The document discusses challenges in prosthodontic treatment of maxillary defects and how surgical alterations can enhance prosthetic outcomes. It notes that for dentulous and edentulous patients with maxillary defects, surgery can help by creating an accessible skin-lined defect that can aid in retention, stability, and support of obturator prostheses. The document outlines several surgical techniques like skin grafting defects and retaining the premaxillary segment that provide prosthetic advantages such as improved retention, support, and potential for dental implant placement. Overall, close cooperation between prosthodontists and surgical oncologists is emphasized to plan defect management that facilitates prosthetic rehabilitation.
The general indications for SARPE are skeletal maturity, transverse maxillary deficiency, excessive display of buccal corridors when smiling, and anterior crowding.
Pterygoid implant insertion is an alternative to avoid sinus-lifting or other grafting procedures to treat the posterior maxilla.They are especially used in partial edentulism in order to avoid distal cantilevers.
The placement of a pterygoid implant requires surgical experience and expertise in the field of implantology.
Pterygoid implants have high success rates, to those of conventional implants, minimal complications and a good patient acceptance.
Dr Sachdeva's Facial Aesthetic and implant institute is one of the leading clinics in Delhi performing Pterygoid Implants in patients with bone resorption. So hurry up and book an appointment with us at Ashok Vihar, Delhi which has state of the art clinic and all the latest and advanced equipments.
To book an appointment contact:
Dr. Rajat Sachdeva
Director & Mentor
Dr Sachdeva’s Dental Aesthetic And Implant Institute
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
Phone : +919818894041,01142464041
Our Websites:
www.sachdevadentalcare.com
www.dentalimplantindia.co.in
www.dentalclinicindelhi.com
www.dentalcoursesdelhi.com
Facebook- dentalcoursesdelhi
Youtube- drrajatsachdeva
Linkedin- drrajatsachdeva
Slideshare- Dr Rajat Sachdeva
Twitter Page- drrajatsachdeva
Instagram page- surgicalmasterrajat
The general indications for SARPE are skeletal maturity, transverse maxillary deficiency, excessive display of buccal corridors when smiling, and anterior crowding.
Pterygoid implant insertion is an alternative to avoid sinus-lifting or other grafting procedures to treat the posterior maxilla.They are especially used in partial edentulism in order to avoid distal cantilevers.
The placement of a pterygoid implant requires surgical experience and expertise in the field of implantology.
Pterygoid implants have high success rates, to those of conventional implants, minimal complications and a good patient acceptance.
Dr Sachdeva's Facial Aesthetic and implant institute is one of the leading clinics in Delhi performing Pterygoid Implants in patients with bone resorption. So hurry up and book an appointment with us at Ashok Vihar, Delhi which has state of the art clinic and all the latest and advanced equipments.
To book an appointment contact:
Dr. Rajat Sachdeva
Director & Mentor
Dr Sachdeva’s Dental Aesthetic And Implant Institute
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
Phone : +919818894041,01142464041
Our Websites:
www.sachdevadentalcare.com
www.dentalimplantindia.co.in
www.dentalclinicindelhi.com
www.dentalcoursesdelhi.com
Facebook- dentalcoursesdelhi
Youtube- drrajatsachdeva
Linkedin- drrajatsachdeva
Slideshare- Dr Rajat Sachdeva
Twitter Page- drrajatsachdeva
Instagram page- surgicalmasterrajat
Ridge preparation for implant placement - part 1Hesham El-Hawary
- criteria of ideal ridge
- implants timing protocol
- implants planning and case selection
- clinical types of bone
- preventive methods to preserve the alveolar ridge
orthognathic surgery is very intresting and well knowing branch in oral surgery ....this presentation is dealing with jaw correction surgery in upper jaw.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Clinical management of edentulous maxillectomy / oral surgery courses Indian dental academy
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Ridge preparation for implant placement - part 1Hesham El-Hawary
- criteria of ideal ridge
- implants timing protocol
- implants planning and case selection
- clinical types of bone
- preventive methods to preserve the alveolar ridge
orthognathic surgery is very intresting and well knowing branch in oral surgery ....this presentation is dealing with jaw correction surgery in upper jaw.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Clinical management of edentulous maxillectomy / oral surgery courses Indian dental academy
Description :
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Micro vascular free flaps used in head and neck reconstruction /certified fi...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Fabrication of functional complete dentures for edentulous patients who have undergone hemimandibulectomy is a very arduous and demanding endeavor.
