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Obturator prosthesis conforming to movement of the soft palate: A clinical report
SECTION
EDITORS
Steven A. Aqnilino,
William
F. P. Malone,
Thomas
D. Taylor
Clinical Reports Obturator prosthesis conforming palate: A clinical report Kiyoshi Shimodaira,a Masahito Mizukami, Tsukuba University ‘I’zukuha, Tsukuba,
Hospital, -Japan
Hiroshi Yoshida, DDS, PhD,b DDS,C and Takashi Funakubo, Tsukuba-shi.
and the Institute
P.
atlents who have undergone extensive surg,cal resection of the maxilla experience dysfunctions in de&tition, mastication, and speech. The placement of an 01 turator prosthesis improves deglutition and speech in most patients. However, for patients with surgically acquired defects that extend into the soft palate, satisfactory results are not always provided with an obturator prosthesis because of compromised palatal pharyngeal function’ ’ or a lack of oronasal separation during elevation of the soft palate.‘, “3’ This problem is particularly significant in patients with few or no remaining teeth for retention of the prosthesis. In patients who have minimal structures within the residual maxilla available to provide adequate retention of the prosthesis, the remaining structures within the defect can be used. Hahn,’ Wood and Carl7 and Vergo and Chapmans proposed the use of a silicone obturator prosthesis to enhance retention and oronasal separation. The residual soft palate has been relied on to provide adequate reTention. Several author@” recommended the use of extemion placed on the nasal side of the soft palate as an obtur,ltor segment to provide retention and oronasal separation. Although they reported clinical success in restoratiol of speech and deglutition with obturator extensions, most of the results obtained were not objectively evaluated. Ideally, the larger the obturator is, the more effecti\ e it should be.“’ However, a large obturator can limit the r;ath
“Certified Dental Technician, Division of Dental Laboral ory. Tsukuba University Hospital. “Professor, Department of Stomatology. Institute of Cliliical Medicine, University of Tsukuba. ‘Senior Resident, Division of Oral and Maxillof’acial Surgery, Tsukuba University Hospital. dAssistant Professor, Department of Stomatology. Institute of Clinical Medicine, University of Tsukuba. ,J PROSTHW DEKT 1994;71:547-51. Copyright ’ 1994 by The Editorial Council of THE ,JOl'f?%i. OF
PROSTHETICDENTISTHY.
JL'XE
1994
to movement
DDS,
of Clinical
of the soft
PhDd
Medicine,
I’niverslty
crf
of insertion and removal of the prosthesis and may be uncomfortable when in place. To provide adequate oronasal separation and retention l’or a patient with a maxillary defect extending into the soft palate and few remaining teeth, an obturator prosthesis with small flexible silicone extensions placed at the nasal and oral sides across the mobile, anterior margin of the soft palate is most effective. In this clinical report, the effect of this obturator prosthesis for oronasal separation and retention was objectively evaluated.
CLINICAL
REPORT
A 70-year-old Japanese woman who underwent a maxillectomy for undifferentiated carcinoma that extended from the entire hard palate to the anterior segment of soft palate, the nasal cavity, and the bilateral maxillary sinuses served as a patient for this report. A surgical obturator prosthesis was placed immediately after surgery to hold surgical dressings, close the area of resection. and provide limited physiologic assistance for speech and deglutition. Four months after surgery. fabrication of a definitive obturator prosthesis was planned to restore deglutition and speech after confirmation of nonrecurrence of tumor and no change in tissue during healing. The patient had no limitation of jaw opening. Oral examination revealed that the surgically acquired defect involved the entire hard palate, bilateral maxillary sinuses, nasal cavity, and anterior portion of the soft palate. The anterior margin of the residual soft palate was mobile. The maxillary alveolar ridge was preserved and only the maxillary right lateral incisor remained. The nasal septum, the sinus walls. and the bilateral inferior turbinates were resected (Fig. 1). The patient did not receive speech therapy before or after placement of the definitive oblurator prosthesis.
Definitive
obturator
prosthesis
The residual alveolar ridge and the soft palate were available for retention of a definitive maxillary obturator prosthesis. A preliminary nnpression was made in irreversible hydrocolloid, over which plaster of paris was poured to produce a cast of the defect. A c,ustom tray for the final im-
SHIMODAIRA
ET AL
Fig. 1. Surgically acquired maxillary defect.
