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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Prosthetic Rehabilitation of Patients with Maxillary Defects in a Nigerian Tertiary Hospital</title><author><name sortKey="Omo, Jo" sort="Omo, Jo" uniqKey="Omo J" first="Jo" last="Omo">Jo Omo</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Sede, Ma" sort="Sede, Ma" uniqKey="Sede M" first="Ma" last="Sede">Ma Sede</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Enabulele, Je" sort="Enabulele, Je" uniqKey="Enabulele J" first="Je" last="Enabulele">Je Enabulele</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25221718</idno><idno type="pmc">4160694</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4160694</idno><idno type="RBID">PMC:4160694</idno><idno type="doi">10.4103/2141-9248.139352</idno><date when="2014">2014</date><idno type="wicri:Area/Pmc/Corpus">002834</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">002834</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Prosthetic Rehabilitation of Patients with Maxillary Defects in a Nigerian Tertiary Hospital</title><author><name sortKey="Omo, Jo" sort="Omo, Jo" uniqKey="Omo J" first="Jo" last="Omo">Jo Omo</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Sede, Ma" sort="Sede, Ma" uniqKey="Sede M" first="Ma" last="Sede">Ma Sede</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Enabulele, Je" sort="Enabulele, Je" uniqKey="Enabulele J" first="Je" last="Enabulele">Je Enabulele</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></analytic><series><title level="j">Annals of Medical and Health Sciences Research</title><idno type="ISSN">2141-9248</idno><idno type="eISSN">2277-9205</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Background:</title><p>Maxillary defects are managed by prosthodontic rehabilitation using obturators. This rehabilitation goes through various stages, which invariably affects the quality-of-life of the patients.</p></sec><sec id="st2"><title>Aim:</title><p>This study aims to analyze the types and design of obturators used in the rehabilitation of maxillary defects at a tertiary health institution in Nigeria.</p></sec><sec id="st3"><title>Materials and Methods:</title><p>This is a retrospective study of all patients with maxillary defects treated at a tertiary institution between the period of October 2010 and May 2013. The data of interest collected from the patient's register and case notes include age, gender, type of defects, design of obturators and conditions for which treatment was offered. The collected data were analyzed using Statistical Package for Social Sciences version 16.0 (Chicago, Illinois, 2010) and result presented in frequencies and tables.</p></sec><sec id="st4"><title>Results:</title><p>A total of 19 case notes were retrieved. The age range was 5-73 years with the mean age of 46.37 ± 19.02 and peak age incidence at 41-60 years. The male: female ratio was 1:1.4. Surgical defects were the most common type of maxillary defects seen; accounting for 89.5% (17/19) of the cases, which were mostly associated with malignant tumors. Immediate surgical obturators were provided for 63.2% (12/19) of the subjects. Majority 70.6% (12/17) of those with surgical defects received immediate surgical obturators while all those with congenital defect were given feeding plate. There was a statistically significant association between the type of maxillary defect and type of obturator provided (<italic>P</italic> < 0.01).</p></sec><sec id="st5"><title>Conclusion:</title><p>The results of this study suggest that majority of the obturators fabricated for patients with maxillary defect at the Tertiary health institution in Nigeria were immediate surgical obturators. Pre-surgical patient education and follow-up care is advocated.