of fluid leakage, the recovery of phonation, the recovery of swallowing, and personal satisfaction. RESULTS Twenty-eight patients (20 males, 8 females) fulfilled the inclusion criteria and were included in the study. Most patients had a maxillary and/or palatal defect because of a malignant tumor. On the whole, 93% of patients reported a complete absence of fluid leakage between maxillary sinuses or nasal fossa and oral cavity; most patients reported a good or complete recovery of phonation and swallowing. CONCLUSIONS Digital technology for the fabrication of maxillary obturator prosthesis may be effective and useful. The reduced laboratory working time, the avoidance of the risk of aspiration of impression materials, and the overcome of the difficulties associated with whole tissue undercut impression are just some of the most important advantages that have been encountered thanks to this promising technology.
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Affiliation(s)
- Matteo Brucoli
- Division of Maxillofacial Surgery, University Hospital "Maggiore della Carita", University of Eastern Piedmont, Novara, Italy
| | - Paolo Boffano
- Division of Maxillofacial Surgery, University Hospital "Maggiore della Carita", University of Eastern Piedmont, Novara, Italy.
| | - Andrea Pezzana
- Division of Maxillofacial Surgery, University Hospital "Maggiore della Carita", University of Eastern Piedmont, Novara, Italy
| | - Chiara Corio
- Division of Maxillofacial Surgery, University Hospital "Maggiore della Carita", University of Eastern Piedmont, Novara, Italy
| | - Arnaldo Benech
- Division of Maxillofacial Surgery, University Hospital "Maggiore della Carita", University of Eastern Piedmont, Novara, Italy
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Bou C, Liang Fat AS, de Mones Del Pujol E, Plaire V, Naveau A. A New Membrane Obturator Prosthesis Concept for Soft Palate Defects. INT J PROSTHODONT 2018; 31:584-586. [PMID: 30408140 DOI: 10.11607/ijp.5755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
When soft palate defects lead to palatal insufficiency, the patient's quality of life is affected by difficulties swallowing, hypernasality, and poor intelligibility of speech. If immediate surgical reconstruction is not an option, the patient may benefit from the placement of a rigid obturator prosthesis. Unfortunately, the residual muscle stumps are often unable to adequately move this stiff and inert obturator to properly restore the velopharyngeal valve function. In the present case history report, a new membrane obturator concept is described: Using a dental dam to compensate for the soft palate defect, swallowing and speech were significantly improved.
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Revoredo ECV, Galembeck A, Ponzi EAC, Leão JC, Arcoverde LS, Araújo LC, Leite SP. Palatal obturator designed by 3-dimensional prototyping for a patient with a large ameloblastoma: a case report. Gen Dent 2018; 66:e12-e17. [PMID: 30188865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The aim of the present report was to detail the advantages of using 3-dimensional (3D) prototyping in the planning, modeling, and manufacturing of an immediate palatal obturator for a 62-year-old man who underwent a left total maxillectomy to remove a solid, multicystic ameloblastoma. The prosthesis provided favorable restoration of stomatognathic functions, including speech, swallowing, and mastication. The use of an immediate obturator prosthesis made with 3D technology is an important aid in the treatment of patients diagnosed with tumors in the head and neck region.
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17
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Vosselman N, Merema BJ, Schepman KP, Raghoebar GM. Patient-specific sub-periosteal zygoma implant for prosthetic rehabilitation of large maxillary defects after oncological resection. Int J Oral Maxillofac Surg 2018; 48:115-117. [PMID: 30041913 DOI: 10.1016/j.ijom.2018.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/04/2018] [Accepted: 06/20/2018] [Indexed: 11/17/2022]
Abstract
A 74-year-old woman needed a subtotal bilateral maxillectomy due to squamous cell carcinoma of the palate. Immediate and secondary reconstruction of the defect was not feasible, so the defect was closed with an obturator prosthesis wired to the zygoma complex. To improve the patient's severely impaired speech and swallowing, a patient-specific sub-periosteal implant (psSPI) was designed that matched the remnants of the zygoma complex. First, the patient's post-surgical anatomy was visualized through segmentation of the pre- and post-maxillectomy computed tomography data. Next, based on the data, a customized zygoma-supported framework was designed to support the obturator prosthesis. Surgical guides for intraoperative navigation were designed and three-dimensionally printed, along with an obturator prosthesis to fit the planned outcome situation. The preoperatively manufactured psSPI and obturator prosthesis matched the intraoperative conditions. The postoperative results were favourable; within a week after surgery the patient could speak and swallow normally without nasal leakage. No problems occurred during follow-up. These results indicate that a psSPI-retained prosthesis can be considered for the restoration of speech and oral functioning in cases with a largely compromised maxillary bone anatomy, accompanied by impaired oral functioning and no feasible conventional reconstruction options.
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Affiliation(s)
- N Vosselman
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands
| | - B J Merema
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands
| | - K P Schepman
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands
| | - G M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen and University Medical Centre Groningen, Groningen, The Netherlands.
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Kortes J, Dehnad H, Kotte ANT, Fennis WMM, Rosenberg AJWP. A novel digital workflow to manufacture personalized three-dimensional-printed hollow surgical obturators after maxillectomy. Int J Oral Maxillofac Surg 2018; 47:1214-1218. [PMID: 29636308 DOI: 10.1016/j.ijom.2018.03.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/07/2018] [Accepted: 03/19/2018] [Indexed: 11/19/2022]
Abstract
Partial or complete resection of the maxilla during tumour surgery causes oronasal defects, leading to oral-maxillofacial dysfunction, for which the surgical obturator (SO) is an important treatment option. Traditional manufacturing of SOs is complex, time-consuming, and often results in inadequate fit and function. This technical note describes a novel digital workflow to design and manufacture a three-dimensional (3D)-printed hollow SO. Registered computed tomography and magnetic resonance imaging images are used for gross tumour delineation. The produced RTStruct set is exported as a stereolitography (STL) file and merged with a 3D model of the dental status. Based on these merged files, a personalized and hollow digital SO design is created, and 3D printed. Due to the proper fit of the prefabricated SO, a soft silicone lining material can be used during surgery to adapt the prosthesis to the oronasal defect, instead of putty materials that are not suitable for this purpose. An STL file of this final SO is created during surgery, based on a scan of the relined SO. The digital workflow results in a SO weight reduction, an increased fit, an up-to-date digital SO copy, and overall easier clinical handling.
