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a marked effect on facial aesthetics. Hence, effective time-saving and light in weight, the surgeon can
treatment modalities for these defects are mandatory. recommend it to patients who require an economical
[7]
Small defects can be managed by surgery, but large defects alternative or who are not willing or able to undergo
require prosthodontic rehabilitation by obturators. surgical reconstruction of their defect.
A multidisciplinary team consisting of an oncologist, an oral The light-weight plastic-based hollow bulb obturator
and maxillofacial surgeon, a maxillofacial prosthodontist, fabricated in the present case rehabilitated the
a specialist nurse, a dietician and a speech therapist is patient aesthetically and functionally, providing him
ideal for care of head and neck cancer patients. A high an opportunity to live his life as close to normal as
level of cooperation between the prosthodontist and the possible.
surgeon prior to surgery is critical to achieving adequate
rehabilitation for patients with maxillary defects. [8]
REFERENCES
This clinical report describes the rehabilitation of a
Class IV maxillary defect with a plastic based light 1. Cummings CW. Cummings Otolaryngology: Head and Neck Surgery. 4th ed.
weight hollow obturator. Class IV defects represent St. Louis: Elsevier; 2004. p. 1604‑8.
the classic maxillary defect in which the hard palate, 2. GPT‑8. The academy of prosthodontics. J Prosthet Dent 2005;94:56.
alveolar ridge, and dentition are removed beyond the 3. Aramany MA. Basic principles of obturator design for partially edentulous
patients. Part I: classification. J Prosthet Dent 1978;40:554‑7.
midline. Advantages of hollow bulb obturators include 4. Fornelli RA, Fedok FG, Wilson EP, Rodman SM. Squamous cell carcinoma
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decreased weight of the obturator, decreased pressure of the anterior nasal cavity: a dual institution review. Otolaryngol Head Neck
on surrounding tissues, and ease of deglutition. In Surg 2000;123:207‑10.
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Comprehensive management of head and neck tumors. 2nd ed. St. Louis:
excessive atrophy and physiological changes in muscle Elsevier; 1998. p. 526‑7.
balance. The hollow bulb adds resonance, thus 6. Depprich R, Naujoks C, Lind D, Ommerborn M, Meyer U, Kübler NR,
[9]
improving the clarity of speech. [10] Handschel J. Evaluation of the quality of life of patients with maxillofacial
defects after prosthodontic therapy with obturator prostheses. Int J Oral
Although prior techniques described in the literature Maxillofac Surg 2011;40:71‑9.
fabricate obturators with the use of wax, sponge, 7. Mohamed Usman JA, Ayappan A, Ganapathy D, Nasir NN. Oromaxillary
polyurethane, foam and gas injection, [11-13] the present prosthetic rehabilitation of a maxillectomy patient using a magnet retained
two‑piece hollow bulb definitive obturator; a clinical report. Case Rep Dent
technique uses a single-step flasking procedure, resulting 2013;2013:190180.
in a comfortable, light-weight prosthesis with reduced 8. Tirelli G, Rizzo R, Biasotto M, Di Lenarda R, Argenti B, Gatto A, Bullo F.
fabrication time. Obturator prostheses following palatal resection: clinical cases. Acta
Otorhinolaryngol Ital 2010;30:33‑9.
In conclusion, the goal of rehabilitation is creation of a 9. Curtis TA, Beumer J. Restoration of acquired hard palate defects: etiology,
prosthesis, which can restore aesthetics and function, disability, and rehabilitation. In: Beumer J, Curtis TA, Firtell DN, editors.
while being easy to use, easy to clean to prevent recurrent Maxillofacial Rehabilitation. Prosthodontic and Surgical Considerations.
St. Louis: C.V. Mosby Co.; 1979. p. 183‑243.
infections, and which can be readily fabricated by simple 10. Rilo B, Dasilva JL, Ferros I, Mora MJ, Santana U. A hollow‑bulb
time saving techniques. In order to achieve these goals, interim obturator for maxillary resection. A case report. J Oral Rehabil
a single unit plastic based polymethylmethacrylate closed 2005;32:234‑6.
hollow obturator was fabricated by the lost salt method 11. Patil PG, Patil SP. Fabrication of a hollow obturator as a single unit for
management of bilateral subtotal maxillectomy. J Prosthodont 2012;21:194‑9.
using single-step flasking. The prosthesis rehabilitated the 12. Iramaneerat W, Seki F, Watanabe A, Mukohyama H, Iwasaki Y, Akiyoshi K,
patient aesthetically by replacing lost teeth and adding Taniguchi H. Innovative gas injection technique for closed‑hollow obturator.
bulk to the depressed facial region, and functionally by Int J Prosthodont 2004;17:345‑9.
providing better masticatory efficiency and phonetics. The 13. Sridevi JR, Kalavathy N, Jayanthi N, Manjula N. Techniques for fabricating
hollow obturator: two case reports. SRM J Res Dent Sci 2014;5:143‑6.
present obturator is an additional alternative for plastic 14. Popli S, Parkash H, Bhargava A, Gupta S, Bablani D, Kar AK. A two‑piece
surgeons, oncologists and prosthodontists when planning sectional interim obturator. A clinical report. J Prosthodont 2012;21:487‑90.
treatment of such cases. In addition to being used
following tissue healing, it can be used as an immediate How to cite this article: Bhatia V, Bhatia G. Aesthetic rehabilitation
surgical obturator by fabricating it on a presurgical model of a patient with an anterior maxillectomy defect, using an innovative
and trimming the affected area on the cast. single-step, single unit, plastic-based hollow obturator. Plast Aesthet
Res 2015;2:140-3.
Educating and motivating the patient about the type
of prosthesis and its limitations are the first steps in Source of Support: Nil, Conflict of Interest: None declared.
successful treatment. As this obturator is economical, Received: 15-11-2014; Accepted: 15-03-2015
[14]

Plast Aesthet Res || Vol 2 || Issue 3 || May 15, 2015 143