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Keyf, F" uniqKey="Keyf F">F Keyf</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Popli, S" uniqKey="Popli S">S Popli</name></author><author><name sortKey="Parkash, H" uniqKey="Parkash H">H Parkash</name></author><author><name sortKey="Bhargava, A" uniqKey="Bhargava A">A Bhargava</name></author><author><name sortKey="Gupta, S" uniqKey="Gupta S">S Gupta</name></author><author><name sortKey="Bablani, D" uniqKey="Bablani D">D Bablani</name></author><author><name sortKey="Kar, Ak" uniqKey="Kar A">AK Kar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Singh, A" uniqKey="Singh A">A Singh</name></author><author><name sortKey="Kumar, N" uniqKey="Kumar N">N Kumar</name></author><author><name sortKey="Singh, V" uniqKey="Singh V">V 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Ann Med Health Sci Res</journal-id><journal-id journal-id-type="iso-abbrev">Ann Med Health Sci Res</journal-id><journal-id journal-id-type="publisher-id">AMHSR</journal-id><journal-title-group><journal-title>Annals of Medical and Health Sciences Research</journal-title></journal-title-group><issn pub-type="ppub">2141-9248</issn><issn pub-type="epub">2277-9205</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25221718</article-id><article-id pub-id-type="pmc">4160694</article-id><article-id pub-id-type="publisher-id">AMHSR-4-630</article-id><article-id pub-id-type="doi">10.4103/2141-9248.139352</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Prosthetic Rehabilitation of Patients with Maxillary Defects in a Nigerian Tertiary Hospital</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Omo</surname><given-names>JO</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>Sede</surname><given-names>MA</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Enabulele</surname><given-names>JE</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib></contrib-group><aff id="aff1"><italic>Department of Restorative Dentistry, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria</italic></aff><author-notes><corresp id="cor1"><bold>Address for correspondence:</bold> Dr. Julie O Omo, Department of Restorative Dentistry, University of Benin Teaching Hospital, P.M.B. 1111, Benin City, Edo State, Nigeria. E-mail: <email xlink:href="omole70@yahoo.com">omole70@yahoo.com</email></corresp></author-notes><pub-date pub-type="ppub"><season>Jul-Aug</season><year>2014</year></pub-date><volume>4</volume><issue>4</issue><fpage>630</fpage><lpage>633</lpage><permissions><copyright-statement>Copyright: © Annals of Medical and Health Sciences Research</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec id="st1"><title>Background:</title><p>Maxillary defects are managed by prosthodontic rehabilitation using obturators. This rehabilitation goes through various stages, which invariably affects the quality-of-life of the patients.</p></sec><sec id="st2"><title>Aim:</title><p>This study aims to analyze the types and design of obturators used in the rehabilitation of maxillary defects at a tertiary health institution in Nigeria.</p></sec><sec id="st3"><title>Materials and Methods:</title><p>This is a retrospective study of all patients with maxillary defects treated at a tertiary institution between the period of October 2010 and May 2013. The data of interest collected from the patient's register and case notes include age, gender, type of defects, design of obturators and conditions for which treatment was offered. The collected data were analyzed using Statistical Package for Social Sciences version 16.0 (Chicago, Illinois, 2010) and result presented in frequencies and tables.</p></sec><sec id="st4"><title>Results:</title><p>A total of 19 case notes were retrieved. The age range was 5-73 years with the mean age of 46.37 ± 19.02 and peak age incidence at 41-60 years. The male: female ratio was 1:1.4. Surgical defects were the most common type of maxillary defects seen; accounting for 89.5% (17/19) of the cases, which were mostly associated with malignant tumors. Immediate surgical obturators were provided for 63.2% (12/19) of the subjects. Majority 70.6% (12/17) of those with surgical defects received immediate surgical obturators while all those with congenital defect were given feeding plate. There was a statistically significant association between the type of maxillary defect and type of obturator provided (<italic>P</italic> < 0.01).</p></sec><sec id="st5"><title>Conclusion:</title><p>The results of this study suggest that majority of the obturators fabricated for patients with maxillary defect at the Tertiary health institution in Nigeria were immediate surgical obturators. Pre-surgical patient education and follow-up care is advocated.</p></sec></abstract><kwd-group><kwd>Maxillary defects</kwd><kwd>Maxillectomy</kwd><kwd>Obturators</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="sec1-1"><title>Introduction</title><p>Maxillary defects are created by surgical treatment of benign or malignant neoplasms, congenital malformation and trauma.