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Affiliation(s)
- J Kortes
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - H Dehnad
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A N T Kotte
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W M M Fennis
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A J W P Rosenberg
- Department of Oral and Maxillofacial Surgery and Special Dental Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Arutyunov AS, Shanidze ZL, Tsareva EV, Arutyunov SD. [Prosthodontic treatment of edentulous patients with postoperative mandibular defects of oncological origin]. Stomatologiia (Mosk) 2018; 97:54-58. [PMID: 29465078 DOI: 10.17116/stomat201897154-58] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The aim of the study was clinical and bacteriological approbation of improved obturator dentures with soft lining. The study involved 116 patients (68 females and 48 males aged 47-78) with edentulous jaws and side palatal defect of oncological origin. Improved elastic obturator maxilla dentures in patients with palatal defects proved to have better stability and provides better comfort effectively preventing inflammation of prosthetic bed soft tissues.
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Affiliation(s)
- A S Arutyunov
- Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia
| | - Z L Shanidze
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow, Russia
| | - E V Tsareva
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow, Russia
| | - S D Arutyunov
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow, Russia
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20
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Murat S, Gürbüz A, Kamburoğlu K. Fabrication of obturator prosthesis by fusing CBCT and digital impression data. Int J Comput Dent 2018; 21:335-344. [PMID: 30539176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This clinical report describes a digital workflow using an intraoral digital impression and cone beam computed tomography (CBCT) volumetric data to create a three-dimensional (3D) virtual model of the dentition, defect area, and soft and hard tissue of a patient who had undergone a hemimaxillectomy. Stereolithography (SLA) 3D printing technology was used to produce a resin mold, from which an obturator prosthesis was fabricated through a conventional technique.
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21
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Krey KF, Ratzmann A, Metelmann PH, Hartmann M, Ruge S, Kordaß B. Fully digital workflow for presurgical orthodontic plate in cleft lip and palate patients. Int J Comput Dent 2018; 21:251-259. [PMID: 30264054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE In most cases, according to our treatment concept, a presurgical orthodontic treatment (POT) is performed on patients with cleft lip and palate (CLP). The aim of this case report is to demonstrate a completely digital workflow for the production of a palate plate. MATERIALS AND METHODS For the assessment of the maxillary arch, a digital impression of the jaw was made on two patients with an intraoral scanner (Cerec Omnicam Ortho). After reconstruction of a virtual model from the scan data, appropriate areas of the jaw could be blocked out and a plate constructed. This was printed with a DLP three-dimensional (3D) printer (SHERA EcoPrint D30) with class IIa biocompatible material. After minor surface finishing, the plates could be incorporated in the patients' mouths. RESULTS The scans could be performed in a short time without affecting the very young patients. All clinically relevant areas for the production and digital measurement of the models could be recorded. The plates showed an extremely good fit, and there were no differences in wear compared with a conventionally manufactured plate. CONCLUSION For the first time, a risk-free digital impression of the edentulous jaw in CLP babies with a subsequently completely digitally constructed and 3D-printed palatal plate could be shown.
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Masarei AG, Wade A, Mars M, Sommerlad BC, Sell D. A Randomized Control Trial Investigating the Effect of Presurgical Orthopedics on Feeding in Infants with Cleft Lip and/or Palate. Cleft Palate Craniofac J 2017; 44:182-93. [PMID: 17328643 DOI: 10.1597/05-184.1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective: To investigate the controversial assertion that presurgical orthopedics (PSO) facilitate feeding in infants with cleft lip and palate. Design: Randomized control trial of 34 infants with nonsyndromic complete unilateral cleft lip and palate and 16 with cleft of the soft and at least two thirds of the hard palate. Allocation to receive presurgical orthopedics or not used minimization for parity and gender. Other aspects of care were standardized. Setting: The North Thames Regional Cleft Centre. Main Outcome Measures: Measurements were made at 3 months of age (presurgery) and at 12 months of age (postsurgery). Primary outcomes were anthropometry and oral motor skills. Objective measures of sucking also were collected at 3 months using the Great Ormond Street Measure of Infant Feeding. Twenty-one infants also had videofluoroscopic assessment. Results: At 1 year, all infants had normal oral motor skills and no clear pattern of anthropometric differences emerged. For both cleft groups, infants randomized to presurgical orthopedics were, on average, shorter. The presurgical orthopedics infants were, on average, lighter in the unilateral cleft and lip palate group, but heavier in the isolated cleft palate group. Infants with complete unilateral cleft and lip palate randomized to presurgical orthopedics had lower average body mass index (mean difference PSO-No PSO: −0.45 (95% confidence interval [−1.78, 0.88]), this trend was reversed among infants with isolated cleft palates (mean difference PSO-No PSO: 1.98 [−0.95, 4.91]). None of the differences were statistically significant at either age. Conclusions: Presurgical orthopedics did not improve feeding efficiency or general body growth within the first year in either group of infants.
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Affiliation(s)
- A G Masarei
- Great Ormond Street Hospital for Children NHS Trust, London, UK.
