An effective, inexpensive, temporary surgical obturator following maxillectomy.

INTRODUCTION Restoring the normal separation that exists between the oral cavity and the nasal cavity is critical in allowing a patient to maintain speech and swallowing function after maxillectomy. Failure of adequate separation after maxillectomy will often result in severe oronasal incompetence, which is generally not possible for the patient to overcome without intervention. Two broad categories are available for the rehabilitation of this patient population: prosthetic obturators and flap reconstruction. Obturators have the advantages of shortening operating room time and eliminating flap donor site morbidity (whether regional or distant). Disadvantages include prolonged process and the high cost of obturator fabrication, as well as the need for regular removal and cleaning by the patient. Surgical flap reconstruction provides for immediate and permanent correction of the abnormal oronasal communication, but is associated with increased operating room time, need for technical expertise, and the possibility of donor morbidity at the flap harvest site. We have used both techniques successfully in our practice. For the patient who will undergo prosthetic rehabilitation, there are three distinct prostheses that will be required: temporary surgical obturator, intermediate obturator, and final prosthesis. The temporary surgical obturator is required immediately after surgical resection to allow the patient to communicate and swallow in the early postoperative period, as well as to maintain the maxillectomy packing in position. This packing is required to increase the success of split-thickness graft application to the cheek flap, thus decreasing long-term cutaneous contracture. The temporary surgical obturator is generally kept in situ for approximately 2 to 3 weeks after surgery. The interim obturator is next fabricated by a maxillofacial prosthodontist and modified regularly over the course of 6 to 12 months as the maxillectomy cavity alters shape with the healing process. Once this cavity has stabilized, the final prosthesis is constructed based in large part on the shape and size of the interim obturator. This process requires a large amount of hands-on time expenditure by a skilled prosthodontist, leading to a substantial cost. In this article, we outline our technique for the construction of an inexpensive, simple, temporary surgical obturator.