Fig. 2. Obturator prosthesis with extensions. pression was fabricated in the cast. The extending impression for the nasal side of the soft palate was taken with alginate loaded onto the tray and with the residual soft palate in relaxed condition. It was necessary to take an accurate impression of both sides of the soft palate at rest. After the master cast was completed, the soft palate segment of the maxillary cast was duplicated with silicone impression material loaded on the tray fabricated from the master cast. The denture was processed in a standard manner with acrylic resin. The denture was adjusted for oral cavity comfort, and then the obturator segment of the prosthesis was fabricated with wax on the duplicated cast. The obturator segment consisted of extensions 10 mm and 7 mm long, which were placed at the nasal and oral surfaces across the anterior margin of the residual soft palate to conform to the movement of the soft palate. After the wax was boiled out, soft silicone material (Molloplast-B, Detax, Ettigen, 548
Germany) was poured to fabricate the extensions. Adhesive (Primo, Buffalo Dental Supply, Buffalo, N. Y.) was used (Figs. 2 and 3) for attachment of the acrylic resin and the soft silicone material. Speech intelligibility, deglutition, conformity of extensions
and
The effect of the silicone extensions on oronasal separation, speech intelligibility, deglutition, and conformity of the extensions with movement of the soft palate were examined and evaluated. Speech intelligibility was measured with and without the definitive obturator prosthesis by use of a standard Japanese speech intelligibility test that consists of 100 syllables. The patient was instructed to pronounce the 100 syllables, which were recorded and then played back to 10 listeners who had never heard the patient before. The listeners transcribed the sounds as the syllables that they believed
VOLUME
71
NUMBER
6
SHIMODAIRA
THE JOURNAL
ET AL
Fig.
OF PROSTHETIC
DENTISTRY
3. Obturator prosthesis with extensions in place in patient’s mouth.
they had heard. Speech intelligibility scoreswere expressed as the mean percentage of correct response for the 10 listeners. Deglutition was radiographically evaluated. Two sequential lateral radiographs were taken with the definitive obturator at the beginning and end of the initial phase of transferring contrast medium (Baritogen Sol., Fushimi, Tokyo, Japan) from the oral cavity to the oropharynx. Two lateral cephalographs were taken of the patient wearing the definitive obturator at rest and during vowel phonation to examine conformity of the extensions. The extensions were tightly coated with contrast medium (Vitapex, Neo Dental Chemical Products Co., Tokyo, Japan). The positions of the contrast medium were compared between the at-rest state and vowel phonation. The relationship between the positions of the contrast medium and the soft palate were observed on the two films.
RESULTS Speech intelligibility The patient’s speech intelligibility score was 17.2% correct without the obturator prosthesis. With the obturator prosthesis the score was approximately 90 % correct, sim ilar to healthy individuals. The percentage of difference with and without the obturator was 72.4% (Table I). The placement of the obturator prosthesis provided noticeable improvement in speech.
Deglutition Radiographic examination revealed no escape of contrast medium from the mouth into the nasal cavity at the posterior border of the obturator prosthesis at the end of the initial phase of deglutition (Fig. 4). This result suggested that the extensions provided effective oronasal separation during deglutition.
IUNE
1994
Fig. 4. Radiograph shows no escape of calntrast medium from mouth into nasal cavity during deglutition.
Conformity
of extensions
The radiograph showed that the contrast medium coated on the extensions had sufficient contact at ‘both nasal and 549
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
SHIMODAIRA
ET AL
6. Radiograph shows slightly upward displacement of contrast medium with soft palate elevation during vowel phonation, maintaining contact with soft palate.
5. Radiograph shows contact between contrast medium coated on extensions and both nasal and oral sides of soft palate at rest.
Fig.
