Oral commissure expansion prosthesis

Oral commissure

expansion

prosthesis

Zafrulla Khan, DDS,a and Joseph C. Banis, Jr., MDb University of Louisville, School of Dentistry and School of Medicine, Louisville, Ky. An expansion prosthesis to stretch cammissures and fibrotic muscles is often essential for patients recovering from head and neck trauma or burns. The prosthesis is easily made in one appointment using Triad resin and a 7 mm expansion screw. Depending on the frequency of use, varying degrees of opening the jaws can be obtained. The prosthesis is inexpensive to make and can easily modified as needed. It is convenient for use because the patient controls the pressure that is applied by the prosthesis. (J PROSTHET DENT 1992;67:383-5.)

M.

icrostomia is a commonoccurrencewith trauma, surgical resection, and burns to the mouth and surrounding tissue. The effects of microstomia and the use of expansion prosthesesare documented in the literature.le4 Microstomia causedby trauma and surgical resection is aProfessor and Acting Chairman, Reconstructive Dentistry; Director, Dental Oncology and Maxillofacial Prosthetics. bAssociate Professor, Department of Medicine. 10/l/31363

of be

due to contraction of the tissuesthat surround the oral cavity and hypotonia of the circumoral musculature. This contraction affects physical appearance,speech,eating, the ability to obtain optimal dental care, and maintenanceof good oral hygiene. Correcting microstomia involves plastic and reconstructive surgery, including microsurgery. Surgery requires an amplesupply of tissuefor reconstructive procedures.Balloons have been inserted under the skin to stretch it to provide more tissue, but this approach is not possiblefor lysis. For the lips, a splint-type prosthesismay accomplish the sameresult. A simple technique for making a splint to stretch the commissuresand fibrotic musclesis described. Only one appointment is necessaryto make the prosthesis,which is then easily inserted and adjusted by the patient. This technique producesa tissuebed for surgeonsthat is supple and usable in most oral and facial reconstruction procedures.

TECHNIQUE 1. With the patient relaxed, measurethe distancebetween the commissuresof the mouth (Fig. 1). 2. Mold Triad denture basematerial (Dentsply Int., York, Pa.) into the commissuresof the mouth and cure it with Fig.

1. Measurement of opening at rest.

Fig. 2. Lateral view of expansionprosthesisand key used for activation. THE

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Fig.

3. Expansion prosthesiswith key in place. 383

KHAN

Fig.

4. Limited opening due to facial trauma.

Fig.

Fig.

BANIS

6. Limited opening due to burns.

5. Activated prosthesisin position. Fig.

a hand-held visible light source for 2 minutes for the initial set. 3. Remove the two halves and, using more Triad denture basematerial and a 7 mm expansionscrew(Dentaurum, Newton, Pa.) in a closedposition, complete the splint while maintaining the previously recorded distance. 4. Cure the prosthesisin the Triad VLC light-curing unit (Dentsply Int.) for 8 minutes and modify it with a carbide bur before polishing (Figs. 2 and 3). 5. Instruct the patient in placement of the prosthesisand screw activation using a key (Figs. 4 and 5).

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7. Prosthesisin position.

DISCUSSION Microstomia is a commoncomplication of facial trauma and resectionsurgery. A simpleprosthesisasdescribedcan be placed easily to apply forces that are controlled by the patient. This control avoids excessivepain and eliminates pressurewounds. The patient activates the screwwith a key on a daily basisand can wear the prosthesisfor 6 to 8 hours. When the

MARCH

1992

VOLUME

07

NUMBER

3

ORALCOMMISSUREEXPANSIONPROSTHESIS

maximum opening of the expansion screw is reached, the patient returns to the office where the prosthesis is sectioned and new material is added to compensate for the expansion of the tissues. The frequency and extent of the opening depends on the compliance of the patient; achievable goals of 25 to 30 mm opening are possible. For children with burns, the parent can insert and activate the prosthesis while the patient sleeps. (Figs. 6 and 7).

SUMMARY A simple procedure for construction of a tissue expansion prosthesis is described. The use of this basic prosthesis to stretch oral tissues gives the reconstructive surgeon an increased amount of tissue with which to work.

Microwave-cured Robert Quinter

tracheostoma

E. McKinstry, DMD, C. Beery, PhDC

Eye and Ear Hospital,

and University

REFERENCES 1. Gay WD. PrOsthe& for oral burn patients. J PROSTHET DENT 1964; 52564-6. 2. Ampil JP, Newell L, Taylor P. A simplified prosthesis for treatment of burnstothe ora1cavity.J PROSTHET DENT 1988;59:608-10. 3. Cjorhan JA. A mouth splint for burn microstomia. Am J Occup Ther 1977;31:105-6. 4. Sele M, Tubiana I. A mouth splint for severe burns of the head and neck. J PROSTHET D~~~1989:62:679-81. Reprint

requests

to:

DRZAFRULLAKHAN SCHOOLOFDENTISTRY UNIVERSITY OF LOUISVILLE LOUISVILLE.KY 40292

vents

MDS, MA,* Ivo Zini,b and of Pittsburgh,

Pittsburgh,

Pa.

This article describes a technique of making custom flexible and combined flexible/ rigid tracheostoma vents. The combined flexible rigid tracheostoma vent provides flexible material that is nonirritating in the peristomial region and maintains a patent tracheostoma by the rigidity of the hard acrylic resin section. The flexible tracheostoma vent can be easily inserted and is more comfortable than the rigid commercially available tracheostomy tube. The use of microwave-cured materials permits fabrication during a single visit. The steps involved in the fabrication of the tracheostoma vents are simple and require no elaborate laboratory equipment. (JPROSTHETDENT 1992;67:985-9.)

A

hollow tube placed within the lumen of the trachea to provide a means of obtaining air is one of the earliest lifesaving surgical procedures known to man.l Following this discovery, studies have been undertaken to determine the ideal tube, both in length and material.2-4 Moore1 reported tracheal diameters of 5 to 6 mm in infants

aDirector, Regional Center for Maxillofacial Prosthetic Rehabilitation, Eye and Ear Hospital, Assistant Professor, Department of Prosthodontics, University of Pittsburgh, School of Dental Medicine. bFacial Technician, Regional Center for Maxillofacial Prosthetic Rehabilitation, Eye and Ear Hospital. CActing Chief, Section of Speech, Language, and Voice Pathology, Eye and Ear Hospital; Associate Professor, Department of Otolaryngology, University of Pittsburgh School of Medicine. 10/l/29120

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and 12 to 23 mm in adults. He recommended that the part of the tube in the trachea, as measured downward from the lower angle of the incision, be one and one-half times the tracheal diameter. Currently available tracheostomy tubes vary in lengths and diameters, depending on the manufacturer.4 To prevent potential complications from long and rigid metal and plastic tracheostomy tubes, flexible silicone rubber (Dow Corning Corp., Midland, Mich.) bi-flanged tracheostomy tubes have been developed.5, 6 These tubes are easily inserted and can be conveniently hidden beneath the clothing. These tubes are generally shorter than the conventional metal or plastic tracheostomy tubes and therefore are called “vents” (Fig. 1). These vents cannot be used where the postsurgical stoma contour is irregular, because the external flange cannot be adapted to the stoma opening. If the stoma vent is too long, it will contact the posterior wall of the trachea. Stoma1 stricture may also be

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