During my residency, without warning, I was presented with some patients who had lots of palatal and facial bone removed due to cancer and subsequent surgeries. In a community hospital environment, patients with late cancers often go to surgery quickly without enough pre-operative treatment planning from the general dentist. Ideally, a general dentist or prosthodontist is involved from the beginning so that when bone or structures are grossly removed, the patient emerges from surgery with at least some interim prosthesis.
After having done one obturator with great success, I was deemed an expert, and all subsequent persons with holes in their faces were directed towards me. PALATAL OBTURATORS is the power point that describes two cases I worked on, and tells the story of how easy it is to get in over your head on this matter. Unfortunately, both cases came to me post-surgery. In the first case, the cancer was continuing to consume the patient, and his tissues were changing every day. He was terminally ill, and I was merely trying to buy time. His lack of one eye, missing zygomatic arch and malar process demand an oral and maxillofacial prosthodontist. But since the patient had little time, and the cancer was spreading into the brain, surgery was no longer indicated, and we were just trying to buy time. It was truly sad, but I just did my best give him something to help him swallow food, to enjoy spending time with him and make his days enjoyable. He was really a nice guy and very appreciative of my efforts. The second case was what I’d call a successful case. This is within the realm of the GP. The cancer had been removed successfully, with no recurrence. The tissues were allowed to mature nicely, and the amount of missing bone allowed for great retention that was possible without even placing implants. I really loved spending time with both of these patients because they were so resilient and positive; both amazing examples of human spirit.
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