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Suzuki K, Yamazaki Y, Sezaki K, Nakakita N. The Effect of Preoperative Use of an Orthopedic Plate on Articulatory Function in Children with Cleft Lip and Palate. Cleft Palate Craniofac J 2017; 43:406-14. [PMID: 16854197 DOI: 10.1597/04-006.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the effect of preoperative use of an orthopedic plate (OP) on postoperative articulatory function in children with cleft lip and palate. Subjects The subjects had complete unilateral or bilateral cleft lip and palate and were scheduled for a one-stage palatoplasty. Main Outcome Measures Tongue movements during sucking were analyzed by ultrasonography. Postoperative articulatory behavior was also assessed at 5 years 4 months of age. Results There was an excessive downward excursion of the rear portion of the tongue during sucking regardless of the use or nonuse of the OP. This indicated that infants with cleft palate could not create negative pressure in the oral cavity, even with the OP. However, the OP appeared effective for preventing irregular movements of the tongue during sucking. The proportion of subjects obtaining excellent articulation was significantly higher in the group using the OP until palatoplasty than in the group who did not continue using the OP. The proportion of subjects with disturbed articulatory function in the latter group was comparable with that in the control group, who never used the OP. Conclusions Continuous use of the OP up to the time of palatoplasty appeared to be effective for the postoperative articulatory function in children with complete cleft lip and palate. Inhibiting irregular movements of the tongue, the OP might assist in preventing “palatalized articulation.”
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Affiliation(s)
- Keiko Suzuki
- Speech-Language-Hearing Therapist, Kitasato University School of Allied Health Sciences, Kanagowa, Japan.
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Prahl C, Kuijpers-Jagtman AM, Van 't Hof MA, Prahl-Andersen B. Infant Orthopedics in UCLP: Effect on Feeding, Weight, and Length: A Randomized Clinical Trial (Dutchcleft). Cleft Palate Craniofac J 2017; 42:171-7. [PMID: 15748108 DOI: 10.1597/03-111.1] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To study the effects of infant orthopedics (IO) on feeding, weight, and length. Design Prospective two-arm randomized controlled trial in three academic Cleft Palate Centers. Treatment allocation was concealed and performed by means of a computerized balanced allocation method. Setting Cleft Palate Centers of Amsterdam, Nijmegen, and Rotterdam, the Netherlands. Patients Infants with complete unilateral cleft lip and palate (UCLP), no other malformations. Interventions One group (IO+) wore passive maxillary plates during the first year of life, but the other group (IO−) did not. All other interventions were the same for both groups. Main Outcome Measures Bottle feeding velocity (mL/min) at intake, 3, 6, 15, and 24 weeks (T0 to T24); weight-for-age, length-for-age, and weight-for-length using z scores; reference values from the Netherlands’ third nationwide survey on growth. Results Feeding velocity increased with time from 2.9 to 13.2 mL/min in the IO− group and from 2.6 to 13.8 mL/min in the IO+ group; no significant differences were found between groups. Weight-for-age, length-for-age, and weight-for-length (z scores) did not differ significantly between groups, but overall the infants with unilateral cleft lip and palate in both groups had significantly lower mean z scores for weight-for-age and height-for-age than the reference during the first 14 months, and had lower mean values for weight-for-length after soft palate closure. Conclusion Infant orthopedics with the aim of improving feeding and consequent nutritional status in infants with unilateral cleft lip and palate can be abandoned.
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Affiliation(s)
- Charlotte Prahl
- Department of Orthodontics and Oral Biology, University Medical Center Nijmegen, Nijmegen, Netherlands
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Oosterkamp BCM, van Oort RP, Dijkstra PU, Stellingsma K, Bierman MWJ, de Bont LGM. Effect of an Intraoral Retrusion Plate on Maxillary Arch Dimensions in Complete Bilateral Cleft Lip and Palate Patients. Cleft Palate Craniofac J 2017; 42:239-44. [PMID: 15865456 DOI: 10.1597/03-109.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of this study was to analyze maxillary arch dimensions in patients with complete bilateral cleft lip and palate treated with an intraoral retrusion plate prior to lip closure. Patients The effects of the intraoral retrusion plate were evaluated on serially obtained maxillary casts of 14 patients with complete bilateral cleft lip and palate. Results The Student's t test for dependent observations showed a significant decrease in distance between the premaxilla and the cleft lateral segments during active treatment. This decrease correlated with an increase in deviation of the premaxilla in relation to the vomer. For each millimeter decrease in distance between the premaxilla and the cleft lateral segments, an average increase in deviation of 4.0 degrees was found. Left and right cleft widths decreased significantly, premaxillary width increased significantly, and transverse dimensions did not change significantly. Conclusion From this study it can be concluded that active presurgical treatment with an intraoral retrusion plate induces a significant decrease in distance between the premaxilla and the lateral segments. This decrease is frequently accompanied by an increase in deviation of the premaxilla relative to the vomer.
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Konst EM, Rietveld T, Peters HFM, Weersink-Braks H. Use of a Perceptual Evaluation Instrument to Assess the Effects of Infant Orthopedics on the Speech of Toddlers with Cleft Lip and Palate. Cleft Palate Craniofac J 2017; 40:597-605. [PMID: 14577817 DOI: 10.1597/1545-1569_2003_040_0597_uoapei_2.0.co_2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To investigate the effects of infant orthopedics (IO) administered in the first year of life on the speech characteristics of 2.5-year-old children with complete unilateral cleft lip and palate (UCLP) using a perceptual evaluation instrument with equal-appearing interval (EAI) scales. Design In a prospective randomized clinical trial (Dutchcleft), two groups of children with complete UCLP were followed longitudinally. One group received IO based on a modified Zurich approach (IO group), and the other group did not (non-IO group). The appliance was used until soft palate closure at age 12 months. Hard palate closure is delayed until 9 years of age. Participants Three groups of 2.5-year-old toddlers participated in this investigation: 10 IO, 10 non-IO, and 8 noncleft controls matched for age and socioeconomic status. Method Five trained listeners assessed the children's speech in a blinded perceptual rating procedure. They judged 13 specific speech characteristics and indicated their total impression of speech on EAI scales. Results The reliability and consistency of 11 of the rating scales was good. The intelligibility rating scale was the single speech characteristic that distinguished the IO group from the non-IO group; the IO group was judged to be superior. The cleft groups differed from the noncleft group on 9 of the 11 scales. Conclusions Evaluation of speech by means of the present newly developed perceptual rating instrument showed that the IO group obtained significantly higher ratings for intelligibility than the non-IO group. The groups did not differ regarding any of the other speech aspects.
