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Etiology
1. Surgical Is the main etiological factor namely resection of tumor masses 2. Disease e.g. Syphilis, osteomeylitis (rare) 3. Trauma Gun shots (suicide attempts)
Disabilities
Most of the disabilities are related to communication of the oral and nasal cavities 1. Mastication Regurgitation 2. Speech Hypernasality 3. Appearance Diplopia etc. 4. Psychological Could be worst of all
Rehabilitation
1. Surgical
2. Prosthetic
Surgical reconstruction
Is definitely the best treatment when feasible: 1. No possibility of recurrence after tumor resection 2. After trauma 3. Relatively small defects (great defects greatly complicates the surgical approach)
Prosthetic reconstruction
Is indicated in cases surgical reconstruction is not possible 1. Possibility of recurrence after tumor resection 2. Relatively large defects (great defects greatly complicates the surgical approach) 3. Large soft palate defects
- Fitting surface of the obturator can be used to support the skin graft. Black gutta percha is preferred because it is less irritant than tissue conditioning materials - Donor sites of skin grafts include inner side of arm (unhairy)
- Block undesired undercuts with vaselinized gauze - Patients complete denture could be used for the same purpose but after modification
Definitive obturator
- Usually constructed 3-4 months after surgery - Exact timing is controlled by the following factors: - Possibilities of recurrence - Progress in the process of healing which is effected by size and whether patient received radiotherapy - Presence of teeth which greatly contributes to retention and stability - Effectiveness of the present obturator
- Extension into the defect - Extension superiorly along the nasal septum is not recommended because pseudostrafied columnar epithelium offers little mechanical advantage
- Weight - Hollow design is recommended - Controversy exists as to whether to use a. open or b. closed designs