Effectiveness of Maxillary Obturator Prosthesis in Maxilectomee- a Case Report

INTRODUCTION Maxillectomy is the surgical removal of part or the entire maxillary bone. It is indestined for tumors of the hard palate, nose, maxillary sinus or other tumors that have grown to involve the maxilla. Speech intelligibility and swallowing difficulties are the major concerns after maxillectomy surgery. These are the after effects of inappropriate coupling between the oral and nasal cavities which results in inadequate intraoral air pressure. This leads to poor speech production including imprecise articulation, hypernasality, nasal air emission and reduced loudness of voice (Plank, Weinberg, Chalian, 1981). Prosthetic obturation is one of available surgical rehabilitation methods due to its immediate accomplishment, low cost, and the possibility of modification according to the patient needs (CarvalhoTeles, Pegoraro-Krook & Lauris, 2006) The intention of using obturator prosthesis is to eliminate the undesired connection between the oral and nasal cavities which can be an automatic as a consequence of maxillectomy. Consequently, there can be a automatic reduction of speech intelligibility and result in swallowing difficulties. However, there is a dearth in the literature for studies focusing on functional aspects of swallowing and perceptual and acoustical basis of speech after maxillary obturator prosthesis fitting. Yoshida, et al. (1990) studied eight maxillectomees' and reported of improvement in speech intelligibility in four patients after prosthetic fitting based on perceptual measures. In another study, Sullivan, et al (2002), considered patients who had undergone partial surgical resection of the maxilla. As per the reports there was 33% improvement in sentence intelligibility, speaking rate increased upto 26-word-per-minute, nasality scored as 4.2 point in a 0-7 scale of hyper nasality. But, both of these studies have not focused regarding the swallowing difficulties which is quite evidently present in maxillectomees. Hence, the present study is aimed to identify the efficacy of palatal obturator prosthesis in swallowing and speech intelligibility using both perceptual and acoustical methods after total maxillectomy.