Optimization of maxillary obturator thickness using a double. The obturator enables the patient to speak more effectively by reproducing normal palatal contours and by covering the defect. A new maxillary obturator prosthesis was constructed for an old obturator wearing patient using a pickup impression technique and bite registration with his previous prosthesis. Inflatable hollow obturator prostheses for patients undergoing an extensive maxillectomy. Intervention nine fibular, 11 rectus abdominus, 3 scapular, 6 radial forearm, and 1 latissimus dorsi free flaps were used to reconstruct these defects. It is necessary for the production of intelligible speech. Nov 15, 2014 an obturator is that component of a prosthesis, which fits into and closes a defect within the oral cavity or another body defect. A soft palate or velopharyngeal obturator speech and feeding aid device replaces the missing part of muscles, fills the defects and.
Palatal obturators are typically shortterm prosthetics used to close defects of the hardsoft palate that may affect speech production or cause nasal regurgitation during feeding. Implantretained obturator for an edentulous patient with. Rehabilitation with an obturator prosthesis is functional, reliablesafe, easy to build and has a low level of invasiveness. Acquired palatal defects resulting from hemimaxillectomy may cause major difficulties with speech. Pdf obturator with soft liner in the management of hard. The feeding obturator restores the separation between the oral and nasal cavities. Maxillofacial obturator an overview sciencedirect topics. Once tooth position and palatal contours have been optimized, the obturator is festooned, and the internal aspect of the bulb is lined with dental stone and packed with silicone putty labputty. The palatal contour on the defect side was formed as a continuation of the palatal form on the normal side. The base was made slightly concave along the borders in the region of right canine.
A 55yearold edentulous turkish female patient with a congenitally maxillary defect was rehabilitated with an open hollow obturator prosthesis. Maxillary obturator prosthesis for a hemimaxillectomy patient. Support is supplied by the remaining natural teeth via widely separated and bilaterally located rests. A temporary or interim prosthesis used to close a defect in the hard andor soft palate. Obturator meaning in the cambridge english dictionary. Constuction of the obturator prostheses and providing the patients comfort with them are very difficult. The use of metallic denture base in the maxillary denture further lightened the prosthesis and increased not only the retention of the denture but also the comfort of the patient. According to the glossary of prosthodontic terms obturator is defined as prosthesis used to close a congenital or a acquired tissue opening, primarily of hard palate and or contigious alveolar structures. For both aesthetic and retention consideration in august of 2004, a new obturator prosthesis was fabricated by sol.
This case report describes the case of carcinoma of maxillary sinus, which is rehabilitated with. This paper describes a clinical report of fabricating a definitive obturator with a cast metal framework using a single flask and onetime. A new retainerfree obturator prosthesis that closes only the defect cavity and is retained by undercuts within the defect was designed and proved useful for problems caused by a claspretained obturator prosthesis for a fully dentulous patient with palatal defects. The layer of silicon closes the defect also in the absence of a prosthesis, thereby permitting the. This report describes a novel method for occluding an anterior palatal fistula in patients with cleft palates. Im the speech pathologist at one of the largest mdaals clinics in the country. Fifteen patients who had undergone palatectomy or maxillectomy for carcinoma and subsequent obturator prosthesis placement were retrospectively studied.
To physically occlude the fistula in the soft palate, an obturator type prosthesis was fabricated. The palatal island flap for reconstruction of palatal and. An interim obturator prosthesis is normally placed 7 to 10 days after surgery. Patient smiling with the obturator prosthesis in the mouth. Use of palatal augmentation prostheses to maintain speech.
Apr 12, 2014 definition the name obturator is derived from the latin verb obturare which means close or to shut off. Patients with palatal defects labor under handicaps that cannot be fully appreciated by those with normal palates. They are similar to dental retainers, but without the front wire. Rehabilitation of a congenital palatal defect with a. Malignant tumors of sinonasal tract constitutes less than 1% of all malignancies in the body and about 3% of head and neck cancers. The obturator may be placed immediately after surgery or seven to ten days post surgically. Clefts of lip and palate are the most common congenital deformities involving the orofacial region feeding problems are often associated with cleft anomalies due to communication between oral cavity and nasal cavity, which make it difficult for the infant to maintain adequate nutrition. Singlestep fabrication of a new maxillary obturator prosthesis. In this clinical scenario, the fabrication of the framework design and the precision attachment is similar to a conventional twopiece hollow bulb. An obturator is that component of a prosthesis, which fits into and closes a defect within the oral cavity or another body defect. The obturator lessens the psychological impact of surgery by making the postoperative course easier to tolerate. The defect was recorded in alginate impression material and full extension palatal plate was fabricated in acrylic resin. Closure of palatal defects with prosthetics has been described. The resulting surgical defect produces an oroantral communication.
