Application of a Simple, Cost-Effective Surgical Obturator Technique in Post-Maxillectomy Rehabilitation, in a Resource–Challenged Clinical Setting

Abstract

Background: Cancers of the nose and paranasal sinuses are not uncommon in our setting and most patients present very late, amplifying the challenge of post-surgical prosthodontics rehabilitation. Management of these patients require multi-disciplinary approach involving the otorhinolaryngologist, maxilla-facial surgeon, oncologist, radiotherapist, prosthodontist, psychologist and speech therapist, who may not be available in some centres in low income Countries. Availability and affordability of prosthodontic materials is another confounding factor to grapple with, in our resource-challenged hospital setting.
Objective: To present a simple, innovative, very cost-effective, surgical obturator and its application technique, with good outcome, in the rehabilitation of post-maxillectomy patients in our centre.
Methodology: Three patients with stage 4 sino-nasal carcinoma (T4N0M0) had total or extended total maxillectomy done. A soft, pliable polyethylene sheet, with hemi-palate shape was sutured to occlude the oro-naso-antral defect and allowed in-situ for four to eight weeks.
Results: All the patients tolerated the stent very well, commenced oral feeding 24 hours after surgery, achieved reasonable speech for communication and had no challenge of regurgitation of fluid or food into the nose. Cosmetic outcome was very satisfactory.
Conclusion: Absence of prosthodontist and surgical obturator materials should no longer be an excuse for failing to do a much needed surgical treatment of these cancer patients. The technique is recommended in view of the enormous cost benefit, even in centres that are financially comfortable.