[<xref rid="ref1" ref-type="bibr">1</xref>] Their occurrence is also associated with the enucleation of maxillary cysts.[<xref rid="ref2" ref-type="bibr">2</xref>] Patients with acquired maxillary defects differ from those with congenital defects due to the abrupt alteration in physiologic processes associated with surgical resection of the maxillae.[<xref rid="ref3" ref-type="bibr">3</xref>] The ensuing defect creates oronasal and oroantral communication leading to difficulties in mastication, hypernasal speech, fluid leakage and various degrees of cosmetic concerns.[<xref rid="ref4" ref-type="bibr">4</xref>] These post-surgical effects usually have serious consequences as they affect the form and function of normal stomatognathic system leading to a reduction in quality-of-life of the patient.[<xref rid="ref5" ref-type="bibr">5</xref>] Early management is therefore important in retaining function and enhancing the patient's self-esteem.[<xref rid="ref2" ref-type="bibr">2</xref>]</p><p>Maxillectomy defects are managed by prosthodontic rehabilitation or surgical correction of defect. The decision to use either of the options is influenced by the site, size, etiology, severity, age and the patient's wishes.[<xref rid="ref6" ref-type="bibr">6</xref>] However, the success of the prosthodontic option depends upon the collaboration and planning of the surgeon, prosthodontists and the patient. Prosthodontic rehabilitation of total or partial maxillectomy in patients includes the separation of oral and nasal cavities to allow adequate deglutition and articulation, support for the orbital contents to prevent enophthalmos and diplopia, support of the soft-tissue to restore the midfacial contour and an acceptable aesthetic result.[<xref rid="ref7" ref-type="bibr">7</xref><xref rid="ref8" ref-type="bibr">8</xref><xref rid="ref9" ref-type="bibr">9</xref>]</p><p>Central to achieving the desired results in the rehabilitation of maxillectomy patients is the use of an intraoral prosthesis known as a maxillary obturator. It is positioned in the closure of a congenital or acquired tissue opening, primarily located in the hard palate and/or contiguous alveolar or soft-tissue structures.[<xref rid="ref10" ref-type="bibr">10</xref>]</p><p>Obturators can be classified as immediate surgical obturator (feeding plates), temporary or interim obturator and definitive obturator depending upon the time period elapsed from surgical resection of maxilla.[<xref rid="ref11" ref-type="bibr">11</xref>] An immediate surgical obturator is the first prostheses placed and is used to minimize post-operative complications.[<xref rid="ref12" ref-type="bibr">12</xref>] It supports soft-tissue, minimizes scar contracture and disfigurement, reproduces the anatomic integrity of the palate, improves post-operative oral hygiene and protects the surgical packing from food debris contamination.[<xref rid="ref13" ref-type="bibr">13</xref>] It also allows the patient to resume normal diet, protect the wound from trauma and maintain pressure either directly or indirectly on split thickness skin graft.[<xref rid="ref14" ref-type="bibr">14</xref>] Furthermore, it restores speech to a reasonable level and obviates the use of nasal gastric tubes. They can also be used to correct lip and cheek contour and reduces the flow of exudates into the mouth.[<xref rid="ref15" ref-type="bibr">15</xref>]</p><p>The temporary or interim obturator is constructed from a post-surgical impression cast, which has a false palate and ridge without teeth. The closed bulb extending into the defect area is hollow.[<xref rid="ref1" ref-type="bibr">1</xref>]</p><p>The definitive obturator is fabricated about 6 months after surgery from post-surgical maxillary cast, when the surgical site has completely healed and minimal dimensional changes are unlikely.[<xref rid="ref1" ref-type="bibr">1</xref>] This obturator has a metal frame work, which acts as the palate and supports the teeth and a closed hollow bulb.[<xref rid="ref16" ref-type="bibr">16</xref>]</p><p>Crucial to achieving adequate rehabilitation for patients with maxillary defects, it is important that there is a high level of cooperation between the prosthodontist and the surgeon prior to surgery.