The most challenging situation encountered during this procedure is the deviation of the mandible to the resected side. The deviation of the mandible to the resected side is directly proportional to the loss of tissues in the area hemi-mandibulectomy has been performed.
In cases with Cantor and Curtis classes II, III, IV, and V, guide flange prosthesis would be a treatment modality. For guide flange prosthesis to be effective, the sufficient number of posterior teeth that are periodontally sound should be present in the opposite arch.
In patients where reconstruction is not done after resection of the mandible, scar tissue formation occurs over a period of time that stiffens the tissues and worsens prosthetic rehabilitation, leading to compromised treatment planning.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Relining & rebasing / dental implant courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
There are three basic phases of the digital workflow when designing and/or fabricating removable partial denture frameworks; data acquisition, designing (computer aided design (CAD)), and computer-aided manufacturing (CAM). The bulk of this presentation is dedicated to the design steps used in this workflow utilizing sample maxillary and mandibular casts
There are three basic phases of the digital workflow when designing and/or fabricating removable partial denture frameworks; data acquisition, designing (computer aided design (CAD)), and computer-aided manufacturing (CAM). The bulk of this presentation is dedicated to the design steps used in this workflow utilizing sample maxillary and mandibular casts
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
11. palatal resections alterations at surgery to enhance the prosthetic prognosis
1. 11. Palatal Resections - Alterations at Surgery to
Enhance the Prosthetic Prognosis
John Beumer III, DDS,MS
Distinguished professor emeritus
UCLA School of Dentistry
2. Maxillary Defects – Prosthodontic
Challenges
Dentulous patients
Restore the partition between the oral and
nasal cavities
Restore palatal contours
Replace needed dentition
Provide retention, stability, support for the
partial denture-obturator prosthesis
Create partial denture designs that do not
stress abutment teeth beyond their
physiologic tolerance
3. Maxillary Defects – Prosthodontic
Challenges
Edentulous patients
Restore partition between the nasal and
oral cavities
Restore palatal contours
Replace the necessary dentition
Provide retention, stability, and support for
the complete denture - obturator prosthesis
To meet these challenges we need the help and
cooperation of our surgical oncology colleagues.
4. Maxillary Defects – Prosthodontic
Challenges
Edentulous patients
Restore partition between the nasal and
oral cavities
Restore palatal contours
Replace the necessary dentition
Provide retention, stability, and support for
the complete denture - obturator prosthesis
The surgeon can help by creating an accessible, skin
lined defect that can be used to help retain, stabilized,
and support the future obturator prosthesis.
5. Alterations at Surgery to Enhance the
Prosthetic Prognosis
Skin grafting the defect
Maintain access to the defect
Salvaging the premaxillary segment
Soft palate resection and velopharyngeal function
Retention of key teeth
Use of palatal mucosa
Placement of osseointegrated implants
6. Skin Grafting - Advantages
In radical maxillectomy defects skin grafting the
inside of the cheek flap creates a divergent lateral
wall which when engaged by the obturator
prosthesis, facilitates retention.
The scar band at the skin graft mucosal junction
creates an undercut superior to this junction .
Engagement of this undercut with the obturator
prosthesis facilitates retention on the defect side.
A skin lined cheek flap is more flexible than one
that epithelializes spontaneously and can be more
effectively displaced by the prosthesis allowing for
the development of better midfacial contours on the
defect side.
