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Prosthesis after maxillectomy
SURGICAL
PROSTHESIS
PROSTHESIS
AFTER
MAXILLECTOMY
A Case Report
L. S. PETTIT, D.D.S.* BENJAMIN H. WILLIAMS, D.D.S., M.S.,"" AND ROBERT M. RYAN, D.D.S.""" The Ohio State University,
College
of
Dentistry,
Columbus,
Ohio
HE OPPORTUNITY FOR DENTISTRY to assume its place on the professional or health team is evident in this report. A prosthesis was needed after a radical surgical operation necessitated by a pathologic growth of tissue involving dental structures. The further development of the dentofacial complex, the restoration of oral function, including speech, and the improvement of appearance were dental factors to be considered.
T
DIAGNOSIS
AND
SURGICAL
OPERATION
The patient, a 4-year-old Negro girl, was referred by a pediatrician to an otolaryngologist because of a large swelling on the left side of the face, presumably the result of a traumatic injury. A hard prominence was present in the maxillary region near the nose. Roentgenographic findings indicated a growth in the proximity of the left maxillary sinus. The patient was admitted to the hospital, and a biopsy of the left maxillary antrum was made by the Caldwell-Luc approach. The biopsy diagnosis made by the Armed Forces Institute of Pathology was that of osteoid osteoma with aggressive growth tendencies.lm7 After the biopsy report, the patient was readmitted to the hospital and a hemimaxillectomy was performed (Fig. 1) . Postoperative recovery was uneventful, and the patient was kept under cornbiotic therapy and tube fed for the first 5 days. On the sixth day, the first packing was removed and a rubber sponge shaped, fitted, and inserted to occlude the orifice and permit further healing of the margins of the tissue involved in the operation. *Professor **Associate ***American
and Chairman, Division of Pedodontics. Professor, Division of Orthodontics. Cancer Society, Inc., Clinical Fellow. 983
984 CONSTRUCTION
PETTIT, OF
THE
PROSTHETIC
WILLIAMS,
AND
RYAN
J. Pros. Den. Sept.-Oct.,
1960
APPLIANCE
A complete roentgenographic and oral examination was performed at the dental clinic approximately 3 months after the surgical operation. All primary teeth were present except the upper left lateral incisor, cuspid, and molars, which were sacrificed in the operation. Extensive caries was present in several remaining teeth ; a stainless steel crown was placed on the lower right second primary molar, and the lower left second molar was removed. Fig.
1.
Fig.
2.
Fig. l.-The oral cavity after left hemimaxillectomy and healing. Note the orthodontic with the retention lug on the cuspid and second deciduous molar. Fig. I.-The completed prosthesis in position. The right side shows the clasp engaged above the retention lug on the cuspid band.
bands
The operative dental work was completed, alginate (irreversible hydrocolloid) impressions were made, and the study casts were mounted on the articulator. To facilitate making the upper impressions, the cavity created by the removal of the left maxilla was packed lightly with gauze saturated with petroleum jelly. The
Volume
10
Number
5
Fig.
PROSTHESIS
3.-The
completed prosthesis. will engage on the
Note retention
AFTER
98.5
MAXILLECTOMY
the notch on the lug on the lingual
lingual side
side of the
of the molar molar band.
clasp
whk:h
gauze created a surface which helped to shape the alginate impression material and gave definition to the borders of the defect. A string was fastened to the gauze pack and brought to the outside of the mouth to prevent displacement or swallowing of the pack. Since anchorage or retention in stabilizing the prosthesis woulcl be unilateral, the upper right first and second primary molars and cuspid were banded, wilth 0.006 inch gold orthodontic band material used on the molars and 0.004 inch material on the cuspid (Fig. 2 ). Retentive areas were created on the labiogingival surface of the bands of the cuspid and second molar and on the lingual surface of
Fig.
4.-The
completed
prosthesis
shows
the
obturator
effect
on
the
left
side.
