A modified technique to fabricate a complete hollow obturator for bilateral maxillectomy in a patient with mucormycosis—A technical case report

Abstract

Maxillectomy performed in acquired lesions is often very extensive or bilateral, sparing very less hard and soft tissue in the oral cavity. These defects need both surgical and prosthetic rehabilitation. A definitive prosthesis is inserted after complete healing, when the patient is accustomed to the interim prosthesis. Definitive obturator warrants better retention and stability and needs a meticulous planning in design for long‐term use. Conventional design has a few disadvantages; it needs modification many times to improve retention and psychological comfort of the patient. The article explains an easy technique in fabrication of an obturator. The conventional obturator design has a hollow antral part but usually a solid oral part, which adds to the weight of the prosthesis pressurizing the soft tissues in a maxillectomy, which affects the function and esthetics. This article demonstrates the hollowing of oral part, which bears the artificial teeth, and modifying the antral bulb, which covers the defect. It was designed considering the potential difficulties shared by the patient in wearing the single piece conventional hollow bulb design. This technique when followed was beneficial in reducing the weight of the prosthesis and enhancing retention, and allowed the patient to perform normal functional movements.

Dental and Oral Manifestations of COVID-19 Related Mucormycosis: Diagnoses, Management Strategies and Outcomes

“…Whenever the maxilla along with palate is resected, there is a resultant defect in the oral cavity leading to formation of an oro-nasal/oro-antral communication, which adversely affects the patient's quality of life in terms of mastication and phonation and therefore requires reconstruction in order to restore the normal functioning of the stomatognathic system. The reconstruction of the maxillary defects can be conducted through the fabrication of obturators, which can be tooth/mucosa supported or implant supported [204,205]. Zygomatic implants have emerged as a successful entity in such cases [206].…”

The rising challenge of mucormycosis for maxillofacial prosthodontists in the Covid-19 pandemic: A literature review

“…As confirmed by the majority of reports in this review [16,[19][20][21][22]25,31,32,34,39], weight reduction is critically important when the prosthesis is suspended without much remnant bone and tooth support. As a result, in such cases, a hollow bulb design should be used [17,23,24,27,32,36,[39][40][41][42]. A lighter obturator improves suspension cantilever mechanics, prevents overstressing of the remaining supporting structures, and increases retention [44].…”

“…Large-sized maxillectomy defects often result after surgical treatment of mucormycosis, and the duration of healing in such defects is determined not only by the aggressive nature of the lesion, but also by the postoperative care [39]. As confirmed by the majority of reports in this review [16,[19][20][21][22]25,31,32,34,39], weight reduction is critically important when the prosthesis is suspended without much remnant bone and tooth support. As a result, in such cases, a hollow bulb design should be used [17,23,24,27,32,36,[39][40][41][42].…”

“…The details on the sites of the defect and types of prosthetic treatment provided are summarized in Table 1. A total of 30 articles [13,14,[23][24][25][26][27][28][29][30][31][32]15,[33][34][35][36][37][38][39][40][41][42][16][17][18][19][20][21][22] on prosthetic rehabilitation in the orofacial region after surgical treatment of mucormycosis published during the 12-year study period were reviewed. Of the 30 articles, 19 reported mucormycosis in diabetic patients, 2 described mucormycosis specifically as a post-COVID 19 complication, and 25 were reports from India.…”

“…The open-hollow bulb design is also preferred over the closed-bulb design because it is lighter in weight, easier to fabricate, and produces noticeably better articulation [39]. However, it should be used when the weight of the prosthesis is a major concern [39], and only with regular follow-up because the open design tends to accumulate mucous secretions, which can be a source of infection [32]. Remote implant-bone anchorage using pterygoid, zygomatic, and nazalus implants was also reported to be a more effective solution than conventional implants in improving prosthesis retention and support [42].…”