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Table of Contents   
EMERGING TECHNOLOGY AND TECHNIQUES  
Year : 2019  |  Volume : 30  |  Issue : 1  |  Page : 133-134
Surgical retention for immediate obturator in maxillectomy patients


1 Department of Dental Surgery, Government Royapettah Hospital, Chennai, Tamil Nadu, India
2 Department of Prosthodontics, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India
3 Chettinad Dental College and Research Institute, Kancheepuram, Tamil Nadu, India

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Date of Web Publication20-Mar-2019
 

   Abstract 

Total maxillectomy for patients with malignant lesions will often incapacitate the patient both functionally and aesthetically. An immediate surgical obturator prosthesis would be of utmost importance for patients in these critical situations to aid in deglutition, phonetics, respiration and effectively avoiding various post-surgical complications. This article emphasizes on utilizing circum-zygomatic wiring for retention of the immediate surgical obturator in cases of total maxillectomy or edentulous patients.

Keywords: Circum-zygomatic wiring, immediate obturator, immediate surgical obturator prosthesis, maxillectomy, suspension wiring

How to cite this article:
Appadurai R, Lingeshwar D, Dilshad B, Maria S. Surgical retention for immediate obturator in maxillectomy patients. Indian J Dent Res 2019;30:133-4

How to cite this URL:
Appadurai R, Lingeshwar D, Dilshad B, Maria S. Surgical retention for immediate obturator in maxillectomy patients. Indian J Dent Res [serial online] 2019 [cited 2019 Oct 17];30:133-4. Available from: http://www.ijdr.in/text.asp?2019/30/1/133/254505

   Introduction Top


Total maxillectomy entails resection of the entire maxilla, including the orbital floor and the ethmoid sinuses. It may even extend to include zygoma and pterygoid plates depending on the extent of the lesion. The ensuing surgical defect results in an enormous oro-antral and oronasal communication.[1] Prosthetic rehabilitation of these defects with immediate surgical obturator is of paramount importance in preventing post-operative complications such as mastication, phonation, deglutition and respiration and protects the surgical site during the initial healing period.[2] This article describes in detail about the surgical technique used for retention of the immediate surgical obturator prosthesis (ISOP) for total maxillectomy and edentulous patients, as these situations are challenging due to the lack of any retentive abutments which could be used as in the case of segmental resection.


   Technique Top


  1. Do a pre-operative assessment. Make primary impression of the maxillary ridge with perforated metal stock trays using irreversible hydrocolloid material (Tropicalgin, IDS DENMED Pvt Ltd.,) and disinfect the impression using 2% glutaraldehyde
  2. Pour the casts with Type III dental stone (Goldstone, ASIAN chemicals) [Figure 1]a and [Figure 1]b
  3. Retrieve the cast and fabricate the obturator with clear auto polymerizing resin (DPI Cold Cure pink; Dental products of India) [Figure 2] and [Figure 2]b
  4. Place four metal hooks with two hooks for right side and two for the left side, respectively, on the intaglio surface of palatal portion of the obturator for suspension wiring [Figure 2]a and [Figure 2]b
  5. Disinfect the obturator using 2% glutaraldehyde solution
  6. Perform Bilateral Circum-Zygomatic wiring with a zygomatic awl by piercing through buccal vestibule into the medial surface of the intact zygomatic arch exiting on the malar region
  7. Sling a 26-gauge stainless steel wire to it and use the same exit wound to bring the wire around the zygomatic arch on the lateral surface
  8. Pass the wires through the hooks placed on the immediate surgical obturator prosthesis
  9. Fill the defect with impression compound and fix the obturator with the retentive wires [Figure 3]a and [Figure 3]b.
Figure 1: (a) Primary Cast A-total maxillectomy. (b) Primary Cast B-edentulous maxilla

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Figure 2: (a) Immediate surgical obturator prosthesis with palatal hooks A. (b) Immediate surgical obturator prosthesis with palatal hooks B

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Figure 3: (a) Immediate surgical obturator prosthesis A with circum-zygomatic wiring in situ. (b) Immediate surgical obturator prosthesis B with circum-zygomatic wiring in situ

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This is an easy way for obtaining retention in the initial healing period. The suspension wires can be untwisted and the ISOP is removed and debrided in the post-operative period [Figure 4]. The ISOP can be retained for a period of one to two weeks as advised by the surgical oncologist. The suspension wires can be removed at a later date under local anaesthesia as a chair side procedure.
Figure 4: Two weeks postoperative of immediate surgical obturator prosthesis B

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   Discussion Top


For the obturator prosthesis, retention must be defined as both resistance to displacement along the path of insertion and resistance to the rotational displacement out of the defect due to the force of gravity and function of the surrounding tissues around the obturator.[3] In edentulous and total maxillectomy patients, retention can be acquired with the help of palatal bone screws, screw-shaped titanium implants, sutures into the surrounding mucosa and suspension wiring such as circumzygomatic wiring. The problem ascends when the patient has severe bone atrophy where it does not permit placement of implants or screws for the retention of the ISOP.[4] In such circumstances, fixing the ISOP using circumzygomatic wiring is the best option and no special instruments are required and the cost of the materials needed are relatively lesser for this technique when compared to implants and screws.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Johan Fagan: Total Maxillectomy and Orbital Exenteration, Open Atlas of Otolaryngology, Head and Neck Operative Surgery. Available from: https://vula.uct.ac.za/access/content/group/ba5fb1bd-be95-48e5-81be-586fbaeba29d/Total%20Maxillectomy%20and%20Orbital%20Exenteration.pdf. [Last accessed on 2018 Aug 11].  Back to cited text no. 1
    
2.
Omondi BI, Guthua SW, Awange DO, Odhiambo WA. Maxillary obturator prosthesis rehabilitation following maxillectomy for ameloblastoma: Case series of five patients. Int J Prosthodont 2004;17:464-8.  Back to cited text no. 2
    
3.
Iqbal Z, Raza Kazmi SM, Yazdanie N, Mehmood Z, Ali S. Maxillary obturator prosthesis: Support and retention case series. Pak J Med Sci 2011;2:394-9.  Back to cited text no. 3
    
4.
Rizzo R, Maglione M, Tofanelli M, Tirelli G. Immediate obturator stabilization (ISO) in severely atrophic edentulous maxilla: Suspension wiring technique. Am J Otolaryngol 2016;37:125-7.  Back to cited text no. 4
    

Top
Correspondence Address:
Dr. D Lingeshwar
Department of Prosthodontics, Tamil Nadu Government Dental College and Hospital, Chennai - 600 001, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_201_17

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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    Abstract
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