986
PETTIT,
WILLLAMS,
AND
RYAN
J. Pros. Sept..Oct.,
Den. 1960
the two molars. The lugs for retention were made by soldering a piece of 0.028 inch round wire to the labial and buccal surfaces of the bands and modifying the solder seam on the lingual surface of the molar bands. Clasps made of 0.028 inch stainless steel wire were fashioned to engage the retaining lugs on the lingual surface of the molars, the labial surface of the cuspid, and the buccal surface of the second molar. Thus, when the prosthesis was inserted, it was locked in place by the rest on the lingual surface and the retaining arm of the clasp on the buccal surface. In order to secure an accurate adaptation of the denture base to the soft tissue and to provide a firm base in development of the occlusion, an acrylic resin-base occlusion rim was constructed. Soft modeling compound was added to the occlusion rim, and it was carried back into the mouth and recontoured on the cheek side for esthetic appearance. The casts were mounted on the articulator with the face-bow, the occlusion developed, and the prosthesis completed in the routine manner used for partial dentures (Figs. 3 and 4). The bands were cemented on the teeth, and the prosthetic restoration was adjusted to the teeth and soft tissue. The patient adapted to the situation readily and without difficulty. Through the effective cooperation of the mother and child, the insertion and removal of the prosthesis for frequent cleansing have not been a problem. The speech is unintelligible without the removable partial denture, but with the denture in place, the patient can enunciate clearly and effectively. This patient will be observed to note the effect of the surgical operation on the further development of the dentition and fa$al structures. REFERENCES
1. Jaffe, H. L. : Osteoid Osteoma; Benign Osteoblastic Tumor Composed of Osteoid and Atypical Bone, Arch. $urg. 31:709,. 1935. 2. Pritchard, J. E., and McKay, J. W. : Osteold Osteoma, Canad. M. A. J. 58:567, 1948. 3. Sherman, M. S.: Osteoid Osteoma, Review of the Literature and Report of 30 Cases, J. Bone & Joint Surg. 29:919, 1947. 4. Dockerty, M. B., Ghormley, R. K., and Jackson, A. E. : Osteoid Osteoma : Clinicopathologic Study of 20 Cases, Ann. Surg. 133~77, 1951. 5. Foss, E. L., Dockerty, M. B., and Good, C. A.: Osteoid Osteoma of the Mandible, Report of a Case, Cancer 8:592, 1955. 6. Nelson, A. R.: Osteoid Osteoma of Maxilla, Report of a Case, A.M.A. Arch. Surg. 70:459, 1955. 7. Shafer, W. G.: Benign Tumors and Cysts of the Jawbones, D. Clin. N. America, November, 1957, pp. 693-708. 305 WEST TWELFTH AVE. COLUMBUS 10. OHIO
PROSTHESIS
PROSTHESIS
AFTER
MAXILLECTOMY
A Case Report
L. S. PETTIT, D.D.S.* BENJAMIN H. WILLIAMS, D.D.S., M.S.,"" AND ROBERT M. RYAN, D.D.S.""" The Ohio State University,
College
of
Dentistry,
Columbus,
Ohio
HE OPPORTUNITY FOR DENTISTRY to assume its place on the professional or health team is evident in this report. A prosthesis was needed after a radical surgical operation necessitated by a pathologic growth of tissue involving dental structures. The further development of the dentofacial complex, the restoration of oral function, including speech, and the improvement of appearance were dental factors to be considered.
T
DIAGNOSIS
AND
SURGICAL
OPERATION
The patient, a 4-year-old Negro girl, was referred by a pediatrician to an otolaryngologist because of a large swelling on the left side of the face, presumably the result of a traumatic injury. A hard prominence was present in the maxillary region near the nose. Roentgenographic findings indicated a growth in the proximity of the left maxillary sinus. The patient was admitted to the hospital, and a biopsy of the left maxillary antrum was made by the Caldwell-Luc approach. The biopsy diagnosis made by the Armed Forces Institute of Pathology was that of osteoid osteoma with aggressive growth tendencies.lm7 After the biopsy report, the patient was readmitted to the hospital and a hemimaxillectomy was performed (Fig. 1) . Postoperative recovery was uneventful, and the patient was kept under cornbiotic therapy and tube fed for the first 5 days. On the sixth day, the first packing was removed and a rubber sponge shaped, fitted, and inserted to occlude the orifice and permit further healing of the margins of the tissue involved in the operation. *Professor **Associate ***American
and Chairman, Division of Pedodontics. Professor, Division of Orthodontics. Cancer Society, Inc., Clinical Fellow. 983
984 CONSTRUCTION
PETTIT, OF
THE
PROSTHETIC
WILLIAMS,
AND
RYAN
J. Pros. Den. Sept.-Oct.,
1960
APPLIANCE
A complete roentgenographic and oral examination was performed at the dental clinic approximately 3 months after the surgical operation. All primary teeth were present except the upper left lateral incisor, cuspid, and molars, which were sacrificed in the operation. Extensive caries was present in several remaining teeth ; a stainless steel crown was placed on the lower right second primary molar, and the lower left second molar was removed. Fig.