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Affiliation(s)
- Emmy M Konst
- Department of Orthodontics and Oral Biology, University Medical Centre St. Radboud, University of Nijmegen, the Netherlands.
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Abstract
Objective A literature review was conducted to identify feeding interventions recommended for infants with cleft conditions. Selected articles were critically appraised using an evidence-based practice framework to determine the strength of the evidence underpinning each intervention. Design Electronic databases were searched for reports of cleft palate feeding interventions. The selected articles were coded as being data driven or not; those containing data were then critically appraised using a recognized evidence hierarchy. Finally, each report was ascribed a level of evidence (from I to IV), depending on the quality of data presented. Results Fifty-five articles published between 1955 and 2002 were reviewed. There are currently no completed systematic reviews relevant to this body of literature (level I evidence). Two well-designed randomized controlled trials (level II evidence) were found. These were considered to provide the strongest evidence for feeding intervention techniques. These articles described a combination of interventions, including early feeding and nutrition education, as well as assisted feeding methods for infants with isolated cleft conditions. Three examples of level III.3 evidence were also found. Fifty (91%) of 55 articles reviewed were non–data-driven reports of expert opinion (level IV). Conclusions A paucity of evidence rated as either moderate or strong prevailed, underscoring the need for ongoing scientific evaluation of feeding interventions used with infants who have cleft palate. A number of factors, including the heterogeneity of samples studied, lack of replication of trials, and small sample sizes, affected the type and strength of evidence underpinning specific feeding interventions.
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Affiliation(s)
- Julie Reid
- Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, Australia.
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Meazzini MC, Chiavenna C, Autelitano L, Garattini G, Brusati R. Photometric Evaluation in Adolescence of Patients With Bilateral Cleft Lip and Palate Treated With Nasoalveolar Molding and Primary Columella Lengthening. Cleft Palate Craniofac J 2017; 55:568-573. [PMID: 29554451 DOI: 10.1177/1055665617732785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Nasal stigma in patients with bilateral cleft lip and palate (BCLP) are a short columella and a flattened nasal tip. DESIGN The aim of this study was to evaluate the aesthetics of adolescents with BCLP, operated with a modified Cutting primary columella lengthening technique, associated to a modified Grayson orthopedic nasoalveolar molding (NAM). SETTING AND PATIENTS 72 BCLP patients were operated with this approach. Standardized photographic records were taken every 2 years. A group of 23 patients between 12 and 13 years of age was compared through normalized photogrammetry to a matched control of 23 noncleft adolescents. RESULTS Nasal protrusion and length of the columella were very close to normal. On the other hand, nasolabial angle and interalar width were still excessively wide compared to the noncleft sample. CONCLUSIONS NAM and primary columella lengthening in BCLP has allowed to avoid traditional secondary columella lengthening at 5 to 6 years of age and given the patients a more pleasing, near-normal nasolabial appearance until adolescence. Some of the patients will require correction of the nasal width at a later stage.
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Affiliation(s)
- Maria Costanza Meazzini
- 1 Smile House, Regional Center for CLP, San Paolo Hospital, Department of Maxillo-Facial Surgery, University of Milan, Milan, Italy
| | - Carlo Chiavenna
- 2 Department of Orthodontics, University of Milan, San Paolo Hospital, Milan, Italy
| | - Luca Autelitano
- 1 Smile House, Regional Center for CLP, San Paolo Hospital, Department of Maxillo-Facial Surgery, University of Milan, Milan, Italy
| | - Giovanna Garattini
- 2 Department of Orthodontics, University of Milan, San Paolo Hospital, Milan, Italy
| | - Roberto Brusati
- 1 Smile House, Regional Center for CLP, San Paolo Hospital, Department of Maxillo-Facial Surgery, University of Milan, Milan, Italy
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Puryer J, Forbes-Haley C. An Implant-Retained Obturator – A Case Study. ACTA ACUST UNITED AC 2017; 44:415-8, 421-2. [PMID: 29188695 DOI: 10.12968/denu.2017.44.5.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
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.
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Abstract
We report a 42-year-old cocaine addicted female patient referred for evaluation of hard palate ulceration resulting in oro-sinus communication with difficulties in swallowing and phonation, an rhino-sinusitis. Acrylic and removable silicone prosthesis was prescribed to relieve severe functional disorders. It is essential that the patient permanently abandons cocaine use to perform surgical reconstruction.
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Affiliation(s)
| | - Maria Cecilia Madeo
- Departament of Dermatology of Hospital General de Agudos
Enrique Tornú - Buenos Aires, Argentina
| | - María Emilia Vázquez
- Departament of Dermatology of Hospital General de Agudos
Enrique Tornú - Buenos Aires, Argentina
| | - Mariana Martínez
- Departament of Dermatology of Hospital General de Agudos
Enrique Tornú - Buenos Aires, Argentina
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Kulkarni PR, Kulkarni RS, Shah RJ, Maru K. Prosthetic Rehabilitation of a Partially Edentulous Patient with Maxillary Acquired Defect by a Two-Piece Hollow Bulb Obturator (Using a Dentogenic Concept). J Coll Physicians Surg Pak 2017; 27:514-516. [PMID: 28903848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 07/14/2017] [Indexed: 06/07/2023]
Abstract
Patients may face functional, aesthetic, and social distress because of the palatal defects. Prosthetic rehabilitation of maxillectomy or developmental defect can be challenging for prosthodontists. Prognosis of the prosthetic appliances can be affected not only by patients' own ability to adapt to the prosthesis but also by the factors like the remaining teeth, bony structure, and existing mucosa. Maxillary defects are usually developed by surgical intercession of the benign or malignant conditions and trauma cases. Speech, mastication and aesthetics can be hampered by any extent of palatal defect. During obturation of palatal/maxillectomy defects, the primary intent of the prosthodontist should be the shutting of the maxillectomy defect and parting of the oral cavity from the sinonasal openings by use of different bulb designs. In the present case, dentogenic concept has been applied while fabricating the two-piece hollow bulb obturator for restoration of the defect. Well known fact about the gravitational force is that it acts on maxillary obturator and reduces its retentive qualities, this can be counteracted to some extent by making the obturator hollow. Dentogenic concept is the skill, training, and procedure of generating the chimera of natural teeth in artificial teeth during prosthodontic restorations.
