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A prosthetic closure of a traumatic palatal perforation
A PROSTHETIC CLOSURE OF A TRAUMATIC PALATAL PERFORATION JOIIN
E.
D.D.S.
LAZZARI,
Bay Pines,
Fla.
HIS REPORT of the procedure used to close, by means of a prosthetic appliance, a traumatic opening in the hard palate is not presented as a recommended technique. It is presented with the thought that a fellow practitioner who is faced with the same problem will gain some information from the method by which this particular appliance was constructed. The patient was a well-developed, 27-year-old white man who was admitted to this hospital for a comminuted fracture of the ala and left innominate bone resulting from an automobile accident. Other than the hip injury his health was good, with a good blood picture and negative serology. The perforation in the hard palate was secondary to admission diagnosis, and in itself had an interesting history (Fig. 1) . It was the result of a gunshot wound from a 3%caliber pistol which occurred in 194X. The projectile entered the back near the left shoulder blade, passed upward into the mouth, thence through the roof of the mouth to exit at the right side of the nose near the eye. Other than the perforation in the hard palate, the results from this gunshot wound were negative. The perforation was ovoid in shape, 15 mm. in diameter, and opened .directly into the nasal cavity. The patient had been unable to eat, drink, or smoke successfully or comfortably, and his speech had a resonance typical of cleft palate nasality. To compensate for this defect, he plugged the opening with a wad of chewing gum (one full pack) and managed fairly well, removing the ,chewing gum from the opening each night. Clinically the examination of his mouth was negative. The tissues were normal and healthy, and the teeth in good position and occlusion. Radiographitally the teeth were negative. Roentgenograms of the maxillae and of the head showed numerous small metallic fragments in the bones and soft tissues of the right side of the face, but there did not appear to be any metallic fragments in the region of the right orbit. There was no sinus involvement. In preparation for the impression for this patient, the opening through the palate was carefully packed with a continuous strip of cotton. The last layer, or portion of the cotton exposed to the impression material, was coated lightly with petrolatum. This packing was carried to within 2 mm. of the margin of the opening on the palate. Impressions could be made without this packing, but the reproduction of the structures on the nasal side of the palatal opening
T
Received
for publication
May
20, 7952.
LAZZARi
832
was not essential for appliance construction, The element of risk of the impression material breaking away and remaining in the nasal cavity, or packing around the septum, is an unnecessary one. A reversible h~dr(~col~oid was used as ihc* impression material.
Fig. l.-Gunshot
wound in the palate.
Fig. 2. Fig. Fig. 2.-The working cast prepared for duplication. Fig. X-The wax pattern of the appliance on the refractory
3.
cast.
The steps in appliance construction were routine, much the same as employed in partial denture construction. The study cast was surveyed for retentive areas of the teeth to be clasped, and the design of the restoration was sketched on this cast. The teeth in the mouth were prepared in accordance with the study cast design, and the final impression was made. On the cast which recovered from the final impression, the peripheral relief of the design was placed. The teeth to be clasped were blocked out (Fig. 2), and the cast was duplicated in a refractory investment for the wax-up (Fig. 3) and casting of the appliance. The appliance was cast in gold (Fig. 4).
Volume 2 Number 6
PROSTHETIC
CLOSURE
OF TRAiJ\l
ATIC
PALATAL,
PERFORATION
833
In the adaptation of the wax about the palatal opening, the wax-up was carried just beyond the lip of the openin,,u and not more than 1 mm. into the nasal cavity. This was the extent of the finished casting. T\;o relief was made in or about this opening as it appeared on the cast. Regardless of the stability of the appliance when it is in position in the mouth, there would be a slight movement of it. If this area had been relieved, the movement would have caused an irritation about the palatal opening. If the slightest irritation caused by movement of the appliance movements appeared about the palatal opening, immediate and judicious ntljustment of the appliance was indicated (Fig. 5).
Fig. 4.-The
Fig. %-The
palatal surface of the casting.
completed
restoration
in place in the mouth.
SUMMARY
1. The construction of an appliance for closure of a traumatic palatal opening is similar to that of cast partial denture construction. 2. The opening in the palate should be packed to within 2 mm. of the palatal surface of the opening with a continuous cotton strip saturated with petrolatum. 3. No relief is made in or about the opening as it appears on the cast. 4. Guard against irritation about the palatal opening that may he caused 10’ appliance movement. DENTAL SERVICE VETERANS ADMINISTRATION RAY PINES. FL.+.
