CASE REPORT


https://doi.org/10.5005/jp-journals-10019-1383
International Journal of Prosthodontics & Restorative Dentistry
Volume 12 | Issue 3 | Year 2022

Maxillofacial and Oral Rehabilitation of an Oncologic Patient: Case Report


Maria CPF Volpato1, Girliane M Costa2, Lorraynne dos S Lara3https://orcid.org/0000-0002-5082-4185, Luiz ER Volpato4https://orcid.org/0000-0002-2969-1963

1-2Department of Dentistry, Hospital de Câncer de Mato Grosso, Cuiabá, MT, Brazil

3Cuiabá Dental School, Universidade de Cuiabá, Cuiabá, MT, Brazil

4Department of Dentistry, Hospital de Câncer de Mato Grosso, Cuiabá, MT, Brazil and Cuiabá Dental School, Universidade de Cuiabá, Cuiabá, MT, Brazil

Corresponding Author: Luiz ER Volpato, Department of Dentistry, Hospital de Câncer de Mato Grosso, Cuiabá, MT, Brazil and Cuiabá Dental School, Universidade de Cuiabá, Cuiabá, MT, Brazil, Phone: +556536221538, e-mail: odontologiavolpato@uol.com.br

Received on: 18 January 2023; Accepted on: 15 February 2023; Published on: 30 March 2023

ABSTRACT

Oral and maxillofacial prostheses are the treatment option to improve the function and psychology of patients with loss of oral and facial structures. This case report describes the rehabilitation of a 59-year-old patient who had undergone hemimaxillectomy for the treatment of squamous cell carcinoma with maxillofacial and dental prostheses. The patient presented with a loss of structures in the middle third of the face, including part of the nasal appendage. The patient was rehabilitated with a palatal obturator, a complete mandibular denture, and a facial prosthesis. The prosthetic rehabilitation improved the oral functions, psychological well-being and social reintegration of the patient.

How to cite this article: Volpato MC, Costa GM, S Lara LD, et al. Maxillofacial and Oral Rehabilitation of an Oncologic Patient: Case Report. Int J Prosthodont Restor Dent 2022;12(3):155-157.

Source of support: Nil

Conflict of interest: None

Patient consent statement: The author(s) have obtained written informed consent from the patient for publication of the case report details and related images.

Keywords: Maxillofacial prosthesis, Mouth Rehabilitation, Palatal Obturators, Quality of life, Squamous cell neoplasms.

BACKGROUND

Squamous cell carcinoma is a malignant tumor of epithelial origin which presents cellular atypia and represents 90% of malignant neoplasms within oral neoplasms. It is usually diagnosed late, thus making it difficult to treat and prone to produce debilitating sequelae. It affects men more often, with a peak incidence in the sixth and seventh decades of life, and smoking increases the risk of developing it.1-3

Treatment followed for squamous cell carcinoma is surgery, radiotherapy, chemotherapy, or a combination of them. It varies according to the tumor’s size, location, clinical course, and patient’s health status.1 As it is an invasive neoplasm with the possibility of recurrence, surgery can result in disfigurement, and repairing such defect with plastic surgery is unfeasible. In these cases, dental and maxillofacial prostheses are successful treatment options for patients to improve function, esthetics, social interaction, and quality of life.4

This case report presents the rehabilitation of a patient who had undergone hemimaxillectomy for the treatment of squamous cell carcinoma with maxillofacial and dental prostheses.

CASE DESCRIPTION

A 59-year-old Caucasian male patient came to the Hospital de Câncer de Mato Grosso, Cuiaba, Mato Grosso, Brazil, with a history of an ulcerated lesion in the right nasolabial sulcus. The patient reported smoking for the last 30 years. On examination, it was found that the lesion was extending to the maxilla and measuring approximately 2 × 2 cm in diameter. The patient reported associated pain for 4 months. The plastic surgeon performed the initial assessment, and the patient was referred to the head and neck surgeon. An incisional biopsy was planned and performed under local anesthesia. The histopathological diagnosis confirmed it as maxillary squamous cell carcinoma (Fig. 1).