Scribd is the worlds largest social reading and publishing site. Ct imaging features of obturator prostheses in patients. The palatal island flap, first applied to the reconstruction of the retromolar trigone and palatal defects, was first described by gullane and. B d aspect of the total obturator prosthesis just over 2 years after its installation. A retainerfree obturator prosthesis in a fully dentulous. An obturator is a prosthesis which is fabricated for the patients with the palatal defects in the form of cleft lip and palate, oroantral fistula or surgical resection after removable of pathology. This article is from international journal of clinical pediatric dentistry, volume 5. Abstractfeeding a neonate with a complete cleft lip and palate is.
Ambrose pare, a french surgeon treated palatal perforations using an obturator. Here we present a case of cleft lip and palate for which a feeding obturator was made to facilitate feeding till the defect could be surgically repaired. The use of an obturator for speech is analogous to wearing eyeglasses to compensate for visual defects. Palatal obturator, a dental prosthesis used to seal an opening in the palate, i. Despite the retention difficulties of the prosthesis inherent to patients with a palatal cavity 2, rehabilitated patients rarely report this complaint. Prosthodontic rehabilitation for edentulous patients with palatal. Obturator fabrication and management for velopharyngeal. Considering the socio economic status and the clinical condition of the patient, it was decided to fabricate the precision attachment retained palatal obturator. The surgical obturator was inserted immediately after resection of the maxilla and held in position.
Gynecare tvt obturator system is a transobturator midurethral sling used for the treatment of female stress urinary incontinence. This was the area around which the prosthesis was planned to turn inside the mouth during insertion and removal figure 3. The dentition is usually preserved, making this obturator prosthesis design simple and effective. May 29, 2009 the type of palatal obturator, we now use, is defined as selfstabilizing by j. In palatal obturator prostheses, the total number of colonising microorganisms showed no significant differences between the groups with and without dry mouth on each side of the prostheses. The design was modified by placing orthodontic wire on the acrylic plate for attaching the ties of mouth. Singlestep fabrication of a new maxillary obturator. An obturator is a removable prosthesis used to close the palatal or maxillectomy defect. Hi, im responding because a patients spouse was inquiring about a palatal prosthesis at als clinic last week. Obturator prosthesis utilizing conventional acrylic and wire clasping with obturation for her maxillary defect was constructed. Cdt codes page 2 of 29 unitedhealthcare medicare advantage policy appendix. Pdf feeding obturator for a 3 day old neonate with cleft. Incisions can be made at the junction of the hard and soft palate and within 5 mm of the dentition.
Palatal obturators free download as powerpoint presentation. It may replace tissue lost due to developmental or surgical alterations. Definitive obturator fabrication for partial maxillectomy. Using this technique, the thickness of obturator walls and palate are reduced to less than 1 mm, resulting in a signi. Applicable code list approval 12112019 proprietary information of unitedhealthcare. In case 2, a congenital cleft palate in a 65yearold man was repaired by a maxillary complete denture with superior extension of the obturator.
Post dam carving and final wax up with full palatal coverage was done. Magee g, roy s, hinoul p, moretz c, kozarev r, waters h, whitmore k. The obturator sounds like a film title from the latin. Tokuyama dental corp, which adhered to the acrylic resin palatal plate with a bonding agent and several retention holes.
After detailed discussion and explanation to the patient, a palatal obturator was planned. Aesthetic rehabilitation of a patient with an anterior. The obturator prosthetic maxillectomy will nickson. A 50yearold female patient presented complaining of nasal regurgitation and looseness of her current palatal obturator. Rehabilitation of surgically resected soft palate with interim.
A palatal obturator can improve speech, proper air flow, eating, reduce regurgitation. The fabrication process and obturator use vary depending upon needs of the patient. The prosthodontist plays an important role in the rehabilitation of such defects with obturators. Palatal obturators are typically shortterm prosthetics used to close defects of the hardsoft palate that may affect speech production or cause nasal. Apr, 2015 prosthodontic management of palatal defects has been employed for many years, in fact maxillary obturator prosthesess history is well documented. There are fewer overall complications than with other transobturator procedures. The nance obturator, a new fixed obturator for patients with. Inflatable hollow obturator prostheses for patients undergoing an. Wed like to understand how you use our websites in order to improve them.
Optimization of maxillary obturator thickness using a. Aesthetics, maxillectomy, palatal obturator, plasticbased, squamous cell carcinoma. They made her obturator before the surgery and it was attached she says my screws inside i guess to her upper jaw. Vertical and horizontal extension of the lateral walls of the obturator can be maximized without additional increase in weight. This case study reports on the design and construction of a removable speech bulb obturator. Oral cancer is one of the more common malignanciesif detected lately massive tissues will be excised surgically and correction will. Implantretained obturator for an edentulous patient with a. Primary and the most important stage for these prostheses is to perform a proper impression. It is defined as a temporary prosthesis used to restore the continuity of the hard palate immediately after surgery or traumatic loss of a portion or all of the hard palate or contiguous alveolar structure. Fifteen patients who had undergone palatectomy or maxillectomy for carcinoma and subsequent obturator prosthesis placement. Pdf surgical treatment for palate cancers can result in oralnasalsinus. The cast partial framework included a complete palate design with embrasure clasps on the remaining posterior abutment teeth on the left side of the maxillary arch.
