_oncology and maxillofacial prosthetics wordpress 口腔颌面部肿瘤假体 课件

Maxillofacial Prosthetic Maxillofacial Prosthetic Rehabilitation of the Head and Rehabilitation of the Head and Neck Cancer PatientNeck Cancer Patient Maureen Sullivan DDSMaureen Sullivan DDS Chief, Dept of Dentistry Chief, Dept of Dentistry Dental Oncology and Maxillofacial Dental Oncology and Maxillofacial ProstheticsProsthetics Erie County Medical CenterErie County Medical Center Dental TeamDental Team n n DentistsDentists n n Maxillofacial ProsthodontistsMaxillofacial Prosthodontists n n HygienistsHygienists n n Maxillofacial Laboratory TechniciansMaxillofacial Laboratory Technicians n n Dental AssistantsDental Assistants Maxillofacial Cancer: affects Maxillofacial Cancer: affects everyone differentlyeveryone differently n n Facial DisfigurementFacial Disfigurement n n Individual Differences in Patient Individual Differences in Patient ResponseResponse n n Extent and Location of DefectExtent and Location of Defect n n Radiation and ChemotherapyRadiation and Chemotherapy n n Age Age n n Functional DisabilitiesFunctional Disabilities Famous Head and Neck Famous Head and Neck Cancer PatientsCancer Patients n n Sigmund FreudSigmund Freud n n Cancer of the Hard Cancer of the Hard palatepalate n n 33 operations33 operations n n Radiation therapyRadiation therapy n n Large defectLarge defect n n Called his Called his prosthesis- the prosthesis- the monstermonster n n Grover ClevelandGrover Cleveland n n Cancer of the hard Cancer of the hard palatepalate n n 1 cancer operation1 cancer operation n n No additional No additional therapiestherapies n n Spoke before Spoke before Congress 2 mos Congress 2 mos following surgeryfollowing surgery Functional Disabilities-Functional Disabilities- Oral and Oral Pharyngeal Acquired Oral and Oral Pharyngeal Acquired DefectsDefects n n Inability to Control SalivaInability to Control Saliva n n Oral IncontinenceOral Incontinence n n Inarticulate SpeechInarticulate Speech n n Nasal LeakageNasal Leakage n n Compromised SwallowingCompromised Swallowing n n Mandibular DeviationMandibular Deviation n n Inefficient MasticationInefficient Mastication n n Xerostomia- Lack of SalivaXerostomia- Lack of Saliva Types of ProstheticsTypes of Prosthetics n n Intraoral ProstheticsIntraoral Prosthetics n n Extra oral ProstheticsExtra oral Prosthetics Reasons Reasons n n NeoplasticNeoplastic n n TraumaTrauma n n CongenitalCongenital Types of ProstheticsTypes of Prosthetics n n FunctionalFunctional n n CosmeticCosmetic n n TreatmentTreatment Intraoral ProstheticsIntraoral Prosthetics n n Maxillary Maxillary n n MandibularMandibular Maxillary ProstheticsMaxillary Prosthetics n n ObturatorObturator n n Speech AidSpeech Aid Obturator ProsthesisObturator Prosthesis n n Used to correct acquired defects of the Used to correct acquired defects of the maxilla, hard palatemaxilla, hard palate n n Occludes a surgical defect to create Occludes a surgical defect to create more normal speech and swallowingmore normal speech and swallowing Obturator ProsthesisObturator Prosthesis n n Surgical IncisionsSurgical Incisions n n Remaining Oro Remaining Oro Nasal DefectNasal Defect Hard Palatal Defect Hard Palatal Defect 3 Phases of Obturator Fabrication 3 Phases of Obturator Fabrication for Acquired Defects of the Maxillafor Acquired Defects of the Maxilla n n Immediate Surgical ObturatorImmediate Surgical Obturator n n Interium Obturator ProsthesisInterium Obturator Prosthesis n n Definitive Obturator ProsthesisDefinitive Obturator Prosthesis Immediate Surgical Immediate Surgical ObturatorObturator n n Designed and fabricated prior to Designed and fabricated prior to maxillectomymaxillectomy n n Affords patient the ability to speak Affords patient the ability to speak following surgeryfollowing surgery n n Provides positive pressure on packing Provides positive pressure on packing and skin graftingand skin grafting n n Prevents fluid leakage into the nosePrevents fluid leakage into the nose Immediate Surgical Immediate Surgical ObturatorObturator Immediate Surgical Immediate Surgical ObturatorObturator n n Design completed Design completed prior to ablative prior to ablative surgery surgery n n Close Close communication with communication with the surgeonthe surgeon Immediate Surgical Immediate Surgical ObturatorObturator n n Restore oral Restore oral function to function to reasonable levels reasonable levels during the initial during the initial post surgical periodpost surgical period Maxillary Interium Maxillary Interium