title: Fabrication of a movable obturator following maxillary reconstruction with slit-shaped fenestration.
abstract: Extensive maxillary resection has generally been reconstructed with free skin flaps. Because drooping of the transferred flap causes instability of the obturator prosthesis, maxillary reconstruction often incorporates a slit-shaped oronasal fenestration. Although obturator prostheses for edentulous patients are stabilized with the help of oronasal slits, those for dentate patients are unstable because of flap mobility, resulting in a harmful lateral force exerted on the abutment teeth, causing dislodging of the denture. This report evaluates the benefits of a movable obturator prosthesis for a 60-year-old dentulous patient with maxillary sinus carcinoma. The patient underwent left-sided total maxillectomy, and the defect was reconstructed with a slit-shaped fenestration using a rectus abdominis flap. A conventional obturator prosthesis was inserted; however, drooping of the flap caused instability of the obturator, resulting in nasal regurgitation and fracture of the clasp. To solve this problem, we designed an obturator prosthesis with a movable connection consisting of a ball attachment (patrix) in the metal base and a socket (matrix) in the obturator, which acted as a stress breaker against the harmful force exerted by the flap. Application of this movable obturator prosthesis was a useful solution for a compromising situation created by the surgical procedure. No clinical disorders were observed at the 3-year follow-up.
authors.affiliation: Department of Denture Prosthodontic Restoration, Kagoshima University Medical and Dental Hospital, Kagoshima, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Murakami
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Nishi
authors.forename: Minoru
authors.initials: M
authors.lastname: Umezono
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kamashita
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nishimura
mesh_terms: D003680:Deglutition Disorders / Q000534:rehabilitation; D003766:Dental Occlusion; D019232:Dental Restoration Failure; D005260:Female; D058752:Free Tissue Flaps / Q000009:adverse effects* / Q000637:transplantation; D006801:Humans; D008409:Mastication; D008437:Maxilla / Q000601:surgery; D008441:Maxillary Neoplasms / Q000601:surgery* / Q000628:therapy; D063166:Maxillary Osteotomy / Q000534:rehabilitation*; D008875:Middle Aged; D037981:Neck Dissection; D009669:Nose Neoplasms / Q000601:surgery* / Q000628:therapy; D010158:Palatal Obturators; D021362:Palate, Hard / Q000601:surgery*; D011474:Prosthesis Design / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000009:adverse effects* / Q000379:methods; D017568:Rectus Abdominis / Q000637:transplantation; D013314:Stress, Mechanical
keywords: Obturator prosthesis; maxillary reconstruction; maxillectomy; slit-shaped fenestration