Recent prosthetic management of hemimaxillectomy /certified fixed orthodontic courses by Indian dental academy

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


Almost 5% of all cancers affect mouth
structures,
tongue,
oropharynx,
nasopharynx and larynx. After excision of
these lesions, problems regarding chewing,
swallowing and speech may appear.
Furthermore, changes in appearance,
psychosocial function and vocational status
may affect the quality of life of these
patients after surgical intervention.


The optimal reconstructive therapy of
maxillary defects remains controversial.
Several therapeutic approaches have been
published, including prosthetic obturators,
nonvascularised grafts, local flaps, regional
flaps
and
free
tissue
transfer.
Reconstruction of maxillary defects by
either reconstructive surgery or an
obturator prosthesis depends on patient
characteristics, such as age, medical history
and defect size.

 1)Classification

and
for

Radiographic
methods
diagnosis
 2) Use of dental implants for
support and retention of the
obturators.
 3) Esthetic approaches

Two horizontal and three vertical buttresses
 Insertion for most muscles of facial
 expression and mastication
 Geometrical structure with 6 walls
hexahedron))





Type I (Limited maxillectomy)



One or two walls, preservation of palate



Type II (Subtotal maxillectomy)



Lower 5 walls, preservation of orbital floor



Type III (Total maxillectomy)



Resection of all six walls



Orbital preservation (IIIa) vs exoneration (IIIb)



Type IV (Orbitomaxillectomy)



Upper 5 walls, preservation of palate

Maxillary Defects

Santamaria & Cordeiro, 2000. Plast Recon Surg








3D Medical Cameras
Digital Laboratory process starts with the capture and
display of a full colour model of the patient’s face using a
non-contact 3D medical photography scanner.
This can provide a 3D face scanner which matches
exact needs. All the systems take no more than 2
seconds to capture a patient’s face as a 3D colour
model.
This 3D model completely replaces the traditional slow
and traumatic casting process.




The conventional and recent diagnosis of
maxillofacial diseases are through using dental
panoramic
radiographs,
the
diagnostic
significance of computed tomography (CT)
including multi detector CT (MDCT) and conebeam (CB) CT, the application of magnetic
resonance imaging (MRI) for various kinds of
oral related diseases, and computer simulations
for dental implant and orthognathic surgery
planning using data of helical CT images.




The usefulness of ultrasonography (US) for
viewing surface soft tissues such as salivary
glands, tongue, and lymph nodes, and the
advantages and limitations of positron emission
tomography (PET) are also described.


Another development in the imaging system of CT
scan, computer-aided surgical navigation technology is
commonly used in oral and maxillofacial surgery . Based
on increased graphic information, computer-aided
navigation systems were applied for surgeries, dental
implant surgery, arthroscopy of the temporomandibular
joint, bone deformities of maxilla and mandible, image
guided biopsies and removal of foreign bodies


The surgical procedure can be simulated on
stereolithographic models to obtain planning data. This
process is applied especially for orthognathic surgery in
patients with deformities of the jaws. The data are merged
with the real image of the patient, whose position is
continuously tracked during the procedure. It can be
performed using fiducial markers, which are fixed on the
patient when obtaining the CT-scan images, by using
anatomical landmarks or by surface matching.
Tracking systems pick up the position of the patient and
the surgical tool and transfer these data to the central
processing unit. In the future, computer aided surgical
navigation technology may be applied to surgical
procedures in the oral and maxillofacial regions.


Recently, it was shown that the findings and parameter
of dynamic contrast-enhanced MR images could be used as
diagnostic tools for tumors in the oral and maxillofacial
regions .In particular, dynamic MR imaging may predict
whether head and neck lesions including those affecting
salivary glands are malignant, it can help limit differential
diagnosis, and has the potential of predicting vascularity
and recurrence .


 Maxillary

obturator prostheses have a
long history of effectively resolving the
functional, cosmetic and psychological
problems associated with the defects
caused by maxillectomy, but the mobility
of maxillary obturator prostheses impairs
function.


 Mobility

of maxillary prostheses is affected
by the size and character of the defect, the
height and contours of the residual alveolar
ridge and palatal shelf ,the availability of
undercuts, and most importantly by the
health and position of any remaining teeth.




In cases that have required extensive resections,
significant problems regarding the retention,
support and stability of maxillary obturator
prostheses are encountered after ablation of the
retentive maxillary anatomy . In such cases , the
main issues are the restoration of functional
recovery, for example by adjusting the level of
occlusion , and improving the quality of life,
prognosis and success rates for implanting
maxillary prostheses.

Since the advent of osseointegration, the
combination of implants and prosthetic
obturators has proven to be beneficial,
especially in the rehabilitation of the
edentulous maxillectomy patients. This
treatment option provides additional
support and retention to a conventional
obturator and renders such a procedure
beneficial to the patient.


Recent prosthetic management of hemimaxillectomy /certified fixed orthodontic courses by Indian dental academy

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