Table I. Speech intelligibility
into the oral side of the intact soft palate2 or the defect on contact with the nasal side of the soft palate during elevatione4,lo-12 Obturator prostheses are usually made with acrylic resin. However, the hardness of the obturators limits their usefulnes@l7 because soft palate elevation during speech and deglutition compromises oral and nasal separation and retention, and movement of the obturator prosthesis may irritate the supporting structures. The use of flexible silicone material has been proposed to provide better retention and less irritation than hard acrylic resin, Other advantages of silicone obturators are lightness of weight and ease of insertion and removal of the prosthesis.6 Although no obturator prosthesis can completely replace the soft palate, an obturator prosthesis should enhance the effectiveness of the residual soft palate and maintain effective oronasal separation during function by synchronously moving with the soft palate during elevation. Based on this concept, extensions as obturator segments on both the oral and nasal sides of the soft palate were made with flexible soft silicone material. To make these extensions, it
Fig.
scores (% correct) of the
patient Without obturator prosthesis 17.2
With obturator prosthesis 89.6
Difference 72.4
oral sides of the soft palate at rest (Fig. 5). Compared with the at-rest state, the contrast medium was slightly displaced upward with soft palate elevation on vowel phonation and maintained contact with the soft palate (Fig. 6). This evidence suggested that the extensions conformed with the movement of the soft palate during phonation.
DISCUSSION To secure oronasal separation during soft palate elevation, impressions for recording the functional movements of the soft palate bordering the defect are usually made with thermoplastic waxes.2 To minimize fluid and food leakage on deglutition, extensions may be placed either
550
VOLUME
71
NUMBER
6
SHIMODAIRA
THE
ET AL
was necessary to obtain accurate impressions of both surfaces of the soft palate at rest. The achievement of effective oronasal separation was demonstrated objectively by an intelligibility test3, *, 13-15 and by radiographs.‘s I7 Conformity of the extensions with the movement of the soft palate was demonstrated radiographically. The obturator prosthesis was comfortable for the patient, restored adequate speech and deglutition, and provided effective retention during function. At the time of the Z-month recall after placement, the patients stated that she was able to communicate without difficulty and was fully satisfied by the results obtained with the obturator prosthesis. CONCLUSION The results obtained from this clinical report suggest that silicone extensions can be useful to alleviate disorders in speech and deglutition and provide adequate retention of a prosthesis in patients with an extensive maxillary defect that involves the mobile soft palate and few remaining teeth. Long-term follow-up is advisable because the soft silicone material may harden and lose flexibility. REFERENCES
JOURNAL
OF PROSTHETIC
DENTISTRY
and prosthetic treatment for speech disorders attributable to surgically acquired soft palate defects. J Oral Maxillofac Surg 1993;51:361-5. 5. Tobey EA, Lincks J. Acoustic analyses of speech changes after maxillectomy and prosthodontic management. J PROSTHET DENT 1989;62: 449-55.
6. Hahn GW. A comfortable silicone bulb obturator with or without dentures. J PROSTHET DENT 1972;28:313-7. 7. Wood RH, Carl W. Hollow silicone abturatorn for patients after total maxillectomy. J PROSTHET DENT 1977;38:643-51. 8. Vergo TJ Jr, Chapman RJ. Maximizing support for maxillary defects. J PROSTHET DENT 1981;45:179-82. 9. Aramany MA, Drane JB. Effect of nasal extension sections on the voice quality of acquired cleft palate patients. J PROSTHET DENT 1972; 27:194-202. 10. Desjardins RP. Obturator prosthesis design for acquired maxillary defects. J PROSTHET DENT 1978;39:424-35. 11. Laney WR. Diagnosis and treatment in prosthodontics. 1st ed. Phila-
delphia: Lea & Febiger, 1983:377-446. 12. Groetsema WR. An overview of the maxillofacial prosthesis as a speech rehabilitation aid. J PROSTHET DENT 1987;57:204-8. 13. Kipfmueller LJ, Lang BR. Presurgical maxillary prosthesis: an analysis of speech intelligibility. J PROSTHET DENT 1972;28:620-5. 14. Majid AA, Weinberg B, Chalian VA. Speech intelligibility following prosthetic obturation of surgically acquired maxillary defects. J PROSTHET DENT 1974;32:87-96. 15. Plank DM, Weinberg B, Chalian VA. Evaluation of speech following prosthetic obturation of surgically acquired maxillary defects. J PROSTHET DENT 1981;45:626-38. 16. Watson RM, Gray BJ. Assessing effective obtura tion. J PHOSTHET DENT 1985;54:88-93. 17. Minsley GE, Warren DW, Hinton V. Physiologic responses to maxillary resection and subsequent obturation. J PROSTHET DENT 1987;57:338-44.