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Affiliation(s)
- Poonam R Kulkarni
- Department of Prosthodontics, Sri Aurobindo College of Dentistry and PG Institute, Madhya Pradesh, India
| | - Rahul S Kulkarni
- Department of Prosthodontics, Index Institute of Dental Sciences, Index City, Madhya Pradesh, India
| | - Rupal J Shah
- Department of Prosthodontics, Government Dental College and Hospital, Ahmedabad, Gujarat, India
| | - Kavita Maru
- Department of Prosthodontics, Sri Aurobindo College of Dentistry and PG Institute, Madhya Pradesh, India
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Bénateau H, Trentesaux AS, Chatellier A, Laurent J, Bellot A, Veyssiere A. Cheiloplasty associated to a palatal obturator in a preterm infant with a cleft lip and palate. J Stomatol Oral Maxillofac Surg 2017. [PMID: 28642187 DOI: 10.1016/j.jormas.2017.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Preterm infants are commonly treated by non-invasive ventilation (NIV) and nasal continuous positive airway pressure (CPAP), which are associated with fewer complications than nasotracheal intubation. In preterm infants with a cleft lip and palate, this method of respiratory management is difficult or impossible to perform because of air leakage through the cleft defect. CASE We report a male infant who was born at 29 weeks of gestation with a left complete unilateral cleft lip and palate. Birth weight was 900 grammes. Because of the cleft, we have any problems to ventile this infant. We decide to close the cleft prematurely on day 17 after multidisciplinary discussion. DISCUSSION NIV cannot be performed with the usual equipment in very premature infants with a cleft lip and palate because of air leakage through the cleft defect. Very few studies report pre term infant with cleft lip and palate and his difficulties of ventilation. This is the first case reported to perform cheiloplasty on a 900g preterm infant.
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Affiliation(s)
- H Bénateau
- Department of maxillofacial surgery, Caen university hospital, 14000 Caen, France
| | - A-S Trentesaux
- Neonatal intensive care unit, Caen university hospital, 14000 Caen, France
| | - A Chatellier
- Department of maxillofacial surgery, Caen university hospital, 14000 Caen, France
| | - J Laurent
- Department of infantil anesthesiology, Caen university hospital, 14000 Caen, France
| | - A Bellot
- Neonatal intensive care unit, Caen university hospital, 14000 Caen, France
| | - A Veyssiere
- Department of maxillofacial surgery, Caen university hospital, 14000 Caen, France.
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33
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Rodney J, Chicchon I. Digital Design and Fabrication of Surgical Obturators Based Only on Preoperative Computed Tomography Data. INT J PROSTHODONT 2017; 30:111-112. [PMID: 28267815 DOI: 10.11607/ijp.5066] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This article describes the digital fabrication of a surgical obturator (SO) using only computed tomography (CT) data from the tumor area. This procedure is a departure from the traditional method of making an impression and obtaining a patient cast prior to surgery to allow for SO fabrication. The present approach allows for a virtual resection based on the patient's CT image; the SO is digitally designed with animation software and fabricated by 3D printing. The SO is relined with a denture reliner at the time of surgery to complete the obturation of the maxillectomy defect.
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Elbashti ME, Hattori M, Patzelt SB, Schulze D, Sumita YI, Taniguchi H. Feasibility and Accuracy of Digitizing Edentulous Maxillectomy Defects: A Comparative Study. INT J PROSTHODONT 2017; 30:147-149. [PMID: 28267823 DOI: 10.11607/ijp.5095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE The aim of this study was to evaluate the feasibility and accuracy of using an intraoral scanner to digitize edentulous maxillectomy defects. MATERIALS AND METHODS A total of 20 maxillectomy models with two defect types were digitized using cone beam computed tomography. Conventional and digital impressions were made using silicone impression material and a laboratory optical scanner as well as a chairside intraoral scanner. The 3D datasets were analyzed using 3D evaluation software. RESULTS Two-way analysis of variance revealed no interaction between defect types and impression methods, and the accuracy of the impression methods was significantly different (P = .0374). CONCLUSION Digitizing edentulous maxillectomy defect models using a chairside intraoral scanner appears to be feasible and accurate.
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Rahman AM, Nizami MMUI, Jamayet NB, Husein A. Application of Functional Impression Technique and Use of Silicone as Bulb for Maxillary Obturator. J Coll Physicians Surg Pak 2017; 27:319-320. [PMID: 28599699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/15/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Ahmed Mushfiqur Rahman
- Maxillofacial Prosthetic Service, School of Dental Sciences, Universiti Sains Malaysia, Malaysia
| | | | - Nafij Bin Jamayet
- Maxillofacial Prosthetic Service, School of Dental Sciences, Universiti Sains Malaysia, Malaysia
| | - Adam Husein
- Maxillofacial Prosthetic Service, School of Dental Sciences, Universiti Sains Malaysia, Malaysia
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36
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Goiato MC, Matheus HR, de Medeiros RA, Dos Santos DM, Bitencourt SB, Pesqueira AA. A photoelastic and strain gauge comparison of two attachments for obturator prostheses. J Prosthet Dent 2017; 117:685-689. [PMID: 27881311 DOI: 10.1016/j.prosdent.2016.07.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Marcelo Coelho Goiato
- Professor, Aracatuba Dental School, São Paulo State University (UNESP), São Paulo, Brazil.