1.
Fig.
2.
Fig. l.-The oral cavity after left hemimaxillectomy and healing. Note the orthodontic with the retention lug on the cuspid and second deciduous molar. Fig. I.-The completed prosthesis in position. The right side shows the clasp engaged above the retention lug on the cuspid band.
bands
The operative dental work was completed, alginate (irreversible hydrocolloid) impressions were made, and the study casts were mounted on the articulator. To facilitate making the upper impressions, the cavity created by the removal of the left maxilla was packed lightly with gauze saturated with petroleum jelly. The
Volume
10
Number
5
Fig.
PROSTHESIS
3.-The
completed prosthesis. will engage on the
Note retention
AFTER
98.5
MAXILLECTOMY
the notch on the lug on the lingual
lingual side
side of the
of the molar molar band.
clasp
whk:h
gauze created a surface which helped to shape the alginate impression material and gave definition to the borders of the defect. A string was fastened to the gauze pack and brought to the outside of the mouth to prevent displacement or swallowing of the pack. Since anchorage or retention in stabilizing the prosthesis woulcl be unilateral, the upper right first and second primary molars and cuspid were banded, wilth 0.006 inch gold orthodontic band material used on the molars and 0.004 inch material on the cuspid (Fig. 2 ). Retentive areas were created on the labiogingival surface of the bands of the cuspid and second molar and on the lingual surface of
Fig.
4.-The
completed
prosthesis
shows
the
obturator
effect
on
the
left
side.
986
PETTIT,
WILLLAMS,
AND
RYAN
J. Pros. Sept..Oct.,
Den. 1960
the two molars. The lugs for retention were made by soldering a piece of 0.028 inch round wire to the labial and buccal surfaces of the bands and modifying the solder seam on the lingual surface of the molar bands. Clasps made of 0.028 inch stainless steel wire were fashioned to engage the retaining lugs on the lingual surface of the molars, the labial surface of the cuspid, and the buccal surface of the second molar. Thus, when the prosthesis was inserted, it was locked in place by the rest on the lingual surface and the retaining arm of the clasp on the buccal surface. In order to secure an accurate adaptation of the denture base to the soft tissue and to provide a firm base in development of the occlusion, an acrylic resin-base occlusion rim was constructed. Soft modeling compound was added to the occlusion rim, and it was carried back into the mouth and recontoured on the cheek side for esthetic appearance. The casts were mounted on the articulator with the face-bow, the occlusion developed, and the prosthesis completed in the routine manner used for partial dentures (Figs. 3 and 4). The bands were cemented on the teeth, and the prosthetic restoration was adjusted to the teeth and soft tissue. The patient adapted to the situation readily and without difficulty. Through the effective cooperation of the mother and child, the insertion and removal of the prosthesis for frequent cleansing have not been a problem. The speech is unintelligible without the removable partial denture, but with the denture in place, the patient can enunciate clearly and effectively. This patient will be observed to note the effect of the surgical operation on the further development of the dentition and fa$al structures. REFERENCES
1. Jaffe, H. L. : Osteoid Osteoma; Benign Osteoblastic Tumor Composed of Osteoid and Atypical Bone, Arch. $urg. 31:709,. 1935. 2. Pritchard, J. E., and McKay, J. W. : Osteold Osteoma, Canad. M. A. J. 58:567, 1948. 3. Sherman, M. S.: Osteoid Osteoma, Review of the Literature and Report of 30 Cases, J. Bone & Joint Surg. 29:919, 1947. 4. Dockerty, M. B., Ghormley, R. K., and Jackson, A. E. : Osteoid Osteoma : Clinicopathologic Study of 20 Cases, Ann. Surg. 133~77, 1951. 5. Foss, E. L., Dockerty, M. B., and Good, C. A.: Osteoid Osteoma of the Mandible, Report of a Case, Cancer 8:592, 1955. 6. Nelson, A. R.: Osteoid Osteoma of Maxilla, Report of a Case, A.M.A. Arch. Surg. 70:459, 1955. 7. Shafer, W. G.: Benign Tumors and Cysts of the Jawbones, D. Clin. N. America, November, 1957, pp. 693-708. 305 WEST TWELFTH AVE. COLUMBUS 10. OHIO