Soft obturator prosthesis for postoperative soft palate. The use of a palatal platetype obturator in patients with palatal defects is a common procedure. Rehabilitation of surgically resected soft palate with. Quality of life and problems associated with obturators of.
The immediate problem to be addressed in a new born with cleft lip and palate is the interference of feeding. An update nikhil srivastava1 and preetika goyal2 1principal, professor and head, peaedodontics and preventive dentistry, subharti dental college and hospital, sv subharti university, meerut up, india 2paedodontics and preventive dentistry, subharti dental college and hospital, sv subharti. An obturator is that component of a prosthesis, which. Maxillectomy defects can result in oroantral communication that causes difficulty in mastication and deglutition, impaired speech, and facial disfigurement. The new design for a fixed obturator is based on the nance appliance, which was originally used as a space maintainer, but has been redesigned for closing an anterior palatal fistula in a patient with cleft lip and palate. In raising the palatal island flap, incisions are made according to the amount of donor tissue required to resurface the oral defect. I have never worn a brace or had any false teeth, so i had no personal reference. Palatal view of the obturator showing the air valve. Considerations for freeflap reconstruction of the hard. Quality of life and problems associated with obturators of patients. The basic steps in fabricating an obturator are making a maxillary dental appliance, modifying the appliance to desensitize the soft palate and extend into the velopharyngeal gap, and creating a speech bulb of a custom shape, position, and size. The sensate nature of the palatal island flap provides an added functional benefit to oral cavity reconstruction. Therefore, a new palatal obturator was made still using pmma but with an addition of an indirect soft acrylic resin over. Class iii class iii involves a midline defect of the hard palate and may include a variable portion of the soft palate as well.
It consisted of a palatal plate, 4 wire clasps, and a flexible structure similar to a palatal lift, composed of soft silicone sofreliner medium soft. The obturator permits deglutition, thus the nasogastric tube may be removed at an earlier date. A palatal obturator is a prosthesis that totally occludes an opening such as an oronasal fistula in the roof of the mouth. The obturator prosthesis is used to restore masticatory function and improve speech, deglutition and cosmetics for maxillary defect patients. Carcinoma of maxillary sinus is a common sinonasal tract tumor. Obturator prostheses for hemimaxillectomy patients keyf. A prosthesis used to close a palatal defect in a dentate or edentulous mouth is referred to as an obturator. In the past, various methods have been used to restore the maxillary defect using silicon bulb obturators, implantsupported obturators, and cast metal obturators. Therefore, a new palatal obturator was made still using pmma but with an addition of an indirect soft acrylic resin over the defect areas.
Openings in the hard and soft palate may affect speech or cause nasal regurgitation during feeding. Dichamp and has a silicon portion which adapts perfectly to the maxillectomy and a device on the opposite surface which anchors the dentures in acrylic resin 5. Patients thirty patients had hard palatal defects that resulted from ablative oncologic surgery. The shape of the palatal obturator was modified to facilitate the easy placement and removal of the prosthesis. Maxillary defects are created following surgical treatment of patients with congenital defects, trauma, or neoplasm. Precision attachment retained palatal obturator in a. A prosthesis used to close a palatal defect in a dentate or edentulous mouth is called an obturator from the latin word obturare, meaning to close up and is a disc or plate, natural or artificial, that closes an opening or defect of the maxilla as a result of a cleft palate or partial or total removal of the maxilla because of a tumour. She has a temporary obturator but it does not go far enough into the throat and so food comes out her nose all the time. A palatal obturator is a prosthesis that can be used to close defects such as an opening in the roof of the mouth. Effects of the obturator type palatal augmentation prosthesis pap as shown by fibreoptic endoscopic examination of swallowing. Background although a host of local soft tissue flaps have been described for the reconstruction of postoperative palatal defects, tissueborne palatal obturators remain the most common form of rehabilitation of these defects. Heres the scoop on a palatal prosthesis or obturator. The nance obturator, a new fixed obturator for patients.
I dont know anyone who wears an obturator so i was a little concerned about the whole thing. A simplified technique for constructing one piece hollow obturator. The patient was understandably unhappy with the esthetics and retention. Cureus split hollow bulb obturator to rehabilitate. The difficulties mostly reported by patients were food reflux in the first case, which was due to the overextension of the prosthesis basis and obturator, which was solved by polishing. The presence of a large palatal or maxillary defect after partial or total maxillectomy for tumor, trauma or congenital. Palatal tumors are often treated with palatectomy or maxillectomy. The oral part of the obturator included a splinted metal ceramic prosthesis with a ball attachment rhein 83, new york, usa on the left maxillary central incisor. Wu and scaaf showed that hollowing the obturator for partial maxillectomy patients significantly decreased the weight of the obturator by 6. The main challenge resides in the proper management of problems such as regurgitation and nasal voice, particularly if the patient uses a palatal plate kind of denture obturator, which, when in function, often causes the denture to move.
1184 756 1460 255 1597 832 539 857 36 1333 1261 241 59 457 496 760 1309 1166 1096 1470 838 925 594 211 466 521 154 1060 918 83 46 1211 868 34 1470