Mouth rehabilitation with maxillary obturator prosthesis after excision of adenoid cystic carcinoma

Abstract

The obturator prosthesis is the main method for the rehabilitation of large maxillary defects. With the purpose to close the defect, separate the oral cavity from the nasal cavity, prevent hypernasal speech, nasal regurgitation of food and liquids and provide support for the facial profile. This article aims to report a case of rehabilitation with maxillary obturator prosthesis after partial maxillectomy. A 72-year-old female patient, diagnosed with adenoid cystic carcinoma in the palate region, underwent partial maxillectomy that resulted in extensive maxillary defect and bucco-sinus communication. After anamnesis, extra, intraoral and radiographic exams, the construction of a palatal plate was planned to be used with the nasogastric tube and during the healing process, to improve swallowing and speech. Then, the manufacture of a maxillary obturator prosthesis and a lower removable partial prosthesis. The palatal plate was made and used until the tube was removed and the insertion of the prostheses. After the impressions, master casts were made and mounted on an articulator after adjustment of wax occlusion rims and registration of the maxillo-mandibular relations. Functional elements of speech, occlusion, and appearance were evaluated during the try-in of the provisional set-up and adjusts were made. After the acrylization, the prostheses were inserted and the occlusal adjustment performed. To obtain satisfactory retention and stability when using the maxillary obturator prosthesis, it was suggested to use denture adhesive. Three post-insertions visits were carried out. The obturator prosthesis rehabilitated aesthetics, phonetics, masticatory function and swallowing, restoring the patient's self-esteem and improving social life.