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 requires a 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. The 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 a good outcome, in the rehabilitation of post-maxillectomy patients in our center. Methodology: Three patients with stage 4 sino-nasal carcinoma (T4N0M0) had total or extended total maxillectomy done. A soft, pliable polyethylene sheet, with a 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 with regurgitation of fluid or food into the nose. The cosmetic outcome was very satisfactory. Conclusion: The absence of prosthodontist and surgical obturator materials should no longer be an excuse for failing to do a much-needed surgical treatment for these cancer patients. The technique is recommended in view of the enormous cost-benefit, even in centers that are financially comfortable.