| | - Henrique Rinaldi Matheus
- Graduate student, Aracatuba Dental School, Sao Paulo State University (UNESP), São Paulo, Brazil
| | | | | | - Sandro Basso Bitencourt
- Postgraduate student, Aracatuba Dental School, São Paulo State University (UNESP), São Paulo, Brazil
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Artopoulou II, Karademas EC, Papadogeorgakis N, Papathanasiou I, Polyzois G. Effects of sociodemographic, treatment variables, and medical characteristics on quality of life of patients with maxillectomy restored with obturator prostheses. J Prosthet Dent 2017; 118:783-789.e4. [PMID: 28456369 DOI: 10.1016/j.prosdent.2017.01.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 01/25/2017] [Accepted: 01/25/2017] [Indexed: 11/18/2022]
Abstract
STATEMENT OF PROBLEM Restoration of maxillary defects resulting from tumor ablative surgery presents a difficult challenge, with both functional and esthetic issues. Whether rehabilitation with an obturator prosthesis could significantly contribute to improved quality of life in patients with maxillary resection has been scarcely studied, with relatively small study samples. PURPOSE The purpose of this survey study was to assess the overall functioning of the obturator prosthesis and the effect of specific sociodemographic, medical, and treatment variables on obturator functioning and quality of life in patients with maxillectomy. MATERIAL AND METHODS Global quality of life (QOL) and satisfaction with the obturator prosthesis of 57 patients who underwent maxillectomy and prosthetic rehabilitation at the National and Kapodistrian University of Athens were assessed using 3 questionnaires: European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (QLQ-C30), the EORTC QLQ-HN35, and the obturator functioning scale. The data were analyzed using the Kruskal-Wallis 1-way ANOVA on ranks, hierarchical multiple regression analysis, and the Spearman rank order correlation (α=.05). RESULTS Satisfactory functioning of the obturator prosthesis was the most significant predictor of improved QOL (P<.05). QOL was significantly related to additional treatments (P<.05), the size of the primary tumor (P<.05), and the size of the maxillectomy defect (P<.05). The most significant predictors of good obturator functioning were additional treatments (P<.01), age at the time of surgery (P<.05), presence of mandibular teeth (P<.05), and previous maxillary removable prosthetic experience (P<.05). Obturator functioning scale appearance and insertion subscales (r=0.47, P<.01), followed by speech (r=0.42, P<.01), were significantly related to better QOL. CONCLUSIONS A well-functioning obturator prosthesis was the most significant determinant for improved QOL in patients with maxillary resection. Age at the time of surgery, adjuvant treatments, presence of mandibular teeth, and previous maxillary removable prosthetic experience were the most significant predictors for better obturator functioning, whereas the size of the maxillectomy defect had a significant effect on QOL but did not influence the functional outcome.
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Affiliation(s)
- Ioli Ioanna Artopoulou
- Lecturer, Department of Prosthodontics, National and Kapodistrian University of Athens, School of Dentistry, Athens, Greece.
| | | | - Nikolaos Papadogeorgakis
- Professor and Chief, Department of Oral and Maxillofacial Surgery, National and Kapodistrian University of Athens, "Evaggelismos" General Hospital, Athens, Greece
| | - Ioannis Papathanasiou
- Predoctoral student, Department of Prosthodontics, National and Kapodistrian University of Athens, School of Dentistry, Athens, Greece
| | - Gregory Polyzois
- Professor, Department of Prosthodontics, National and Kapodistrian University of Athens, School of Dentistry, Athens, Greece
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Oki M, Kanazaki A, Taniguchi H. Osteoradionecrosis Following Carbon Ion Radiotherapy: Case History Report of a Soft Palate Defect. INT J PROSTHODONT 2017; 29:448-50. [PMID: 27611746 DOI: 10.11607/ijp.4836] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Carbon ion radiotherapy, a form of charged particle radiotherapy that has been used to treat various inoperable and radio-resistant tumors, has been associated with less severe late effects than conventional radiotherapy. A 63-year-old woman with a soft palate defect received carbon ion radiotherapy (total dose: 64 Gray equivalents). Several late effects were observed, and osteoradionecrosis was observed not only on the tumor side but also on the other side and gradually expanded during maxillofacial prosthetic rehabilitation. While the definitive prosthesis improved her speech and eating ability, careful adjustments and close follow-up should continue with respect to postradiation effects.
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Brauner E, Jamshir S, Guarino G, Ciolfi A, Valentini V, Pompa G, Di Carlo S. Pleomorphic adenoma rehabilitative treatment in growing up patient: a 20-years follow-up. Eur Rev Med Pharmacol Sci 2016; 20:3523-3527. [PMID: 27649650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Although tumors of minor salivary glands are rare, the pleomorphic adenoma is the most common pathology among the benign neoplasm and can be found with high prevalence in the junction between hard palate and soft palate. Most of the maxillary tumors are surgically treated through either a total or partial maxillectomy. However, surgical defects lead to both clinical and psychologic disorders for the patient. A postoperative obturator prosthesis is a good option in patients who underwent maxillectomy. It allows to restore both masticatory and speaking functions, as well as aesthetic appearance. When reconstruction of the surgical site is possible, an implant-supported prosthesis can be considered to guarantee a better function and aesthetic's rehabilitation. CASE REPORT This clinical report presents the prosthetic rehabilitation of a patient who underwent maxillectomy because of a pleomorphic adenoma of hard palate minor salivary glands. The patient was treated with a palatal obturator prosthesis first and with an implant-supported prosthesis after surgical site's reconstruction and complete healing. CONCLUSIONS The rehabilitation of the patient after maxillectomy through both these devices was an excellent option and provided clinical benefits, improving the patient's quality of life, allowing the patient's reinsertion into society.
