Unit Thirty Nine
Maxillofacial rehabilitation: Restoration of acquired hard palate defects Prosthodontic therapy for patients with acquired surgical defects of the maxilla can be arbitrarily divided into two phases of treatment with each phase having different objectives. The initial phase is called immediate surgical obturation and entails the placement of prosthesis at surgery immediately thereafter. This prosthesis must be modified at frequent intervals to accommodate for the rapid soft tissue changes that o留学作业定做ccur within the defect during organization and healing of the wound. The objective of immediate surgical obturation is to restore and maintain oral functions at reasonable levels during the postoperative period until healing is substantially completed. Three to four months after surgery the surgical site becomes stable dim6nsionany thus permitting construction of the definitive prosthesis, or the second phase of prosthodontic therapy. Immediate surgical obturation Immediate surgical obturation is particularly well suited for dentulous patients requiring a partial or total maxilleteomy because the remaining teeth can be used to help retain the prosthesis in position. The advantages of immediate surgical obturation are as follows: l. The prosthesis provides a matrix on which the surgical packing can be placed; on closure of the wound, the obturator maintains the packing in the proper relationship thus ensuring close adaptation of the skin graft to the raw surface of the cheek flap.
  2. The prosthesis reduces oral contamination of the wound during the immediate postsurgical period and may thus reduce the incidence of local infection.
  3. The prosthesis enables the patient to speak more effectively postoperatively by reproducing normal palatal contours and by covering the defect.
  4. The prosthesis permits deglutition: thus the nasogastric tube may be removed at an earlier date.
  5. The prosthesis lessens the psychologic impact of surgery by making the postoperative course easier to bear. The patient is reassured that rehabilitation has begun.
  6. The prosthesis may reduce the period of hospitalization (Nakamoto. 1971 ). This benefit assumes even greater importance with the escalating costs of hospitalization. There are several principles relative to the design of immediate surgical obturators that the prosthodontist should consider: l. The obturator should terminate short of the skin graft-mucosal junction. As soon as the surgical packing is removed, extension into the defect may be accomplished with interim soft reline materials.
  2. The prosthesis should be kept simple, lightweight, and inexpensive. Round 18-gauge wrought gold or stainless steel wire retainers are sufficient for dentulous patients.
  3. The prosthesis for dentulous patients should be perforated at the interproximal extensions with a small dental bur to allow the p留学作业定做rosthesis to be wired to the teeth at the time of surgery.
  4. Normal palatal contours should be reproduced to facilitate postoperative speech and deglutition.

  5. Posterior occlusion should not be established on the defect side until the surgical wound is well organized. If the patient is scheduled for a total maxillectomy with resection to the midline, the three maxillary anterior teeth included in the resection may be added to the prosthesis to improve esthetics.
  6. In some patients the existing complete or partial prosthesis may be adapted for use as an immediate surgical obturator. However, the arrange of the prosthesis corresponding to the proposed defect should be reduced and the posterior denture teeth removed prior to surgery. Interim lining materials may be added to the revised prosthesis at the time of surgery to improve adaptation. Definitive obturation Three to 4 months after surgery consideration may be given to the construction of a definitive obturator prosthesis. The timing will vary depending on the size of the defect, the prognosis of healing align, the prognosis for tumor control, the effectiveness of the present obturator, and the presence or absence of teeth. The detect must be engaged more aggressively for edentulous patients to maximize support, retention and stability. Therefore, the recovery period is often extended for these patients. As with conventional immediate dentures, changes associated with healing and remodeling will continue to occur in the border areas of the defect for at least l year. However in contrast with immediate dentures, dimensional changes are primarily related to the peripheral soft tissues rather than to bony support areas. By this time the mental outlook of most patients will have improved. They realize that speech, mastication and deglutition will not be compromised significantly. Most dentulous patients are prepared physically and emotionally for the extensive restorative procedures that may be required prior to the construction of a definitive obturator. In addition to treatment planning associated with a standard prosthodontic evaluation, the clinician should elicit information relative to the prognosis for tumor control and the general health and desires of the patient. A patient' s poor prognosis www.51lunwen.orgor poor health does not preclude the construction of a definitive obturator prosthesis, but the treatment plan should reflect the possible altered needs of such a patient. Mounted diagnostic casts are essential, and new radiograghs of questionable teeth should be ob留学作业定做tained. The evaluation should include opinions from the surgeon, the radiation therapist, and the clinical social worker. Most patients will be functioning well with their surgical prosthesis, so the treatment plan may be developed systematically and thoroughly. VOCABULARY l. Maxillofacial rehabilitation
  2. obturation
  3. obturator
  4. immediate surgical obturator
  5. maxillectomy
  6. surgical packing
  7. contamination
  8. nasogastric
  9. nasogastric tube 颌面修复 充填,填塞,闭塞 人工口盖,堵塞器 额护板 上颌骨切除术 外科填塞物 污染,污染物 鼻胃的 鼻胃管留学作业定做

  10. psychologic
  11. psychologic impact
  12. soft reline materials
  13. stainless steel wire
  14. resection
  15. flange
心理学的 心理影响 软衬材料 不锈钢丝 切除(术) 翼
 

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