4. Function of velopharyngeal sphincter:
to close naso-pharynx by contraction of posterior
and lateral pharyngeal walls against soft palate.
What is Passavant’s ridge or pad?
1. It is a horizontal cross roll on posterior
pharyngeal wall which occur during speech and
swallowing in cleft palate patient
2. It serves as a guide for proper placement of soft
palate obturation prosthesis
4
5. Method of reconstruction:
Denture fabrication
Get a wire and extend it to defect
Green compound molding by head tilting and
swallowing
Scrap(correcta wax impression)
Replace be self cure acrylic
5
15. Found in edentulous and fully dentate
patients
Etiology:
1. Benign or malignant tumors of palate and
maxillary sinus.
2. Traumatic loss
3. Pathological condition eg: osteomylitis,
syphilis.
15
16. Disabilities:
i. Hyper nasal speech
ii. Fluid leakage in nasal cavity
iii. Impaired mastication
iv. Cosmetic deformity
16
17. Class l
Class ll
Class lll
Class iv
Class v
Class vi
The classification of acquired hard palate defect was
originally proposed by Armany .1978 as follows
17
18. Class l Class ll Class lll
In classical
maxillectomy
resection,
The dentition and
the alveolar bone
are removed
along the midline
In the
classification
The premaxilla on
the defect side is
maintained
The defect Area is
Located On the
Central
Portion of the
palate
And all the
Dentition is
preserved
18
19. Class iv Class v Class vi
The defect
includes the
pre-maxilla on
the no surgical
side
The anterior teeth
are preserved, the
posterior teeth
,hard palate
,portions of soft
palate are
resected.
Anterior palatal
defects ,the least
frequently
occurring class
,are caused by
trauma more
often than
surgery
19
22. Removal of a part or all maxilla.
Can be done with inta oral/extra oral approach
Extension of resection depends on:
1. Size
2. Location
3. Behavior of tumor
22
23.
Complete(total)maxillectomy.(removal of 1 of 2
maxilla)
Partial maxillectomy:(partial removal of a part of 1
maxilla)
Total bilateral maxillectomy:(removal of upper jaw
totally)
23
25. 1. Safe as much of hard palate as possible
2. Try to retain the key teeth (canines)
3. Extract the tooth just adjacent to defect
with trans-alveolar resection through distal
portion of this socket improving bony
support to tooth adjacent to defect.
25
26. 4. Save palatal mucosa to line palatal margin
to defect which increases lateral stability of
prosthesis.
5. If resection include anterior 2/3 of soft
palate remove the remaining 1/3 (non
functional)
6. Turbinates and bands of oral mucosa
preventing the prosthesis from engaging
key areas of defect should be removed
26
27. 7. Place Osseo-integrated implant if possible.
8.Line the cheek with a split thickness
skin graft to:???
Decrease scar tissue formation
Form a scar band at line of junction between
skin graft and mucosa (pure string effect)
Improves support, stability and retention of
obturator
27
31. surgical construction:
Using soft or hard tissue.
Disadvantage:
1. Not morphologically well
2. Difficult to build prosthesis on it
3. Not used with aggressive tumors(fear of
recurrences)
32. Prosthetic rehabilitation:
Before surgery:
1. Examine the patient
2. Gain mounted diagnostic casts
3. X-ray
4. Prophylaxis by restoring carious teeth
,extraction of hopeless teeth.
35. Obturation :latin word means (to close)
Inserted during or immediately after surgery
It is a plate of clear acryl
Should be left 7-10 days post surgically
36. Advantages:
1. Holds surgical pack to ensure close
adaptation of skin graft to raw surface of
cheek
2. Decreases oral contamination of wound
3. Improves speech
4. Improves deglutition
5. Decreases psychological impact of surgery
6. Faster healing
37. Retention of surgical obturator:
1. Clasps on remaining teeth
2. Suturing with mucosa
3. Ligature to remaining teeth
4. Wired to available structure
38. Steps of construction:
1. Impression
2. Outlining the resection by surgeon
3. Modification of cast(explained next slide)***
4. Planning for retention
5. Waxing up with no artificial teeth
6. Processing in clear acryl
7. Surgical defect is filled with surgical pack or
tissue conditioner
44. Constructed after 10 days of surgery
In most cases, the surgical obturator is only
modified by tissue conditioner.
45. Steps of construction:
1. Wax rim is added to surgical obturator and jaw
relation is made
2. An opposing impression ,then pour ,then
mount to articulator
3. Denture teeth are set ..process in heat cure
resin
4. Reline in patient mouth periodically
46. Differences with surgcal obturators:
1. Teeth
2. More accurate
3. Obturator portion
53. Started after complete healing(3-6 months)
Treatment concept:
1. Clasps on remaining teeth
2. Lateral extention into defect
3. Engaging undercut over the scar band on
cheek
61. Hollow /bulb obturator:
How is it made hollow????
method 1
1. After packing
2. open a vent
3. start to scrap the obturator portion
4. Cover the vent with self cure acryl
62. Hollow /bulb obturator:
How is it made hollow????
Method 2
1. Pack the defect walls,
2. fill it with a sugar bag.
3. complete packing .
4. cure…
5. after curing ,
6. open a small hole
7. dissolve the sugar
64. Advantage:
1. Simple
2. Light in weight
3. Easily adjusted
Disadvantage:
1. Accumulation of secretion
2. Added weight and odor
3. Need very well selected cases
65. Steps of construction.
1. Special tray and ZnO impression to non
defect side.
2. Mold defect with green compound..correcta
wax impression…flask..cure.
3. Jaw relation..teeth setting on final base
plate..attach teeth with self cure resin.
4. Teeth are chosen to be flat.
