Rehabilitation of post surgical maxillectomy defects using interim obturators-a case series

Abstract

Prosthetic rehabilitation of extensive maxillectomy defects are exigent given the difficulties faced due to loss of palatal bone,teeth and surrounding supporting tissues which help in retention, support and stability of the prosthesis. An interim maxillary obturator is a prosthesis which is made after surgical resection of a portion or all of one or both maxilla where initial healing is completed. Frequently many or all teeth in the defect area are replaced by this prosthesis. It plays a vital role in preventing the facial disfigurement and irritation to the surgical site thereby enhancing the healing and restores the functional capabilities such as speech, mastication, deglutition etc. To gain better retention and stability, preservation of the unaffected regions is needed which can be achieved by proper surgical planning and designing of the prosthesis. This case series describes rehabilitation of three extensive maxillectomy defects with hollow open and closed interim obturators.

Keywords: Hollow bulb; Interim obturator; Squamous cell carcinoma; Surgical obturator.

Fig. 1

Pre-operative MRI showing the tumor extension

Fig. 2

Custom made acrylic stent and impression of bulb with the help of the stent

Fig. 3

Impression of the bulb with alginate pick up impression reoriented

Fig. 4

The palatal plate and the inner bulb

Fig. 5

Post operative defect and the obturator lined with soft liner in place

Fig. 6

Post operative defect extension

Fig. 7

First interim obturator

Fig. 8

Final interim obturator

Fig. 9

Pre-operative ulcerative lesion in premaxilla and post operative defect extensions

Fig. 10

Modified surgical obturator and Putty with medium body impression using the surgical obturator as tray

Fig. 11

First total hollow interim obturator

Fig. 12

Final interim open bulb hollow obturator in place