1. Bloomer HH, Hawk AW. ASHA Reports No 8. Orofacial anomalies:
Clinical and research implications. Washington, DC: American Speech and Hearing Association, 197342-61. 2. Curtis TA, Beumer J III. Maxillofacial rehabilitation: prosthodontic and surgical considerations. 1st ed. St Louis: Mosby, 1979188-243. 3. Yoshida H, Michi K, Ohsawa T. Prosthetic treatment for speech disorders due to surgically acquired maxillary defects. J Oral Rehabil 1990;17:565-71. 4. Yoshida H, Michi K, Yamashita Y, Ohno K. A comparison of surgical
I
JUNE
1994
Bound volumes
available
Reprint requests to: DR. HIROSHI YOSHIDA DEPARTMENT OF STOMATOLOCY INSTITUTE OF CLINICAL MEDICINE UNIVERSITY OF TSUKUBA l-l-l TENNOUDAI, TSUKUBA-SHI IBARAKI-KEN 305 JAPAN
to subscribers
Bound volumes of THE JOURNAL OF PROSTHETIC DENTISTRY are available to subscribers (only) for the 1994 issues from the publisher at a cost of $67.00 ($80.00 international) for Vol. 71 (January-June) and Vol. 72 (July-December). Shipping charges are included. Each bound volume contains a subject and author index, and all advertising is removed. Copies are shipped within 30 days after publication of the last issue in the volume. The binding is durable buckram with the journal name, volume number, and year stamped in gold on the spine. Volumes 69 and 70 are also available. Payment must accompany all orders. Contact Mosby-Year Book, Inc., Subscription Services, 11830 Westline Industrial Drive, St. Louis, MO 63146-3318, USG; phone (800)453-4351, or (314)453-4351. Subscriptions must be in force to qualify. Bound volumes are not available in place of a regular JOURNAL subscription.
551
EDITORS
Steven A. Aqnilino,
William
F. P. Malone,
Thomas
D. Taylor
Clinical Reports Obturator prosthesis conforming palate: A clinical report Kiyoshi Shimodaira,a Masahito Mizukami, Tsukuba University ‘I’zukuha, Tsukuba,
Hospital, -Japan
Hiroshi Yoshida, DDS, PhD,b DDS,C and Takashi Funakubo, Tsukuba-shi.
and the Institute
P.
atlents who have undergone extensive surg,cal resection of the maxilla experience dysfunctions in de&tition, mastication, and speech. The placement of an 01 turator prosthesis improves deglutition and speech in most patients. However, for patients with surgically acquired defects that extend into the soft palate, satisfactory results are not always provided with an obturator prosthesis because of compromised palatal pharyngeal function’ ’ or a lack of oronasal separation during elevation of the soft palate.‘, “3’ This problem is particularly significant in patients with few or no remaining teeth for retention of the prosthesis. In patients who have minimal structures within the residual maxilla available to provide adequate retention of the prosthesis, the remaining structures within the defect can be used. Hahn,’ Wood and Carl7 and Vergo and Chapmans proposed the use of a silicone obturator prosthesis to enhance retention and oronasal separation. The residual soft palate has been relied on to provide adequate reTention. Several author@” recommended the use of extemion placed on the nasal side of the soft palate as an obtur,ltor segment to provide retention and oronasal separation. Although they reported clinical success in restoratiol of speech and deglutition with obturator extensions, most of the results obtained were not objectively evaluated. Ideally, the larger the obturator is, the more effecti\ e it should be.“’ However, a large obturator can limit the r;ath
“Certified Dental Technician, Division of Dental Laboral ory. Tsukuba University Hospital. “Professor, Department of Stomatology. Institute of Cliliical Medicine, University of Tsukuba. ‘Senior Resident, Division of Oral and Maxillof’acial Surgery, Tsukuba University Hospital. dAssistant Professor, Department of Stomatology. Institute of Clinical Medicine, University of Tsukuba. ,J PROSTHW DEKT 1994;71:547-51. Copyright ’ 1994 by The Editorial Council of THE ,JOl'f?%i. OF
PROSTHETICDENTISTHY.