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Affiliation(s)
- E Brauner
- Implantoprosthesis Unit, Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Rome, Italy.
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Dawood A, Kalavrezos N, Tanner S. A New Approach to Implant-Based Midface Reconstruction Following Subtotal Maxillectomy. Int J Oral Maxillofac Implants 2016; 31:e98-e101. [PMID: 27447167 DOI: 10.11607/jomi.4579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This case presentation describes the reconstruction of an extensive maxillary-orbital defect following subtotal resection of the maxilla en bloc with orbital exenteration in a young adult following the diagnosis of chondrosarcoma. A new approach to composite midface reconstruction with dental implants is described, in which computer-guided surgery (CGS) was used to obliquely position dental implants interradicularly in the residual maxilla, such that the implant tips lie in close proximity to the root apices of the remaining teeth. The implants were then used to fixate a milled-titanium bar, fabricated using computer-aided design and manufacture (CAD/CAM), and provided with attachments for the stabilization and retention of a maxillary obturator.
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41
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Sekele IB, Lutula PS, Ntumba MK, Dilu NJ. [Early bucco-naso-sinus communication and shutter prosthetic treatment: About a clinical case]. Odontostomatol Trop 2016; 39:5-8. [PMID: 30230803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The authors describe the early neglected oral communication of maxillary sinus and nasal cavity, causing reflux of liquid and sometimes solids through the nose, followed by immediate intrabuccal flow or posterior pharyngeal with fetidness. The objective of this work was to improve the therapy of immediate or delayed oral communication of maxillary sinus with nasal cavity and eventually and the quality of life.
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42
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Rokhssi H, Azhari M, Benfdil F, Merzouk N, Bentahar O. [Prosthodontic care of orofacial clefts in adulthood: About a clinical case]. Odontostomatol Trop 2016; 39:38-48. [PMID: 30234273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This paper relates, through a clinical case, the different steps of the prosthodontic rehabilitation of a palate-pharyngeal cleft, sequelae to surgery, by performing a Suersen’s Velar obturator since the soft Palate is divided but toned. A functional reeducation in conjunction with a prosthodontic care improves the quality of life’s patients and help for their resocialization. This therapeutic is non-invasive, quick, efficient and evolutive method.
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Artopoulou II, Lemon JC. Prosthetic Rehabilitation of a Complex Maxillofacial Defect as an Alternative to Surgical Reconstruction: A Case History Report. INT J PROSTHODONT 2016; 29:227-9. [PMID: 27148980 DOI: 10.11607/ijp.4553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Free tissue transfers are used to restore maxillofacial resected tissues during tumor ablative surgery. The maxillofacial prosthodontist remains an integral member of the therapeutic team, since conventional retained facial prostheses are in certain cases the most practical, trouble-free, cost-efficient, and successful means of rehabilitation.
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44
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Ali R, Altaie A, Nattress B. Rehabilitation of Oncology Patients with Hard Palate Defects Part 2: Principles of Obturator Design. ACTA ACUST UNITED AC 2016; 42:428-30, 433-4. [PMID: 26964444 DOI: 10.12968/denu.2015.42.5.428] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The first part of this series on the conventional rehabilitation of oncology patients with hard palate defects discussed the dental challenges posed by oncology patients and the surgical/restorative planning interface for conventional dental rehabilitation. This article will describe Aramany's classification of hard palate defects, Brown's classification of palatal defects and focus on the basic principles of obturator design which need to be appreciated when prosthetically rehabilitating a patient with a hard palate defect. CPD/CLINICAL RELEVANCE: A good understanding of basic removable prosthodontic theory relating to denture design, dental materials science and head and neck anatomy is a prerequisite when designing an obturator for a patient.
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45
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Chen C, Ren W, Gao L, Cheng Z, Zhang L, Li S, Zhi PKQ. Function of obturator prosthesis after maxillectomy and prosthetic obturator rehabilitation. Braz J Otorhinolaryngol 2016; 82:177-83. [PMID: 26671022 PMCID: PMC9449036 DOI: 10.1016/j.bjorl.2015.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/28/2015] [Indexed: 12/01/2022] Open
Abstract
Introduction Maxillary defects are usually rehabilitated by a prosthetic obturator. Objective This study aimed to evaluate the functioning of obturators prosthesis in patients with unilateral defects after maxillectomy. Methods Of 49 patients, 28 underwent to maxillectomy as a result of tumor ablative surgery, and acquired unilateral maxillary defects. Evaluation of the function was performed by applying the Obturator Functional Scale (OFS). Results From a total of 49 patients, 28 were treated as follows: 9 with a conventional retained obturator prosthesis (COP), 11 (39%) with an enhanced retentive obturator prosthesis with stud attachment (POP) and 8 (28%) with an enhanced retentive obturator prosthesis with magnetic attachment (POM). The mean OFS score was 80. Scores on functions of speech, swallowing and chewing reached statistical significances (p < 0.05) among these three subgroups. Comparing COP and MOP groups, the scores of OFS in the domains of “Speech-ability to speak in public” and “Swallowing-leakage with liquids” were significantly higher in AOP group. Comparing COP group, the scores of OFS in “Swallowing-leakage with solid” and “Chewing/eating” domains were increased significantly (p < 0.05) both in MOP and AOP groups. Conclusion Obturator prosthesis improves oral function of patients after maxillary defects; the retention of the obturator prosthesis enhanced by the addition of attachments showed more benefits in oral function.
