restoration of the head and neck cancer...
TRANSCRIPT
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Restoration of the Head and Neck Cancer Patient
Michael J. Maginnis, D.D.S., M.S., F.A.C.P.Board Certified, Removable Prosthodontics
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Treatment of head and neck cancer often involves surgical removal of a portion of the upper or lower jaw. The resulting surgical defect can severely compromise a patient’s ability to eat, swallow or speak. The
role of the prosthodontist is to construct a prosthesis that will, as much as possible, return the patient to a level of normal function.
Pre-opSquamous cell carcinoma
Post-opRight hemi-maxillectomy
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Prosthodontics:The dental specialty that repairs and/or replaces damaged teeth and associated oral structures.Fixed Prosthodontics: Crowns, bridges, veneers and implant restorations.Removable Prosthodontics: Complete Dentures, Partial Dentures, Snoring Cessation.Maxillofacial Prosthodontics: Obturators, mandibular resection prostheses, speech and palatal lift prostheses, eye, ear, nose and facial prostheses.
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Oral Cancer Lesions:
Squamous Cell CA Squamous Cell CA
Pleomorphic Adenoma Ameloblastoma
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Oral Cancer Lesions:
Mucoepidermoid CA Basal Cell CA
Adenoid Cystic CA
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Oral Cancer Lesions:
Squamous Cell CA
Osteoradionecrosis
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Loss of an eye and the surrounding orbital bone can necessitate construction of a silicone facial prosthesis with a prosthetic eye.
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Facial Moulage
Prosthesis in wax
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Tinted and cured silicone prosthesis held in place with adhesive.
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Maxillofacial Prosthetician: Richard AbdaAbda Artificial Eye & Facial Center1111 Veterans Memorial Blvd.Kenner, LA(504) 466-5757
Adhesives and skin oils eventually deteriorate the prosthesis and necessitate remakes.
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Partial Denture Obturators:
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The obturator is formed to seal the edges of the
surgical defect and prevent leakage of air
and liquids into the nasal and sinus cavities.
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Mucosal Melanoma (left maxillary sinus)
Male precision attachment
Female precision attachment
Precision attachment partial dentures can provide secure anchorage for obturators.
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Obturator
Palatal defect
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Mucoepidermoid Carcinoma
Obturator
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An obturator occludes the palatal defect left by surgical removal of the
tumor and prevents aspiration of liquids and air into the nasal cavity.
Eventually, a tongue graft was placed over the
palatal defect and the obturator portion of the prosthesis was removed.
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Maxillary ridge: post hemi-maxillectomy and obturator addition to complete denture
Normal maxillary edentulous ridge and typical maxillary complete denture
Complete Denture Obturators:
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Extensions onto the palatal shelf may increase stability of the prosthesis.
Complete Denture Obturators:
Hollow obturators require drain hole.
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Squamous Cell CA / Hard Palate /Surgical Excision
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Final reline and obturator in Molloplast-B
(heat-cured silicone soft liner)
Porcelain posterior teeth setin linqualized occlusion
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Temporary obturator prosthesis
Sil-Tech laboratory putty(Ivoclar Vivadent)
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Existing denture prostheses modified with addition of
obturator and new porcelain posterior teeth.
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Palatal Drop Prosthesis:
Left posterior quadrant of tongue has been removed for adenoid cystic
carcinoma. Tongue has been immobilized on left side causing
problems with speech and swallowing. A palatal drop prosthesis was
constructed to lower the roof of the mouth for better approximation with
the ventral surface of the tongue.
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Palatal Drop Prosthesis:
Prosthesis is thicker on left side to allow for contact with tongue during speech and
swallowing.Speech therapy is
required to adequately use this prosthesis.
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Speech Bulb Prosthesis:
Velopharyngeal Inadequacy (VPI) results from surgical removal or alteration of the soft palate. Placement of a speech bulb allows the patient to close off the nasal cavity during swallowing and production of certain speech sounds. Speech therapy is required to use this prosthesis.
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Surgical Stents:
Pleomorphic Adenoma, 10 yr. old male
Prosthesis used to cover surgical wound following removal of tumors of the hard and soft palates.
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Surgical stent used to cover wound in hard palate following removal of
pleomorphic adenoma. Stent can be relined with soft liner to improve fit as
tissue shrinks during healing. Maintaining closure of the opening to
the nasal cavity is necessary for adequate speech and swallowing.
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Surgical Stent and InterimObturator Prosthesis:
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Osteoradionecrosis of the Maxilla:
Approximately three years after radiation treatment for
Squamous Cell CA of left nasal vestibule, the maxillary left
cuspid was extracted.
The resulting osteoradionecrosis did not resolve with hyperbaric oxygen therapy necessitating an
infrastructure maxillectomy.
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An infrastructure maxillectomy results in loss of all maxillary teeth, the maxillary anterior
alveolus and an oral-nasal fistula that severely compromises the
retention of the maxillary denture prosthesis. Implant
placement becomes the treatment of choice.
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Surgery for osteoradionecrosis resulted in loss of entire anterior
maxillary alveolus. The only bone remaining for implant placement was in the area of the tuberosities. Mini-
implants (2.4 mm) are considered non-invasive and can be used in
irradiated bone.
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Mini-Implants in Irradiated Maxilla:
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Mini-Implants in Irradiated Mandible:
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Implant Retention of the Obturator Denture:
Mucoepidermoid Carcinoma,(hard palate)
Hemi-maxillectomy followed by placement of two
osseointegrated implants.
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Locator® Retention of the Obturator Denture:
Four months following initial surgery,
Locator® implant abutments in place for retention of definitive obturator prosthesis.
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Definitive Obturator Prosthesis
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Definitive Obturator Prosthesis
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Drs. Maginnis and Appleton
PROSTHODONTICS:
Dr. Michael J. Maginnis
Dr. Isaac E. Appleton
GENERAL DENTISTRY:
Dr. Glenn E. Appleton
On the Web: www.drsmanda.com7742 Office Park Blvd.Baton Rouge, LA 70809
(225) 201-1000