JL'XE
1994
to movement
DDS,
of Clinical
of the soft
PhDd
Medicine,
I’niverslty
crf
of insertion and removal of the prosthesis and may be uncomfortable when in place. To provide adequate oronasal separation and retention l’or a patient with a maxillary defect extending into the soft palate and few remaining teeth, an obturator prosthesis with small flexible silicone extensions placed at the nasal and oral sides across the mobile, anterior margin of the soft palate is most effective. In this clinical report, the effect of this obturator prosthesis for oronasal separation and retention was objectively evaluated.
CLINICAL
REPORT
A 70-year-old Japanese woman who underwent a maxillectomy for undifferentiated carcinoma that extended from the entire hard palate to the anterior segment of soft palate, the nasal cavity, and the bilateral maxillary sinuses served as a patient for this report. A surgical obturator prosthesis was placed immediately after surgery to hold surgical dressings, close the area of resection. and provide limited physiologic assistance for speech and deglutition. Four months after surgery. fabrication of a definitive obturator prosthesis was planned to restore deglutition and speech after confirmation of nonrecurrence of tumor and no change in tissue during healing. The patient had no limitation of jaw opening. Oral examination revealed that the surgically acquired defect involved the entire hard palate, bilateral maxillary sinuses, nasal cavity, and anterior portion of the soft palate. The anterior margin of the residual soft palate was mobile. The maxillary alveolar ridge was preserved and only the maxillary right lateral incisor remained. The nasal septum, the sinus walls. and the bilateral inferior turbinates were resected (Fig. 1). The patient did not receive speech therapy before or after placement of the definitive oblurator prosthesis.
Definitive
obturator
prosthesis
The residual alveolar ridge and the soft palate were available for retention of a definitive maxillary obturator prosthesis. A preliminary nnpression was made in irreversible hydrocolloid, over which plaster of paris was poured to produce a cast of the defect. A c,ustom tray for the final im-
SHIMODAIRA
ET AL
Fig. 1. Surgically acquired maxillary defect.
Fig. 2. Obturator prosthesis with extensions. pression was fabricated in the cast. The extending impression for the nasal side of the soft palate was taken with alginate loaded onto the tray and with the residual soft palate in relaxed condition. It was necessary to take an accurate impression of both sides of the soft palate at rest. After the master cast was completed, the soft palate segment of the maxillary cast was duplicated with silicone impression material loaded on the tray fabricated from the master cast. The denture was processed in a standard manner with acrylic resin. The denture was adjusted for oral cavity comfort, and then the obturator segment of the prosthesis was fabricated with wax on the duplicated cast. The obturator segment consisted of extensions 10 mm and 7 mm long, which were placed at the nasal and oral surfaces across the anterior margin of the residual soft palate to conform to the movement of the soft palate. After the wax was boiled out, soft silicone material (Molloplast-B, Detax, Ettigen, 548
Germany) was poured to fabricate the extensions. Adhesive (Primo, Buffalo Dental Supply, Buffalo, N. Y.) was used (Figs. 2 and 3) for attachment of the acrylic resin and the soft silicone material. Speech intelligibility, deglutition, conformity of extensions
and
The effect of the silicone extensions on oronasal separation, speech intelligibility, deglutition, and conformity of the extensions with movement of the soft palate were examined and evaluated. Speech intelligibility was measured with and without the definitive obturator prosthesis by use of a standard Japanese speech intelligibility test that consists of 100 syllables. The patient was instructed to pronounce the 100 syllables, which were recorded and then played back to 10 listeners who had never heard the patient before. The listeners transcribed the sounds as the syllables that they believed
VOLUME
71
NUMBER
6
SHIMODAIRA
THE JOURNAL
ET AL
Fig.