Obturator Obturator n n Placed shortly after surgeryPlaced shortly after surgery n n Used throughout the healing phaseUsed throughout the healing phase n n Can modify and existing denture if Can modify and existing denture if availableavailable Maxillary Interium Maxillary Interium ObturatorObturator Maxillary Interium Maxillary Interium ObturatorObturator n n Modification of an Modification of an exisitng partial exisitng partial denturedenture n n Extension into the Extension into the soft palatesoft palate Maxillary Interium Maxillary Interium ObturatorObturator Maxillary Interium Maxillary Interium ObturatorObturator n n Clasp assembly is Clasp assembly is used to aid in used to aid in retentionretention n n Soft liner is used to Soft liner is used to provide a seal provide a seal during functionduring function n n Provide pt with Provide pt with comfort and comfort and function until function until healing is completehealing is complete Definitive Obturator Definitive Obturator ProsthesisProsthesis n n Design is determined by the size of the Design is determined by the size of the defect, presence of teeth, and trismusdefect, presence of teeth, and trismus n n May be complete or partialMay be complete or partial n n May be hollow or solidMay be hollow or solid n n Timing of fabrication depends upon Timing of fabrication depends upon healing and secondary treatmentshealing and secondary treatments n n Defect must be dimensionally stableDefect must be dimensionally stable Defects- Small or LargeDefects- Small or Large Larger Defect- Larger Larger Defect- Larger ChallengeChallenge Total Maxillectomy DefectTotal Maxillectomy Defect Two Part Obturator Two Part Obturator ProsthesisProsthesis Definitive Two Part Definitive Two Part Obturator ProsthesisObturator Prosthesis Maxillary Speech Aid Maxillary Speech Aid ProsthesisProsthesis n n Used to Reconstruct Acquired Soft Used to Reconstruct Acquired Soft Palatal Defects Palatal Defects n n Surgical Resection of the Soft Palate Surgical Resection of the Soft Palate Creates Velopharyngeal InsufficiencyCreates Velopharyngeal Insufficiency n n Usually extends into the PharynxUsually extends into the Pharynx Unreconstructed Cleft Unreconstructed Cleft Palates Require Speech AidsPalates Require Speech Aids Variabilities in Variabilities in Velopharyngeal ClosureVelopharyngeal Closure n n Individual VariationIndividual Variation n n Task RelatedTask Related n n Sex RelatedSex Related n n Age RelatedAge Related n n Head PositionHead Position Muscles Involved in Muscles Involved in Velopharyngeal ClosureVelopharyngeal Closure n n Levator veli PalatiniLevator veli Palatini n n Uvular Uvular n n Superior ConstrictorSuperior Constrictor Levator veli palatini- insertion is Levator veli palatini- insertion is the middle 1/3 of the soft palatethe middle 1/3 of the soft palate Nerve Supply to the Nerve Supply to the Velopharyngeal MusculatureVelopharyngeal Musculature n n Pharyngeal Plexus IX, X, XI (mostly X, Pharyngeal Plexus IX, X, XI (mostly X, the vagus nerve)the vagus nerve) n n Exceptions- V2- Tensor Veli PalatiniExceptions- V2- Tensor Veli Palatini Small Soft Palate DefectSmall Soft Palate Defect Speech Aid ProsthesisSpeech Aid Prosthesis n n Palatal Portion- Palatal Portion- Maxillary DentureMaxillary Denture n n Pharyngeal Pharyngeal ExtensionExtension n n Speech BulbSpeech Bulb Speech Aid BulbSpeech Aid Bulb n n Bulb is shaped by Bulb is shaped by functional functional Impression of the Impression of the Superior Pharyngeal Superior Pharyngeal Constrictor MuscleConstrictor Muscle Maxillary Speech Aid Maxillary Speech Aid ProsthesisProsthesis n n Bar Extending into Bar Extending into the Pharynxthe Pharynx Palatal Augmentation Palatal Augmentation ProsthesisProsthesis n n Prosthesis that reconstructs the Prosthesis that reconstructs the function of the tongue and floor of the function of the tongue and floor of the mouthmouth n n Glossectomy patients lose the ability to Glossectomy patients lose the ability to swallowswallow chewchew clear the buccal vestibuleclear the buccal vestibule speak clearly speak clearly Partial Glossectomy Partial Glossectomy Residual Tongue in Residual Tongue in FunctionFunction Palatal Aumentation Palatal Aumentation ProsthesisProsthesis n n Tongue Remnant Tongue Remnant Contacts the Contacts the Maxillary PortionMaxillary Portion n n Floor of Mouth is Floor of Mouth is extended with the extended with the Mandibular PortionMandibular Portion Palatal Augmentation Prosthesis may Stimulate Palatal Augmentation Prosth