1、Maxillofacial Prosthetic Rehabilitation of the Head and Neck Cancer Patient,Maureen Sullivan DDS Chief, Dept of Dentistry Dental Oncology and Maxillofacial Prosthetics Erie County Medical Center,Dental Team,Dentists Maxillofacial Prosthodontists Hygienists Maxillofacial Laboratory Technicians Dental
2、 Assistants,Maxillofacial Cancer: affects everyone differently,Facial Disfigurement Individual Differences in Patient Response Extent and Location of Defect Radiation and Chemotherapy Age Functional Disabilities,Famous Head and Neck Cancer Patients,Sigmund Freud Cancer of the Hard palate 33 operatio
3、ns Radiation therapy Large defect Called his prosthesis- the monster,Grover Cleveland Cancer of the hard palate 1 cancer operation No additional therapies Spoke before Congress 2 mos following surgery,Functional Disabilities- Oral and Oral Pharyngeal Acquired Defects,Inability to Control Saliva Oral
4、 Incontinence Inarticulate Speech Nasal Leakage Compromised Swallowing Mandibular Deviation Inefficient Mastication Xerostomia- Lack of Saliva,Types of Prosthetics,Intraoral ProstheticsExtra oral Prosthetics,Reasons,NeoplasticTraumaCongenital,Types of Prosthetics,FunctionalCosmeticTreatment,Intraora
5、l Prosthetics,Maxillary Mandibular,Maxillary Prosthetics,ObturatorSpeech Aid,Obturator Prosthesis,Used to correct acquired defects of the maxilla, hard palate Occludes a surgical defect to create more normal speech and swallowing,Obturator Prosthesis,Surgical IncisionsRemaining Oro Nasal Defect,Hard
6、 Palatal Defect,3 Phases of Obturator Fabrication for Acquired Defects of the Maxilla,Immediate Surgical Obturator Interium Obturator Prosthesis Definitive Obturator Prosthesis,Immediate Surgical Obturator,Designed and fabricated prior to maxillectomy Affords patient the ability to speak following s
7、urgery Provides positive pressure on packing and skin grafting Prevents fluid leakage into the nose,Immediate Surgical Obturator,Immediate Surgical Obturator,Design completed prior to ablative surgery Close communication with the surgeon,Immediate Surgical Obturator,Restore oral function to reasonab
8、le levels during the initial post surgical period,Maxillary Interium Obturator,Placed shortly after surgery Used throughout the healing phase Can modify and existing denture if available,Maxillary Interium Obturator,Maxillary Interium Obturator,Modification of an exisitng partial denture Extension i
9、nto the soft palate,Maxillary Interium Obturator,Maxillary Interium Obturator,Clasp assembly is used to aid in retention Soft liner is used to provide a seal during function Provide pt with comfort and function until healing is complete,Definitive Obturator Prosthesis,Design is determined by the siz
10、e of the defect, presence of teeth, and trismus May be complete or partial May be hollow or solid Timing of fabrication depends upon healing and secondary treatments Defect must be dimensionally stable,Defects- Small or Large,Larger Defect- Larger Challenge,Total Maxillectomy Defect,Two Part Obturat
11、or Prosthesis,Definitive Two Part Obturator Prosthesis,Maxillary Speech Aid Prosthesis,Used to Reconstruct Acquired Soft Palatal Defects Surgical Resection of the Soft Palate Creates Velopharyngeal Insufficiency Usually extends into the Pharynx,Unreconstructed Cleft Palates Require Speech Aids,Varia
12、bilities in Velopharyngeal Closure,Individual Variation Task Related Sex Related Age Related Head Position,Muscles Involved in Velopharyngeal Closure,Levator veli PalatiniUvular Superior Constrictor,Levator veli palatini- insertion is the middle 1/3 of the soft palate,Nerve Supply to the Velopharyng
13、eal Musculature,Pharyngeal Plexus IX, X, XI (mostly X, the vagus nerve)Exceptions- V2- Tensor Veli Palatini,Small Soft Palate Defect,Speech Aid Prosthesis,Palatal Portion- Maxillary DenturePharyngeal ExtensionSpeech Bulb,Speech Aid Bulb,Bulb is shaped by functional Impression of the Superior Pharyng
14、eal Constrictor Muscle,Maxillary Speech Aid Prosthesis,Bar Extending into the Pharynx,Palatal Augmentation Prosthesis,Prosthesis that reconstructs the function of the tongue and floor of the mouth Glossectomy patients lose the ability to swallowchewclear the buccal vestibulespeak clearly,Partial Glo
15、ssectomy,Residual Tongue in Function,Palatal Aumentation Prosthesis,Tongue Remnant Contacts the Maxillary PortionFloor of Mouth is extended with the Mandibular Portion,Palatal Augmentation Prosthesis may Stimulate Tongue Movement,Maxillary Prosthetics and Speech Performance,Is affected by the weight
16、 of the prosthesis May relate to the extension superiorly into the defect May relate to the shape of the superior surface of the prosthesis,Quality of Maxillofacial Prosthetic Rehabilitation,Most pts with acquired maxillary surgical defects can be restored to normal function Pts with composite surgical resections including the mandible, tongue, FOM, demonstrate more lingering functional disabilities,