Skin lined defects provide keratinized surfaces in
the defect that can be engaged more aggressively
with the prosthesis thereby improving stability,
retention and support for the obturator prosthesis.
7. Skin grafting
Note the undercut just superior to the skin graft mucosal
junction (arrows). In addition, the lateral walls of these
skin lined defects diverge superiorly and if properly
engaged, retention of the obturator prosthesis is
significantly enhanced.
8. Skin grafting vs spontaneous epithelialization
Note the difference between these two defects. The defect on the left
is lined with skin and can be aggressively engaged prosthodontically
enhancing stability, retention and support. The defect on the
right is lined with poorly keratinized squamous epithelium and
respiratory epithelium. Neither of these epithelial surfaces are suited to
resist the abrasion associated with the use of an obturator prosthesis.
9. Skin grafting vs spontaneous epithelialization
Both these patients had similar resections. In one a skin
graft was used to line the defect. In the other, the wound
was allowed to epithelialize spontaneously.
The skin lined defect can be used to help support, stabilize,
and retain the obturator prosthesis whereas the defect
without skin lining cannot be so utilized .
10. Skin grafting vs spontaneous epithelialization
Total palatectomy defects
Although large, such defects can be restored prosthodontically if
skin lined. In this patient there were soft tissue undercuts
bilaterally and these were engaged by using a two piece
prosthesis providing the patient with a well retained obturator
prosthesis. Speech and swallowing were fully restored but
mastication was still severely compromised.
11. Total palatectomy defects
Two piece obturator
prosthesis
This type of prosthesis is
effective in restoring speech
and swallowing but
mastication will be severely
compromised.
12. Skin grafting vs spontaneous epithelialization
Total palatectomy defects
This defect was not lined with skin and has undergone
contraction. Unfortunately, it is not restorable using
prosthodontic means.
13. Skin grafts vs secondary epithelialization
Even though these patients are edentulous their defects are
relatively easy to obturate because the defects are lined with
skin. Properly engaging the lateral wall of the defect and the
undercut just superior to the skin graft mucosal junction will
greatly facilitate the retention and stability of the obturator
prosthesis.
14. Skin grafting vs spontaneous epithelialization
Grafting this defect prevented undesirable contraction of the
upper lip and it retains much of its original flexibility.
The result: A properly extended obturator prosthesis
will restore the contours of the upper lip.
15. Anterior defects
Skin lined defects vs defects which are allowed
to granulate and epithelialize spontaneously
Advantages of skin lined anterior defects
b) Improved support provided by the defect
c) Less contraction of the lip
d) More control over the lip contours with the obturator
prosthesis
16. Skin graft vs Secondary Epithelialization
This wound was closed primarily and the
raw tissue surfaces were not skin grafted.
Result: The upper lip contracted and normal lip contours could
not be restored with the labial flange of the prosthesis.
17. Anterior defects
a b
An attempt was made to close this defect
primarily.
Note scarring and lip retraction that results.
18. Skin grafts vs spontaneous epithelialization
Note the poor quality tissues in the defect. Defects such as
these are difficult to restore because the defect can not be
properly engaged with the obturator extension.
Result: The retention and stability of the prosthesis is
compromised.
19. Skin grafts vs secondary epithelialization
The skin graft placed into this defect sloughed and the wound epithelialized
with poorly keratinized epithelium and respiratory epithelium. This type of
mucosal lining does not tolerate well the abrasion associated with the wear
of an obturator prosthesis. In addition, because of contraction of the defect
and the lack of a skin graft mucosal junction there are no undercuts to
engage.
Result: Retention and stability are compromised.
20. Access to the defect
Large defects should not be closed surgically and
access to the defect should be maintained.
An attempt was made to close this defect primarily. This defect
can be obturated but the forces of gravity and the long lever arm
of the prosthesis will place great stress and strain on the abutment
teeth which could lead to their premature loss.