OF PROSTHETIC
DENTISTRY
3. Obturator prosthesis with extensions in place in patient’s mouth.
they had heard. Speech intelligibility scoreswere expressed as the mean percentage of correct response for the 10 listeners. Deglutition was radiographically evaluated. Two sequential lateral radiographs were taken with the definitive obturator at the beginning and end of the initial phase of transferring contrast medium (Baritogen Sol., Fushimi, Tokyo, Japan) from the oral cavity to the oropharynx. Two lateral cephalographs were taken of the patient wearing the definitive obturator at rest and during vowel phonation to examine conformity of the extensions. The extensions were tightly coated with contrast medium (Vitapex, Neo Dental Chemical Products Co., Tokyo, Japan). The positions of the contrast medium were compared between the at-rest state and vowel phonation. The relationship between the positions of the contrast medium and the soft palate were observed on the two films.
RESULTS Speech intelligibility The patient’s speech intelligibility score was 17.2% correct without the obturator prosthesis. With the obturator prosthesis the score was approximately 90 % correct, sim ilar to healthy individuals. The percentage of difference with and without the obturator was 72.4% (Table I). The placement of the obturator prosthesis provided noticeable improvement in speech.
Deglutition Radiographic examination revealed no escape of contrast medium from the mouth into the nasal cavity at the posterior border of the obturator prosthesis at the end of the initial phase of deglutition (Fig. 4). This result suggested that the extensions provided effective oronasal separation during deglutition.
IUNE
1994
Fig. 4. Radiograph shows no escape of calntrast medium from mouth into nasal cavity during deglutition.
Conformity
of extensions
The radiograph showed that the contrast medium coated on the extensions had sufficient contact at ‘both nasal and 549
THE
JOURNAL
OF PROSTHETIC
DENTISTRY
SHIMODAIRA
ET AL
6. Radiograph shows slightly upward displacement of contrast medium with soft palate elevation during vowel phonation, maintaining contact with soft palate.
5. Radiograph shows contact between contrast medium coated on extensions and both nasal and oral sides of soft palate at rest.
Fig.
Table I. Speech intelligibility
into the oral side of the intact soft palate2 or the defect on contact with the nasal side of the soft palate during elevatione4,lo-12 Obturator prostheses are usually made with acrylic resin. However, the hardness of the obturators limits their usefulnes@l7 because soft palate elevation during speech and deglutition compromises oral and nasal separation and retention, and movement of the obturator prosthesis may irritate the supporting structures. The use of flexible silicone material has been proposed to provide better retention and less irritation than hard acrylic resin, Other advantages of silicone obturators are lightness of weight and ease of insertion and removal of the prosthesis.6 Although no obturator prosthesis can completely replace the soft palate, an obturator prosthesis should enhance the effectiveness of the residual soft palate and maintain effective oronasal separation during function by synchronously moving with the soft palate during elevation. Based on this concept, extensions as obturator segments on both the oral and nasal sides of the soft palate were made with flexible soft silicone material. To make these extensions, it
Fig.
scores (% correct) of the
patient Without obturator prosthesis 17.2
With obturator prosthesis 89.6
Difference 72.4
oral sides of the soft palate at rest (Fig. 5). Compared with the at-rest state, the contrast medium was slightly displaced upward with soft palate elevation on vowel phonation and maintained contact with the soft palate (Fig. 6). This evidence suggested that the extensions conformed with the movement of the soft palate during phonation.
DISCUSSION To secure oronasal separation during soft palate elevation, impressions for recording the functional movements of the soft palate bordering the defect are usually made with thermoplastic waxes.2 To minimize fluid and food leakage on deglutition, extensions may be placed either
550
VOLUME
71
NUMBER
6
SHIMODAIRA
THE
ET AL
was necessary to obtain accurate impressions of both surfaces of the soft palate at rest. The achievement of effective oronasal separation was demonstrated objectively by an intelligibility test3, *, 13-15 and by radiographs.‘s I7 Conformity of the extensions with the movement of the soft palate was demonstrated radiographically. The obturator prosthesis was comfortable for the patient, restored adequate speech and deglutition, and provided effective retention during function. At the time of the Z-month recall after placement, the patients stated that she was able to communicate without difficulty and was fully satisfied by the results obtained with the obturator prosthesis. CONCLUSION The results obtained from this clinical report suggest that silicone extensions can be useful to alleviate disorders in speech and deglutition and provide adequate retention of a prosthesis in patients with an extensive maxillary defect that involves the mobile soft palate and few remaining teeth. Long-term follow-up is advisable because the soft silicone material may harden and lose flexibility. REFERENCES
JOURNAL
OF PROSTHETIC
DENTISTRY
and prosthetic treatment for speech disorders attributable to surgically acquired soft palate defects. J Oral Maxillofac Surg 1993;51:361-5. 5. Tobey EA, Lincks J. Acoustic analyses of speech changes after maxillectomy and prosthodontic management. J PROSTHET DENT 1989;62: 449-55.
