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DR Salah Abdel Fatah Hegazy: Lecturer of Removable Prosthodontic Department Faculty of Dentistry, Mansoura University

The document discusses maxillary defects and reconstruction after cancer surgery. It covers classification of maxillary defects, radiographic diagnosis methods, use of dental implants to support obturators, and 3D imaging techniques. Reconstruction depends on factors like age, medical history, and defect size. Obturators can resolve functional and psychological issues after maxillectomy but implant-supported obturators provide better support and retention, especially for large defects.

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Ahmed Elmogy
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96 views37 pages

DR Salah Abdel Fatah Hegazy: Lecturer of Removable Prosthodontic Department Faculty of Dentistry, Mansoura University

The document discusses maxillary defects and reconstruction after cancer surgery. It covers classification of maxillary defects, radiographic diagnosis methods, use of dental implants to support obturators, and 3D imaging techniques. Reconstruction depends on factors like age, medical history, and defect size. Obturators can resolve functional and psychological issues after maxillectomy but implant-supported obturators provide better support and retention, especially for large defects.

Uploaded by

Ahmed Elmogy
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPT, PDF, TXT or read online on Scribd
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Dr Salah Abdel Fatah Hegazy

Lecturer of Removable Prosthodontic Department Faculty of Dentistry, Mansoura University

By

Dr Salah Hegazy

Almost 5% of all cancers affect mouth structures, tongue, oropharynx, nasopharynx and larynx. After excision of these lesions, problems regarding chewing, swallowing and speech may appear. Furthermore, changes in appearance, psychosocial function and vocational status may affect the quality of life of these patients after surgical intervention.

Dr Salah Hegazy

The optimal reconstructive therapy of maxillary defects remains controversial. Several therapeutic approaches have been published, including prosthetic obturators, nonvascularised grafts, local flaps, regional flaps and free tissue transfer. Reconstruction of maxillary defects by either reconstructive surgery or an obturator prosthesis depends on patient characteristics, such as age, medical history and defect size.
Dr Salah Hegazy

1)Classification

and Radiographic methods for diagnosis 2) Use of dental implants for support and retention of the obturators. 3) Esthetic approaches

Dr Salah Hegazy

Two horizontal and three vertical buttresses Insertion for most muscles of facial expression and mastication Geometrical structure with 6 walls (hexahedron(

Dr Salah Hegazy

Type I (Limited maxillectomy) One or two walls, preservation of palate Type II (Subtotal maxillectomy) Lower 5 walls, preservation of orbital floor Type III (Total maxillectomy) Resection of all six walls Orbital preservation (IIIa) vs exoneration (IIIb)

Type IV (Orbitomaxillectomy)
Upper 5 walls, preservation of palate
Dr Salah Hegazy

Maxillary Defects

Santamaria & Cordeiro, 2000. Plast Recon Surg

Dr Salah Hegazy

3D Medical Cameras Digital Laboratory process starts with the capture and display of a full colour model of the patients face using a non-contact 3D medical photography scanner. This can provide a 3D face scanner which matches exact needs. All the systems take no more than 2 seconds to capture a patients face as a 3D colour model. This 3D model completely replaces the traditional slow and traumatic casting process.

Dr Salah Hegazy

Dr Salah Hegazy

Dr Salah Hegazy

The conventional and recent diagnosis of maxillofacial diseases are through using dental panoramic radiographs, the diagnostic significance of computed tomography (CT) including multi detector CT (MDCT) and conebeam (CB) CT, the application of magnetic resonance imaging (MRI) for various kinds of oral related diseases, and computer simulations for dental implant and orthognathic surgery planning using data of helical CT images.

Dr Salah Hegazy

The usefulness of ultrasonography (US) for viewing surface soft tissues such as salivary glands, tongue, and lymph nodes, and the advantages and limitations of positron emission tomography (PET) are also described.

Dr Salah Hegazy

Dr Salah Hegazy

Another development in the imaging system of CT scan, computer-aided surgical navigation technology is commonly used in oral and maxillofacial surgery . Based on increased graphic information, computer-aided navigation systems were applied for surgeries, dental implant surgery, arthroscopy of the temporomandibular joint, bone deformities of maxilla and mandible, image guided biopsies and removal of foreign bodies

Dr Salah Hegazy

The surgical procedure can be simulated on stereolithographic models to obtain planning data. This process is applied especially for orthognathic surgery in patients with deformities of the jaws. The data are merged with the real image of the patient, whose position is continuously tracked during the procedure. It can be performed using fiducial markers, which are fixed on the patient when obtaining the CT-scan images, by using anatomical landmarks or by surface matching. Tracking systems pick up the position of the patient and the surgical tool and transfer these data to the central processing unit. In the future, computer aided surgical navigation technology may be applied to surgical procedures in the oral and maxillofacial regions.

Dr Salah Hegazy

Dr Salah Hegazy

Recently, it was shown that the findings and parameter of dynamic contrast-enhanced MR images could be used as diagnostic tools for tumors in the oral and maxillofacial regions .In particular, dynamic MR imaging may predict whether head and neck lesions including those affecting salivary glands are malignant, it can help limit differential diagnosis, and has the potential of predicting vascularity and recurrence .

Dr Salah Hegazy

Dr Salah Hegazy

Dr Salah Hegazy

Dr Salah Hegazy

Maxillary obturator prostheses have a long history of effectively resolving the functional, cosmetic and psychological problems associated with the defects caused by maxillectomy, but the mobility of maxillary obturator prostheses impairs function.

Dr Salah Hegazy

Mobility of maxillary prostheses is affected by the size and character of the defect, the height and contours of the residual alveolar ridge and palatal shelf ,the availability of undercuts, and most importantly by the health and position of any remaining teeth.

Dr Salah Hegazy

In cases that have required extensive resections, significant problems regarding the retention, support and stability of maxillary obturator prostheses are encountered after ablation of the retentive maxillary anatomy . In such cases , the main issues are the restoration of functional recovery, for example by adjusting the level of occlusion , and improving the quality of life, prognosis and success rates for implanting maxillary prostheses.
Dr Salah Hegazy

Since the advent of osseointegration, the combination of implants and prosthetic obturators has proven to be beneficial, especially in the rehabilitation of the edentulous maxillectomy patients. This treatment option provides additional support and retention to a conventional obturator and renders such a procedure beneficial to the patient.

Dr Salah Hegazy

Dr Salah Hegazy

Dr Salah Hegazy

Dr Salah Hegazy

Dr Salah Hegazy

Dr Salah Hegazy

Dr Salah Hegazy

Dr Salah Hegazy

Dr Salah Hegazy

Dr Salah Hegazy

Dr Salah Hegazy

Dr Salah Hegazy

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