21. Access to the defect must be maintained
In this patient the middle turbinates were retained. They
subsequently became edematous and extended down into the
oral cavity, distorted the palatal contours of the obturator
prosthesis, violating the tongue space. They were
subsequently removed.
22. Access to the defect must be maintained
This defect was closed with a flap. Note the distortion of
the palatal contours and the elimination of the tongue
space. This patient could not be fitted with a prosthesis.
He was unable to masticate and his speech articulation
was severely compromised.
23. Access to the defect
This defect was closed with a radial forearm free flap. Note the
distortion of the palatal contours and the compromise of the
tongue space. Absent the retentive contribution of the defect, the
partial denture restoring the posterior dentition delivers clinically
significant stress to the abutment teeth.
24. Access to the defect
Result:
Over time the teeth retaining this partial denture and obturator
may be lost prematurely.
In addition, the patient complained about the accumulation of
secretions in the nasal cavity on the defect side.
25. Access to the defect
Problems as a result of these mucous accumulations:
b) Local infections.
c) A very strong and unpleasant odor emanating from the nasal
passages on the defect side.
26. A
Retention of the premaxilla:
Advantages-Edentulous
Patients
Improved support because of
increased palatal shelf surface
area B
Improved stability
Additional implant sites
In patient “B” only a small portion of the premaxilla on the defect side was
retained, but as a result significant amounts of palatal shelf were saved
leading to increased support for the obturator prosthesis.
27. Retention of the premaxilla: Advantages-
Edentulous Patients
In this patient sufficient bone remained to permit the
placement of three implants.
28. Retention of the premaxilla
Advantages in partially edentulous
patients
Retaining the premaxilla on the
defect side allows for more
favorable partial denture designs
Rests can be positioned so that
occlusal forces can
be directed
along the long
axis of the
abutment
teeth.
29. Retention of the premaxillary segment
When the premaxillary segment has been completely
removed, support is significantly compromised and the
partial denture framework will expose the remaining teeth
to clinically significant lateral forces.
30. Retention of the premaxilla
Implant sites
The best implant site in the upper jaw is the premaxilla. In most
maxillectomy patients, 2-4 implants can be placed in this region.
The more of the premaxilla available for implant placement the
more favorable the implant distribution pattern (A-P spread).
31. Retention of key abutment teeth
Abutment teeth adjacent to the defect are subjected to the
greatest stress and bony cuts through the alveolus next to these
teeth should be interproximal rather than intraseptal
In this patient the transalveolar bony cut was properly made.
The result: This abutment tooth is circumscribed by alveolar
bone, making it a suitable partial denture abutment.
32. Retention of key abutment teeth
In these three patients bony cuts through the alveolus
were made too close to the roots of teeth. The result:
These teeth are of limited value as partial denture
abutments for the obturator prosthesis.
33. Soft palate resection and velopharyngeal
closure
Middle third of the soft palate is responsible for palatal
elevation (levator veli palatini) during velopharyngeal
closure.
In partially edentulous patients when teeth can effectively
retain the obturator prosthesis, when the middle third is
resected for tumor control the remaining posterior third
should also be resected. This will insure appropriate access
to the residual velopharyngeal musculature.
In edentulous patients, when difficulty with retention is
anticipated, these nonfunctional posterior one third remnants
are retained to facilitate retention.
34. Soft palate resection and velopharyngeal closure
Remnants of the levator are
generally present and functional
after complete removal of the soft
palate. These muscle remnants
are imbedded within the lateral
wall of the pharynx and their
contracture plus contraction of the
superior constrictor comprise the
residual velopharyngeal
mechanism. the obturator to restore
In order for
speech to normal the obturator
extension must interact with this
residual musculature in a precise
manner. Retaining nonfunctional soft
palate remnants may make it difficult
to achieve this precise interaction.
