SONRADAN KAZANILMIŞ MAKSİLLER DEFEKTİN PROTETİK REHABİLİTASYONU: 2 OLGU SUNUMU

Öz

Amaç: Tümör rezeksiyonu sonucu geniş maksiller defekti bulunan 45 yaşındaki erkek ve 57 yaşındaki kadın hastanın bulb obturatörler ile gerçekleştirilen protetik rehabilitasyonlarının sunulması amaçlanmıştır. Olgu Sunumu: Maksillalarında skuamöz hücreli karsinom bulunan erkek hasta ile mukoepidermoid karsinom bulunan kadın hastanın, parsiyel maksillektomi operasyonları sonrası protetik olarak rehabilite edilmeleri planlanmıştır. Bu doğrultuda, defekt bölgelerinden alınan ölçüler ile erkek hastaya bulb obturatör, kadın hastaya hollow bulb obturatör uygulanmış; her iki hastanın parsiyel dişsizliği bulunan alt çeneleri ise metal iskeletli parsiyel protezler ile rehabilite edilmiştir. Oronazal açıklığı bulunan erkek hastanın rezonans ve beslenme probleminin obturatör protez ile giderildiği, üst dudağın desteklenmesiyle birlikte yüz estetiğinin iyileştirildiği gözlenmiştir. Kadın hastaya uygulanan hollow bulb obturatör ile de hasta konforunun arttırıldığı tespit edilmiştir. Sonuç: Erkek hastanın 6, kadın hastanın ise 12 aylık takibinde; rezeksiyon sonrası ortaya çıkan fonksiyon, fonetik ve estetiğe dair şikayetlerin giderildiği gözlenmiştir. Bu tip büyük defektlerde implant üstü protezlerin daha yüksek düzeyde retansiyon ve stabilizasyon sağladığı bilinmektedir. Ancak genel sağlık problemleri, maddi durumları, kontrendikasyon vb. sebeplerle implant tedavilerinin uygulanamadığı durumlarda; konvansiyonel obturatör protez rehabilitasyonları güvenle uygulanabilmektedir. Anahtar Kelimeler: Maksiller Defekt, Obturatör, Hollow Bulb, Protetik Rehabilitasyon Prosthetic Rehabilitation of An Acquired Maxillary Defect: 2 Case Reports ABSTRACT Aim: It’s aimed to present the prosthetic rehabilitations performed with bulb obturators of a 45-year-old male and 57-year-old female patient with large maxillary defects after tumor resection. Case Reports: A male patient with squamous cell carcinoma and a female patient with mucoepidermoid carcinoma were scheduled to be rehabilitated with prostheses after partial maxillectomy operations. Accordingly, a bulb obturator was applied to the male patient and a hollow bulb obturator was applied to the female patient with the impressions made from the defect areas. The lower jaws of both patients with partial edentulism were rehabilitated with metal partial dentures. It has been observed that the resonance and nutrition problems of the male patient with oronasal fistula were eliminated with obturator prosthesis and facial esthetics were improved with the support of the upper lip. It was also determined that the comfort of the female patient was increased with the hollow bulb obturator applied. Conclusion: In 6-month follow-up of male patient and 12-month follow-up of female patient; the complaints about function, phonetics and esthetics occurred after resection were eliminated. The implant-supported prosthesis is known to provide a higher level of retention and stabilization in large defects. However, in cases where implant treatments cannot be applied due to the general health problems, financial situation and contraindications, conventional obturator prosthesis rehabilitation can be applied safely.