[<xref rid="ref9" ref-type="bibr">9</xref>] This will ensure that the patient benefits maximally from the rehabilitation. However, it is important to note that the rehabilitation goes through various stages, which invariably affects the quality-of-life of the patients. Therefore, the aim of the present study is to analyze the rehabilitation of maxillary defects, the types, design of obturators and conditions for which they were indicated at the Tertiary Health Institution in Nigeria.</p></sec><sec sec-type="materials|methods" id="sec1-2"><title>Materials and Methods</title><p>This was a retrospective study of all maxillectomy patients treated at the Prosthodontic unit, Department of Restorative Dentistry in a Tertiary Health Institution in Nigeria between the period of October 2010 and May, 2013. The data of interest collected from the patient's register and case notes include demographic characteristics (age and gender), type of defect, design of obturators, conditions for which they were indicated, pre-surgical education and post-rehabilitation follow-up. Ethical approval was sought from the ethical committee of the University of Benin Teaching Hospital.</p><sec id="sec2-1"><title>Statistical analysis</title><p>The collected data were analyzed using Statistical Package for Social Sciences version 16.0 (Chicago, Illinois, USA, 2010) and result presented in frequencies and tables. Chi-square was used to compare relevant variables. Confidence interval of 95% was used and <italic>P</italic> < 0.05 was considered to be statistically significant.</p></sec></sec><sec sec-type="results" id="sec1-3"><title>Results</title><p>A total of 19 case notes were collected during the study period. The age range was 5-73 years with the mean age of 46.37 ± 19.02 and peak age incidence at 41-60 years. The male: female ratio was 1:1.4 [<xref ref-type="table" rid="T1">Table 1</xref>].</p><table-wrap id="T1" position="float"><label>Table 1</label><caption><p>Demographic characteristics of subjects</p></caption><graphic xlink:href="AMHSR-4-630-g001"></graphic></table-wrap><p>Surgical defects were the most frequent type of maxillary defect seen accounting for 89.5% (17/19) of the cases while congenital and traumatic defects accounted for 5.3% (1/19) each. Malignant tumors were the main indication for surgery 76.5% (13/17) [<xref ref-type="table" rid="T2">Table 2</xref>]; of which squamous cell carcinoma constituted 84.6% (11/13) and adenocystic carcinoma 15.4% (2/13). Immediate surgical obturators were provided for 63.2% (12/19) of the subjects while 26.3% (5/19) subjects received the definitive obturator [<xref ref-type="table" rid="T3">Table 3</xref>]. Majority 70.6% (12/17) of those with surgical defects received immediate surgical obturators while the subject with congenital defect received a feeding plate. There was a statistically significant association between the type of maxillary defect and type of obturator provided (<italic>P</italic> < 0.01) [<xref ref-type="table" rid="T4">Table 4</xref>]. The case record of the subjects lacked information on pre-surgical education, counseling and post-rehabilitation support.</p><table-wrap id="T2" position="float"><label>Table 2</label><caption><p>Indications for surgery in subjects with surgical maxillary defect</p></caption><graphic xlink:href="AMHSR-4-630-g002"></graphic></table-wrap><table-wrap id="T3" position="float"><label>Table 3</label><caption><p>Obturator types provided for subjects</p></caption><graphic xlink:href="AMHSR-4-630-g003"></graphic></table-wrap><table-wrap id="T4" position="float"><label>Table 4</label><caption><p>Association between maxillary defect and type of obturator provided</p></caption><graphic xlink:href="AMHSR-4-630-g004"></graphic></table-wrap></sec><sec sec-type="discussion" id="sec1-4"><title>Discussion</title><p>After maxillectomy, prosthetic restoration of the resulting defect is an essential step because it signals the beginning of patient's rehabilitation.[<xref rid="ref17" ref-type="bibr">17</xref>] In this study, a total of 19 subjects were seen during the period under review. Although it appears small, the number is similar to those reported in previous studies.