35. Soft palate resection
The posterior one third of the soft palate was retained in both
these patients. This strip of mucosa is nonfunctional and
prevents proper extension an precise placement of an obturator
prosthesis into the residual, still functional velopharyngeal
mechanism.
Result: Speech will be hypernasal.
36. Soft palate resection and velopharyngeal closure
In edentulous patients the needs of retention outweigh the
needs of precise velopharyngeal closure
Extension onto the
nasal side of the
residual soft palate
In this patient the soft palate remnant was retained because it
can be used to aid retention of the obturator prosthesis.
37. Palatal mucosa The palatal margin of the defect
is a fulcrum around which the
prosthesis rotates, particularly in
edentulous patients. When
possible this bony margin should
be covered with palatal mucosa
as was done in these two
patients.
Bony cut
Palatal
incision
38. Placement of osseointegrated implants
immediately following resection of the tumor
Considered:
In edentulous patients
When the prognosis for the remaining dentition
is poor
39. Placement of osseointegrated implants
immediately following resection of the tumor
in patients to receive postoperative radiation
Inpatients scheduled to receive postoperative radiation
therapy the dose enhancement effect at the bone
implant interface is outweighed by the bone anchorage
achieved during the 6 week postoperative period prior
to commencement of radiation therapy.
40. Rehabilitation – Surgery vs Prosthodontics
Arguments in favor of prosthodontic rehabilitation
It is more cost effective
The open defect can be monitored for tumor recurrence
Bulky flaps distort palatal contours and reduce the tongue
space compromising speech articulation and control of the
bolus during mastication.
Palatal contours and speech articulation are best restored
with an obturator prosthesis
Mucous tends to accumulate on the nasal side of the flap
causing unpleasant odors and local infections
Partial denture designs and stresses on abutment teeth
Inability to use the defect to facilitate retention on the side of the
defect results in additional stresses on the residual dentition leading
to premature loss of abutment teeth.
41. Surgery vs Prosthodontics (cont’d)
Small defects in dentulous patients
Small defects, secondary to
removal of benign tumors, such as
this one, can be closed without
distorting palatal contours.
This patient played a reed
instrument and although her
speech was normal, she could
not play effectively with an
obturator prosthesis. The
tumor was benign, a suitable
followup period had elapsed,
and so the defect was closed
with local flaps.
Note: A partial denture was still needed to restore
the missing molar dentition.
42. Surgery vs Prosthodontics
Large defects are best restored
prosthodontically
This defect was closed with a radial forearm flap. A
prosthesis was still necessary for esthetics, lip
support, and to prevent supereruption of the
opposing mandibular dentition . Without, the
benefit of the retentive qualities of the defect
however, the abutment teeth, particularly the cuspid
may be exposed to forces beyond the physiologic
limits of the periodontal ligament.
Following reconstruction the patient complained of a foul odor coming from the
sinus. Exam revealed significant accumulations of dried mucous on the sinus
side of the flap which could not be easily removed by the patient.
43. Surgery vs Prosthodontics
This large maxillectomy - orbital exenteration defect was
restored with radial forearm flap combined with an orbital
prosthesis and a maxillary obturator prosthesis. Note
that the maxillary defect was not obliterated by the
flap. The obturator prosthesis replaces the missing
teeth, and restores palatal contours. Speech articulation
is normal and hypernasality is eliminated.
44. Surgery vs Prosthodontics
Selected maxillary defects can be effectively
reconstructed with vascularized free flaps.
This technique is generally best suited for
secondary reconstruction after the patient is proven
to be free of disease.
The defect must be of sufficient size because the
vascularization of small free flaps with bone grafts
of less than 2 cm is not predictable
45. Surgery vs Prosthodontics
a b c
d e g
h a. Surgical defect. b and c. Drill guide secured,
implant sites prepared and osteotomies completed.
d and e. Graft secured in position. f and g.
Occlusion of fixed partial denture. Note palatal
contours are near normal.
Courtesy Dr. D. Rohner and Dr. H. Reintsema
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