Anahtar Kelimeler

• Maksiller Defekt
• Obturatör,
• Hollow Bulb,
• Protetik Rehabilitasyon

Kaynakça

1. 1- Roumanas ED, Freymiller EG, Chang TL, Aghaloo T, Beumer J, 3rd. Implant-retained prostheses for facial defects: an up to 14-year follow-up report on the survival rates of implants at UCLA. Int J Prosthodont 2002;15:325-32.
2. 2- Minsley GE, Warren DW, Hinton V. Physiologic responses to maxillary resection and subsequent obturation. J Prosthet Dent 1987;57:338-44.
3. 3- Lucas RB. Ameloblastoma. In: Pathology of the Oral Diseases, ed 4. London: Churchill Livingstone: 1984. p. 31-60.
4. 4- Hanawa S, Kitaoka A, Koyama S, Sasaki K. Influence of maxillary obturator prostheses on facial morphology in patients with unilateral maxillary defects. J Prosthet Dent 2015;113:62-70.
5. 5- Nguyen CT, Driscoll CF, Coletti DP. Reconstruction of a maxillectomy patient with an osteocutaneous flap and implant-retained fixed dental prosthesis: a clinical report. J Prosthet Dent 2011;105:292-5.
6. 6- Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, O'Ryan F. American Association of, O.; Maxillofacial, S. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. J Oral Maxillofac Surg 2014;72:1938-56.
7. 7- Meenakshi A, Shah D. The obturator prostheses for maxillectomy. SRM J Res Dent Sci 2012;3:193.
8. 8- Akay C, Yaluğ S. Kısmi maksillektomi yapılmış hastaların bukkal uzantılı obturatör ile protetik rehabilitasyonu: Vaka raporu. Atatürk Üniv Diş Hek Fak Derg 2014;24:278-82.