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Affiliation(s)
- Cheng Chen
- Department of Oral Maxillofacial Surgery, Stomatology Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, China
| | - Wenhao Ren
- Department of Oral Maxillofacial Surgery, Stomatology Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, China
| | - Ling Gao
- Key Laboratory of Environment and Genes Related to Diseases, College of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zheng Cheng
- Department of General Dentistry, Stomatology Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, China
| | - Linmei Zhang
- Department of Oral Maxillofacial Surgery, Stomatology Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, China
| | - Shaoming Li
- Department of Oral Maxillofacial Surgery, Stomatology Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, China
| | - Pro Ke-qian Zhi
- Department of Oral Maxillofacial Surgery, Stomatology Hospital of Xi'an Jiaotong University College of Medicine, Xincheng District, China.
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Ali R, Altaie A, Nattress B. Rehabilitation of Oncology Patients with Hard Palate Defects Part 3: Construction of an Acrylic Hollow Box Obturator. ACTA ACUST UNITED AC 2015; 42:612-4, 616, 618-20. [PMID: 26630859 DOI: 10.12968/denu.2015.42.7.612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article will discuss the clinical stages in the fabrication of a definitive acrylic hollow box obturator to restore a hard palate defect. The first two papers described the restorative/surgical planning phase and the principles of obturator design. CPD/CLINICAL RELEVANCE: Each of the clinical stages required to make a hollow box obturator must be performed to the highest possible standard to ensure than an optimal prosthesis.is fabricated.
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47
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Bourne GK, Barber AJ, Wilson PHR. Cast Titanium for Obturator Framework Construction in Maxillofacial Prosthodontics. Eur J Prosthodont Restor Dent 2015; 23:213-218. [PMID: 26767244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 37 year old male presented with the complaint of a loose and bulky acrylic obturator prosthesis. He had previously tried to using a different acrylic obturator prostheses as well as both cobalt chromium and titanium framework obturators. The most successful previous prosthesis was a titanium based obturator which had performed well prior to a fractured clasp. Accordingly, following an exploration of the available surgical and prosthodontic treatment options, a further tooth borne partial maxillary obturator was provided successfully. The case highlights the relative merits and limitations of the use of cast titanium as a denture base material in partial denture and obturator construction.
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Aljadeff L, Fisher CA, Wolf SL, Byrd KM, Curtis W, Ward BB, Munz SM, Fullen DR, McHugh JB, Danciu TE. Red exophytic mass of the maxillary anterior gingiva. Oral Surg Oral Med Oral Pathol Oral Radiol 2015; 122:379-84. [PMID: 26906949 DOI: 10.1016/j.oooo.2015.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 11/10/2015] [Accepted: 11/12/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Lior Aljadeff
- University of Michigan School of Dentistry, Ann Arbor, MI, USA; current address: Oral and Maxillofacial Surgery Division, UT Southwestern Medical Center, Charles Sprague Clinical Sciences Building, 3rd Floor, Suite CS3, 104, 5161 Harry Hines Blv., Dallas TX 75390
| | - Clayton A Fisher
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA
| | - Steve L Wolf
- Private Practice, Legacy Periodontics & Implant Center, Novi, MI, USA
| | - Kevin M Byrd
- Department of Pathology and Laboratory Medicine, The University of North Carolina, Chapel Hill, NC, USA
| | - William Curtis
- Department of Oral and Maxillofacial Surgery, University of Kentucky Hospital, Lexington, KY, USA
| | - Brent B Ward
- Department of Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan Health System, Ann Arbor, MI, USA
| | - Stephanie M Munz
- Department of Oral and Maxillofacial Surgery/Hospital Dentistry, University of Michigan Health System, Ann Arbor, MI, USA
| | - Douglas R Fullen
- Department of Pathology, University of Michigan Health System, University Hospital, Ann Arbor, MI, USA
| | - Jonathan B McHugh
- Department of Pathology, University of Michigan Health System, University Hospital, Ann Arbor, MI, USA
| | - Theodora E Danciu
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, MI, USA.
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Srivastava N, Bansal V, Kantoor P. Palatal Mucormycosis in An Infant. J Dent Child (Chic) 2015; 82:153-156. [PMID: 26731251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The maxilla rarely undergoes necrosis due to its rich vascularity. Maxillary necrosis can occur due to bacterial infections, viral infections, or fungal infections. Mucormycosis is an opportunistic fulminant fungal infection that mainly infects immunocompromised patients. The fungus invades the arteries, leading to thrombosis that subsequently causes necrosis of hard and soft tissues. The occurrence of mucormycosis is not considered rare in the jaws of adults, but involvement of the maxilla in infants is not usually seen. The purpose of this report is to discuss the diagnosis and management of a rare case of mucormycosis in the palate of a two-month-old boy.
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Affiliation(s)
- Nikhil Srivastava
- Department of Paedodontics and Preventive Dentistry, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India.
| | - Vishal Bansal
- Department of Oral and Maxillofacial Surgery, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Pallavi Kantoor
- Department of Paedodontics and Preventive Dentistry, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
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Manosudprasit M, Chongcharueyskul P, Wangsrimonkol T, Pisek P. Presurgical Nasoalveolar Molding Techniques for a Complete Unilateral Cleft Lip and Palate Infant: A Case Report. J Med Assoc Thai 2015; 98 Suppl 7:S234-S242. [PMID: 26742395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this article was to present a modified protocol and devices of presurgical nasoalveolar molding techniques to improve deformity of lip, nose and alveolus at Department of Orthodontic, Khon Kaen University (KKU). This new protocol was developed in order to address nasal problems as early as possible with a new extra-oral type of nasal molding device, "forehead type of nasoalveolar molding device". Extra-oral strapping was applied to approximate lip segments and also help to reduce alveolar cleft rapidly. The remaining alveolar cleft was reduced till completely, using alveolar molding plate with traction screw. The forehead type of nasal molding device could be used continuously after cheiloplasty to maintain nasal configuration until the secondary palate repaired. A case of complete unilateral cleft lip and palate girl was presented to clearly demonstrate treatment steps and results of lips, nose and alveolus after being treated with this new presurgical nasoalveolar molding protocol and devices for a period of four months.
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