6. Hahn GW. A comfortable silicone bulb obturator with or without dentures. J PROSTHET DENT 1972;28:313-7. 7. Wood RH, Carl W. Hollow silicone abturatorn for patients after total maxillectomy. J PROSTHET DENT 1977;38:643-51. 8. Vergo TJ Jr, Chapman RJ. Maximizing support for maxillary defects. J PROSTHET DENT 1981;45:179-82. 9. Aramany MA, Drane JB. Effect of nasal extension sections on the voice quality of acquired cleft palate patients. J PROSTHET DENT 1972; 27:194-202. 10. Desjardins RP. Obturator prosthesis design for acquired maxillary defects. J PROSTHET DENT 1978;39:424-35. 11. Laney WR. Diagnosis and treatment in prosthodontics. 1st ed. Phila-
delphia: Lea & Febiger, 1983:377-446. 12. Groetsema WR. An overview of the maxillofacial prosthesis as a speech rehabilitation aid. J PROSTHET DENT 1987;57:204-8. 13. Kipfmueller LJ, Lang BR. Presurgical maxillary prosthesis: an analysis of speech intelligibility. J PROSTHET DENT 1972;28:620-5. 14. Majid AA, Weinberg B, Chalian VA. Speech intelligibility following prosthetic obturation of surgically acquired maxillary defects. J PROSTHET DENT 1974;32:87-96. 15. Plank DM, Weinberg B, Chalian VA. Evaluation of speech following prosthetic obturation of surgically acquired maxillary defects. J PROSTHET DENT 1981;45:626-38. 16. Watson RM, Gray BJ. Assessing effective obtura tion. J PHOSTHET DENT 1985;54:88-93. 17. Minsley GE, Warren DW, Hinton V. Physiologic responses to maxillary resection and subsequent obturation. J PROSTHET DENT 1987;57:338-44.
1. Bloomer HH, Hawk AW. ASHA Reports No 8. Orofacial anomalies:
Clinical and research implications. Washington, DC: American Speech and Hearing Association, 197342-61. 2. Curtis TA, Beumer J III. Maxillofacial rehabilitation: prosthodontic and surgical considerations. 1st ed. St Louis: Mosby, 1979188-243. 3. Yoshida H, Michi K, Ohsawa T. Prosthetic treatment for speech disorders due to surgically acquired maxillary defects. J Oral Rehabil 1990;17:565-71. 4. Yoshida H, Michi K, Yamashita Y, Ohno K. A comparison of surgical
I
JUNE
1994
Bound volumes
available
Reprint requests to: DR. HIROSHI YOSHIDA DEPARTMENT OF STOMATOLOCY INSTITUTE OF CLINICAL MEDICINE UNIVERSITY OF TSUKUBA l-l-l TENNOUDAI, TSUKUBA-SHI IBARAKI-KEN 305 JAPAN
to subscribers
Bound volumes of THE JOURNAL OF PROSTHETIC DENTISTRY are available to subscribers (only) for the 1994 issues from the publisher at a cost of $67.00 ($80.00 international) for Vol. 71 (January-June) and Vol. 72 (July-December). Shipping charges are included. Each bound volume contains a subject and author index, and all advertising is removed. Copies are shipped within 30 days after publication of the last issue in the volume. The binding is durable buckram with the journal name, volume number, and year stamped in gold on the spine. Volumes 69 and 70 are also available. Payment must accompany all orders. Contact Mosby-Year Book, Inc., Subscription Services, 11830 Westline Industrial Drive, St. Louis, MO 63146-3318, USG; phone (800)453-4351, or (314)453-4351. Subscriptions must be in force to qualify. Bound volumes are not available in place of a regular JOURNAL subscription.
551