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Intraoperative Fabrication of Palatal Prosthesis for Maxillary Resection
Gady Har-El, MD;
Mahesh Bhaya, MD
Arch Otolaryngol Head Neck Surg. 2001;127:834-836.
Background Immediate placement of a palatal prosthesis has become the standard
of care after maxillectomy or palatectomy, except when free-flap reconstruction
is used. Palatal prostheses are usually fabricated preoperatively. Infrequently,
the surgeon may face a situation where upper jaw resection has been performed
and a prefabricated prosthesis is not available.
Objective To describe a method of rapid intraoperative fabrication of a palatal
prosthesis, which allows immediate oral intake and excellent speech.
Procedure Two sheets of thermoplastic dressing (Aquaplast; WFR/Aquaplast Corporation,
Wyckoff, NJ) were immersed in hot water. As they became soft and pliable,
they were applied to the remaining hard palate and alveolar ridge. As the
material cooled, it hardened, with its shape conforming to the remaining hard
palate, alveolar ridge, and teeth. The rigid stent was then removed, trimmed,
and fashioned to cover the palatal and maxillary defect. The stent was then
wired to the remaining alveolar ridge and to the ipsilateral zygomatic buttress
or lateral orbital rim. Removal of the stent was easily accomplished in an
office setting.
Patients Twelve patients required partial upper jaw resection without available
prefabricated prostheses. Of these, 3 patients underwent emergency surgery
for mucormycosis and 2 for bleeding malignant tumors; 3 underwent bone resection
more extensive than that anticipated preoperatively; and 4 did not have prefabricated
prostheses for other reasons.
Results The thermoplastic prosthesis achieved its goals in all 12 patients.
Eleven patients achieved oral food intake within 24 hours. One patient remained
in a coma after extensive maxillary, orbital, and skull base resection for
mucormycosis. The prosthesis was removed after 4 to 12 weeks and replaced
with a permanent implant in 11 of the 12 patients.
Conclusions This simple, quick, and inexpensive intraoperative fabrication of palatal
prosthesis requires no special expertise and equipment. It allows immediate
oral intake and excellent speech.
From the Department of Otolaryngology, State University of New York
Health Science Center at Brooklyn. The authors have no relationship with the
manufacturer mentioned in this article.
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Arch Otolaryngol Head Neck Surg. 2001;127(7):889-890.
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