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Faciomaxillary prosthesis in rehabilitation

This is a study done in the Department of Dental Surgery, Govt.Stanley Medical College Chennai, on prosthetic rehabilitation of patients with a residual defect on the face following treatment of maxillary tumours with maxillectomy. The study aimed at analyzing the tissue changes from the preoperative condition of the patient to the post-operative state followed by post-radiotherapy state and the materials used in fabrication of the prosthesis. It was found that there was a progressive decrease in mouth opening and the resilience of the buccal mucosa following surgery and radiotherapy which adversely affected the impression and fabrication of the prosthesis. This necessitates the use of advanced impression materials like elastomers, and lining of the obturator with soft liner to prevent stress on the mucosa which in turn adds to the cost of the procedure. This study also took into consideration the important factors which affect the retention of the obturator such as the size of the defect present postoperatively, and the presence of teeth. If there are sufficient numbers of healthy teeth, the obturator can be effectively clasped to increase its functional efficiency. In case of a completely edentulous maxilla, where there are no teeth to help in retention, the obturator will have to be fixed to the maxilla by circumzygomatic wiring. In spite of all these factors the success of an obturator depends on its acceptance and usage by the patient. So we analysed the psychological impact the obturator has on the patient. We concluded that initially, the patients experience a lot of difficulty in wearing an obturator because of the sudden change in the pattern of eating and swallowing. But they overcome it gradually and successfully and learn to make the best use of the obturator. After analyzing the pros and cons we have formulated a protocol beginning from pre surgical assessment to post-operative rehabilitation, as every case has got its own variations on the design as well as in the material used.

Author(s): Prasad c Parimala V Vijjaykanth M Sivakumar P