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7/23/2019 Oral Prosthetic in Head and Neck Reconstructions (Presentation)
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Oral Prosthetic in Head andNeck Reconstructions
Jacques Peltier, MD
Faculty Advisor: Anna M. Pou, MD
The University of Texas Medical Branch
Department of Otolaryngology
Grand Rounds Presentation
November 2003
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Preoperative evaluation
Evaluation by surgeon
History, Physical
Endoscopy
Biopsy
CT
MRI
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Preoperative Evaluation
Evaluation by Maxillofacial Prosthodontist
Dental health status (Carries)
Panorex
Extraction?
Preoperative Dental Molds
Surgical suggestions
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Surgical Strategies
Resection limited to disease only
Avoid hemimaxillectomy if possible
Preserve alveolar ridge
Preserve central incisors
Preserve tuberosity
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Surgical Strategies
Resection through socket of extracted
tooth
Prevents additional loss of teeth
Preservation of strip of mucosa
Used for coverage of bone
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Surgical Strategies
Skin grafting of maxillary cheek
Resection of inferior turbinate
Skin grafting to contact areas of obturator
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Final position of
obturator.
Note retention
dependent on contactwith maxillary sinus.
Skin grafting to area
of contact prevents
complications
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Classification of obturators
Surgical
Postsurgical
Definitive
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Surgical Obturator
Designed preoperatively
Installed sterilely
Scaffolding for packing Increases postoperative function
Psychological advantage for patient
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Surgical obturator design
Communication between surgeon and
prosthodontist
Anticipated defect
Method of securing surgical prosthetic
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Surgical Obturator Design
Minimal resection coverage
May have incomplete coverage, exposed
packing, poor fit
No need for modification
Radical resection coverage
May require intraoperative modifications by
surgeon
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Methods to secure
surgical obturator
Palatal bone screw
Suturing
Circumzygomatic wiring
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Postsurgical obturators
Used from packing removal to 3-12
months post-op
Bulb extension into defect
Contact with remaining teeth important
Anterior teeth only
Avoid occlusive relationship
Tissue-conditioning/soft reline material
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Definitive obturator
Placed after tissue remodeling a minimum
Occlusive relationship important.
Modifications a minimum
Removable to allow cleaning
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Edentulous patient
Resection of inferior turbinate
Skin grafting of contact areas
Tri-poding effect
Spring loaded dentures
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The Irradiated Patient
When to remove teeth
Dental health
Reliability of the patient
Location of teeth in question
Area to be radiated
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Preservation of Maxillary teeth
Pre-extraction antibiotics
Experienced Oral surgeon
Osteoradionecrosis in 1-30%
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Common Complications
Xerostomia
Trismus
Mucositis
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Xerostomia
Salivary rates as low as 1%
Artificial saliva
Topical sodium fluoride
• Custom tray
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Mucositis
Erethema, tenderness, desquamation as
early as 2 weeks
Decrease oral intake
Unable to tolerate obturator
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Treatment of Mucositis
Good oral hygiene (soft brush, mild
toothpaste)
Sodium bicarbonate, H2O2 rinses
Benadryl elixirs
Sucrafate solutions
Topical anestheticsG-tube placement
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Trismus
Fibrosis of muscles of mastication, TMJ
Daily exercises required for long periods of
time
Prolonged holiday from exercises results
in permanent fibrosis
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Conclusion
Early consultation with Maxillofacial
Prosthodontist
Surgical planning to include post-operative
rehabilitation
Communication throughout treatment
process
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