CENTER
E.
D.D.S.
LAZZARI,
Bay Pines,
Fla.
HIS REPORT of the procedure used to close, by means of a prosthetic appliance, a traumatic opening in the hard palate is not presented as a recommended technique. It is presented with the thought that a fellow practitioner who is faced with the same problem will gain some information from the method by which this particular appliance was constructed. The patient was a well-developed, 27-year-old white man who was admitted to this hospital for a comminuted fracture of the ala and left innominate bone resulting from an automobile accident. Other than the hip injury his health was good, with a good blood picture and negative serology. The perforation in the hard palate was secondary to admission diagnosis, and in itself had an interesting history (Fig. 1) . It was the result of a gunshot wound from a 3%caliber pistol which occurred in 194X. The projectile entered the back near the left shoulder blade, passed upward into the mouth, thence through the roof of the mouth to exit at the right side of the nose near the eye. Other than the perforation in the hard palate, the results from this gunshot wound were negative. The perforation was ovoid in shape, 15 mm. in diameter, and opened .directly into the nasal cavity. The patient had been unable to eat, drink, or smoke successfully or comfortably, and his speech had a resonance typical of cleft palate nasality. To compensate for this defect, he plugged the opening with a wad of chewing gum (one full pack) and managed fairly well, removing the ,chewing gum from the opening each night. Clinically the examination of his mouth was negative. The tissues were normal and healthy, and the teeth in good position and occlusion. Radiographitally the teeth were negative. Roentgenograms of the maxillae and of the head showed numerous small metallic fragments in the bones and soft tissues of the right side of the face, but there did not appear to be any metallic fragments in the region of the right orbit. There was no sinus involvement. In preparation for the impression for this patient, the opening through the palate was carefully packed with a continuous strip of cotton. The last layer, or portion of the cotton exposed to the impression material, was coated lightly with petrolatum. This packing was carried to within 2 mm. of the margin of the opening on the palate. Impressions could be made without this packing, but the reproduction of the structures on the nasal side of the palatal opening
T
Received
for publication
May
20, 7952.
LAZZARi
832
was not essential for appliance construction, The element of risk of the impression material breaking away and remaining in the nasal cavity, or packing around the septum, is an unnecessary one. A reversible h~dr(~col~oid was used as ihc* impression material.
Fig. l.-Gunshot
wound in the palate.
Fig. 2. Fig. Fig. 2.-The working cast prepared for duplication. Fig. X-The wax pattern of the appliance on the refractory
3.
cast.
The steps in appliance construction were routine, much the same as employed in partial denture construction. The study cast was surveyed for retentive areas of the teeth to be clasped, and the design of the restoration was sketched on this cast. The teeth in the mouth were prepared in accordance with the study cast design, and the final impression was made. On the cast which recovered from the final impression, the peripheral relief of the design was placed. The teeth to be clasped were blocked out (Fig. 2), and the cast was duplicated in a refractory investment for the wax-up (Fig. 3) and casting of the appliance. The appliance was cast in gold (Fig. 4).
Volume 2 Number 6
PROSTHETIC
CLOSURE
OF TRAiJ\l
ATIC
PALATAL,
PERFORATION
833
In the adaptation of the wax about the palatal opening, the wax-up was carried just beyond the lip of the openin,,u and not more than 1 mm. into the nasal cavity. This was the extent of the finished casting. T\;o relief was made in or about this opening as it appeared on the cast. Regardless of the stability of the appliance when it is in position in the mouth, there would be a slight movement of it. If this area had been relieved, the movement would have caused an irritation about the palatal opening. If the slightest irritation caused by movement of the appliance movements appeared about the palatal opening, immediate and judicious ntljustment of the appliance was indicated (Fig. 5).
Fig. 4.-The
Fig. %-The
palatal surface of the casting.
completed
restoration
in place in the mouth.
SUMMARY
1. The construction of an appliance for closure of a traumatic palatal opening is similar to that of cast partial denture construction. 2. The opening in the palate should be packed to within 2 mm. of the palatal surface of the opening with a continuous cotton strip saturated with petrolatum. 3. No relief is made in or about the opening as it appears on the cast. 4. Guard against irritation about the palatal opening that may he caused 10’ appliance movement. DENTAL SERVICE VETERANS ADMINISTRATION RAY PINES. FL.+.
CENTER