9. 9- Ariani N, Visser A, Van Oort RP, Kusdhany L, Rahardjo T, Krom BP, Van der Mei HC, Vissink A. Current state of craniofacial prosthetic rehabilitation. Int J Prosthodont 2013;26:57-67.
10. 10- Rieger JM, Tang JA, Wolfaardt J Harris J, Seikaly H. Comparison of speech and aesthetic outcomes in patients with maxillary reconstruction versus maxillary obturators after maxillectomy. J Otolaryngol Head Neck Surg 2011;40:40-7.
11. 11- Yip JK, Borrell LN, Cho SC, Francisco H, Tarnow DP. Association between oral bisphosphonate use and dental implant failure among middle-aged women. J Clin Periodontol 2012;39:408-14.
12. 12- Chigurupati R, Aloor N, Salas R, Schmidt BL. Quality of life after maxillectomy and prosthetic obturator rehabilitation. J Oral Maxillofac Surg 2013;71:1471-78.
13. 13- Dos Santos D, de Caxias F, Bitencourt S, Turcio K, Pesqueira A, Goiato M. Oral rehabilitation of patients after maxillectomy. A systematic review. Br J Oral Maxillofac Surg 2018;56:256-66.
14. 14- Ali MM, Khalifa N, Alhajj MN. Quality of life and problems associated with obturators of patients with maxillectomies. Head Face Med 2018;14:2.
15. 15- Taylor TD, Fyler A, LaVelle WE. Alternative obturation for the maxillectomy patient with severely limited mandibular opening. J Prosthet Dent 1985;53:83-5.
16. 16- Minsley GE, Nelson DR, Rothenberger SL. An alternative method for fabrication of a closed hollow obturator. J Prosthet Dent 1986;55:485-90.
17. 17- Devlin H, Barker GR. Prosthetic rehabilitation of the edentulous patient requiring a partial maxillectomy. J Prosthet Dent 1992;67:223-7.
18. 18- Yazıcıoğlu H, Yaluğ S, Akalın MR. İki farklı obturatör yapım yöntemine göre dişler arasındaki boyutsal farklılığın değerlendirilmesi. Atatürk Üniv Diş Hek Fak Derg 2001;11:28-32.
19. 19- Shimodaira K, Yoshida H, Mizukami M, Funakubo T. Obturator prosthesis conforming to movement of the soft palate: a clinical report. J Prosthet Dent 1994;71:547-51.
20. 20- Özdemir H, Aladağ Lİ. Oral Malign Melanom'un Rezeksiyonu Sonucu Oluşan Maksiller Defektin Protetik Tedavisi: Olgu Sunumu. Atatürk Üniv Diş Hek Fak Derg 2018;28:405-9.
21. 21- Aramany MA. Basic principles of obturator design for partially edentulous patients. Part II: design principles. J Prosthet Dent 1978;40:656-62.
22. 22- Özdemir H, Aladağ Lİ. Sonradan Kazanılmış Bir Maksiller Defektin Protetik Obturasyonu : Bir Olgu Sunumu. Atatürk Üniv Diş Hek Fak Derg 2011;4:122-7.
23. 23- Furokawa S, Kimoto S, Furuse N, Furuya Y, Ogawa T, Nakashima Y, Okubo M, Yamaguchi H, Kawai Y. The effects of silicone-based resilient denture liners on pain: A randomized controlled trial. J Prosthodont Res 2020;64:417-23.
24. 24- Hayakawa I, Hirano S, Takahashi Y, Keh ES. Changes in the Masticatory Function of Complete Denture Wearers After Relining the Mandibular Denture with a Soft Denture Liner. Int J Prosthodont 2000;13:227-31.
25. 25- Kar S, Tripathi A, Fatima T. A comparative study of masticatory performance in complete denture patients before and after application of soft liner. Med J Armed Forces India 2019;75:437-43.
26. 26- Tomar BS, Chandu GS, Singh S, Goutam M. Panacea to lost gingival tissue architecture and spacing: Silicone gingival prosthesis. J Indian Prosthodont Soc 2016;16:400-4.
27. 27- Ohno T, Hojo K, Fujishima I. Soft obturator prosthesis for postoperative soft palate carcinoma: A clinical report. J Prosthet Dent 2018;119:845-7.
28. 28- Prema S, Fenlo MR. Two-piece obturator using “lock-and-key” mechanism. J Indian Prosthodont Soc 2017;17:207-11.
29. 29- Aras E. Bukkal uzantılı obturatör yapım yöntemi. Ankara Üniv Diş Hek Fak Derg 1984;11:245-56.
30. 30- Özdemir AK, Coşkun A, Tunalı A, Yaluğ S. Maksiller Rezeksiyonların Protetik Obturasyonu. Cumhuriyet Üniv Diş Hek Fak Derg 1998;2:1.
31. 31- Buurman DJ, Speksnijder CM, Engelen BH, Kessler P. Masticatory performance and oral health‐related quality of life in edentulous maxillectomy patients: A cross‐sectional study to compare implant‐supported obturators and conventional obturators. Clin Oral Implants Res 2020;31:405-16.
32. 32- Aladağ Lİ, Güngör H, Ahmetoğlu F, Holoğlu B, Aras MH. Kısmi Maksillektomi Yapılmış Hastaların Hollow Bulb Obtüratör İle Protetik Rehabilitasyonu: İki Vaka Raporu. Atatürk Üniv Diş Hek Fak Derg 2009;19:105-10.
33. 33- Brown J, Schache A, Butterworth C. Liverpool Opinion on Unfavorable Results in Microsurgical Head and Neck Reconstruction: Lessons Learned. Clin Plast Surg 2016;43:707-18.
34. 34- Sreeraj R, Krishnan V, Thankappan K. Comparison of Masticatory and Swallowing Functional Outcomes in Surgically and Prosthetically Rehabilitated Maxillectomy Patients. Int J Prosthodont 2017;30:573-6.
35. 35- Buurman DJ, Speksnijder CM, de Groot RJ, Kessler P, Rieger JM. Mastication in maxillectomy patients: A comparison between reconstructed maxillae and implant supported obturators: A cross‐sectional study. J Oral Rehabil 2020;47:1171-7.
36. 36- Brown J, Schache A, Butterworth C. Liverpool opinion on unfavorable results in microsurgical head and neck reconstruction: lessons learned. Clin Plast Surg 2016;43:707-18.
37. 37- Gandhi N, Talwar H, Gandhi S, Alageshan V, Abraham G, Mehdiratta S. Prosthodontic rehabilitation of a sub-total maxillectomy defect with a definitive hollow obturator prosthesis using the modified lost-wax concept: A novel technique. National J Maxillofacial Surg 2018;9:225-8.
38. 38- Givi B, Schiff BA, Chinn SB ,Clayburgh D, Iyer NG. Safety Recommendations for Evaluation and Surgery of the Head and Neck During the COVID-19 Pandemic. JAMA Otolaryngol Head Neck Surg 2020;146:579-84.
39. 39- Kowalski LP, Sanabria A, Ridge JA , Ng WT , de Bree R. COVID-19 pandemic: Effects and evidence-based recommendations for otolaryngology and head and neck surgery practice. Head Neck 2020;42:1259-67.
40. 40- Cai YC, Wang W, Li C, Zeng DF, Zhou YQ. Treating head and neck tumors during the SARS‐CoV‐2 epidemic, 2019 to 2020: Sichuan Cancer Hospital, Head Neck 2020;42:1153-8.
41. 41- Brandão TB, Migliorati CA, Vechiato-Filho AJ, Silva WG, Ribeiro ACP, Parise-Junior O, Kowalski LP, Santos-Silva AR. Strategic use of obturator prostheses for the rehabilitation of oral cancer patients during the COVID-19 pandemic. Support Care Cancer 2020:1-5.