[<xref rid="ref18" ref-type="bibr">18</xref><xref rid="ref19" ref-type="bibr">19</xref><xref rid="ref20" ref-type="bibr">20</xref>] This may be attributed to the fact that approximately 5% of all malignant diseases are located within the oral and maxillofacial area[<xref rid="ref21" ref-type="bibr">21</xref>] and are associated with increased mortality; thereby making maxillectomy a rare surgical procedure.</p><p>Majority of the subjects in this study were over 40 years of age; and therefore falls within the age range commonly affected by maxillary carcinomas.[<xref rid="ref22" ref-type="bibr">22</xref><xref rid="ref23" ref-type="bibr">23</xref>] A male/female ratio of 1:1.4 was observed in this study; a value that is lower than those reported in other studies.[<xref rid="ref19" ref-type="bibr">19</xref><xref rid="ref24" ref-type="bibr">24</xref>] It however compares with the result of a 10 years retrospective study[<xref rid="ref25" ref-type="bibr">25</xref>] that examined the pattern of maxillectomy defects in Ibadan, Nigeria.</p><p>Congenital maxillary defect was found in only 5.3% of the subjects. This may be due to the use of the surgical option in the closure of congenital defects or as a result of the challenges of retention, compliance and changes in the maxillary growth in growing children.[<xref rid="ref26" ref-type="bibr">26</xref>] Prosthodontic rehabilitation of missing oral and facial structure is indicated when surgical procedures cannot produce satisfactory functional or cosmetic outcomes.[<xref rid="ref27" ref-type="bibr">27</xref>] The large number of subjects with surgical defects in this study can be explained by the fact that the study center is a tertiary health facility with full complement of specialties that adequately meets the needs of maxillectomy patients; providing services to her immediate environs and neighboring states.</p><p>The major indication for surgery in these subjects was malignant tumors; accounting for 82.4%. This is in agreement with the observation that malignant tumors of the maxilla are more common than the benign tumors.[<xref rid="ref24" ref-type="bibr">24</xref><xref rid="ref27" ref-type="bibr">27</xref>] In this study, squamous cell carcinoma was the commonest indication for surgery (64.6%); a finding that is similar to a report from a previous studies.[<xref rid="ref9" ref-type="bibr">9</xref><xref rid="ref28" ref-type="bibr">28</xref>] The immediate surgical obturator (feeding plate) was the obturator prosthesis mostly constructed for the patients with maxillary defect in this study. It was provided for 68.5% of the subjects while the definitive obturator was received by 26.3% of the study population. This implies that a majority of the subjects did not receive the definitive obturator; hence the desired functions of mastication, speech and esthetics may not have been optimally restored; with the consequence of a deteriorating quality-of-life in the subjects. According to Irish <italic>et al</italic>.,[<xref rid="ref29" ref-type="bibr">29</xref>] patients with increasing difficulties with obturator function reported increased disease impact, depression, loss of behavior or emotional control and decreased positive effect. These may have been the complaints of the subjects in this study, but due to inadequate follow-up or perhaps as a result of recurrence of the malignant condition, deteriorating health and death; they never returned.</p><p>The case records of the subjects reviewed in this study lacked information on pre-surgical education, counseling and post-rehabilitation support. This may be attributed to the absence of adequate discussion and communication of the treatment plan between the surgeons, prosthodontists and the patients. Patient's motivation and education about the type of prosthesis along with its limitations are the first steps toward a successful treatment.[<xref rid="ref2" ref-type="bibr">2</xref>] In a relatively illiterate society like ours,[<xref rid="ref30" ref-type="bibr">30</xref>] the patients must be informed of what is required of them at every stage of treatment; else they will be lost to follow up at the earliest difficulty. This may have been the situation with those that terminated their treatment at the immediate surgical obturator (feeding plate) stage.</p><p>The results of this study suggest that majority of the obturators fabricated for patients with maxillary defect at the Tertiary Health Institution in Nigeria were immediate surgical obturators. 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