Fig. 1: Histological section revealing a fragment of epithelial neoplasia formed by cells with disorganized architecture, intense cellular pleomorphism, cellular atypia, and figures of atypical mitosis

Around 2 months later, the patient underwent surgical intervention under general anesthesia for tumor resection. Hemimaxillectomy was performed, which led to the loss of structures in the middle third of the right side of the face, including part of the nasal appendage (Fig. 2). Adjuvant chemotherapy with cisplatin was started 20 days after surgery and was performed weekly, for 12 weeks, along with three-dimensional radiotherapy, for 33 days, with a total dose of 5940 cGy.

Fig. 2: Front view of the patient with loss of structures of the middle third of the face and part of the nasal appendage

Later prosthetic rehabilitation was planned with a one-piece closed bulb acrylic palatal obturator and mandibular conventional complete denture for the functional restoration of mastication, swallowing, and phonation. In addition, a facial prosthesis was planned to restore the facial contour and appearance.

The classic sequence was followed, with the anatomical impression in alginate (Zelgan 2002, Konstanz, Germany) and making the individual custom trays. Condensation silicone (Zhermack, Badia Polesine, Italy) was loaded in the custom tray, and functional molding was done to obtain the final impression of the maxillary and mandibular arches. The sequence of the vertical dimension and centric relation records was performed, followed by articulation in a semi-adjustable articulator (Hanau Wide-view, Louisville, United States of America). After the selection and arrangement of artificial teeth, a try-in was done. The processing of the palatal obturator and the mandibular denture was done following the standard laboratory procedures. The prostheses were installed and the appropriate occlusal adjustments were made (Fig. 3).

Fig. 3: Palatal obturator installed

After the placement of the dental prostheses, the fabrication of facial prosthesis started. Before starting the facial molding sequence, the skin was cleaned, and the hairy areas were lubricated with Vaseline. The patient’s face was completely filled with alginate, over which gauze was placed. Dental plaster (Rutenium, Queimados, Rio de Janeiro, Brazil) was added over the mold in order to give rigidity and facilitate its easy removal without any deformation. Soon after, the obtained impression was poured with dental stone (Fujirock EP, GC, Leuven, Belgium) to obtain a model. The model was evaluated and verified so that the areas of interest were properly recorded.

Photographs of the patient were taken for reference of skin color and lips for the laboratory procedures. The facial prosthesis was made of silicone (Technovent, Bridgend, United Kingdom) (Fig. 4). The prosthesis was retained on the face with an adhesive and the extrinsic pigmentation (Technovent, Bridgend, United Kingdom) of the silicone was performed in the presence of the patient using the hit-and-miss technique until achieving a tone similar to the patient’s skin (Fig. 5). The patient was instructed on the care of the prosthesis and continues to be monitored periodically.

Fig. 4: Facial prosthesis obtained from silicone

Fig. 5: Facial prosthesis adapted to the patient

DISCUSSION

This case report presents the rehabilitation of a patient with extensive facial deformity caused by the treatment of maxillary squamous cell carcinoma using dental and facial prostheses. The patient had a risk profile for squamous cell carcinoma, being male, which is the most affected sex, Caucasian and 59-year-old (the age group with the highest involvement).5 The patient also reported smoking, the most important risk factor for head and neck cancer, for 30 years.3,6

In view of the symptoms and the extent of the lesion, it is concluded that the patient took a long time to seek the diagnosis and start his treatment, which affects the prognosis.1,2 Due to the evolution of the lesion, the treatment performed was hemimaxillectomy, which caused the loss of structures in the middle third of the face, including part of the nasal appendage. The patient also underwent adjuvant chemotherapy with cisplatin and radiotherapy in order to minimize the chance of cancer recurrence.

After controlling the lesion, the patient faced health problems common to survivors of this type of cancer. Physical, emotional, and socioeconomic needs, such as social withdrawal due to changes in self-image; eating and drinking difficulties, alcohol and nicotine dependence and loss of income.7

Understanding cancer survival, the process begins with the diagnosis of the disease. Comprehensive and multidisciplinary care is essential in view of the changes in the quality of life that an abscised patient may suffer.8 Especially when the patient suffers facial mutilation, as in this case, he can suffer stigmatization so that he becomes the bearer of a mark that distinguishes him from the others.9-11 To reduce the consequences of cancer and its treatment, a palatal obturator, a complete mandibular denture, and a facial prosthesis were performed. Rehabilitation aimed to improve the quality of life and physical, psychological, and social well-being of the patient.

The palatal obturator, in addition to fulfilling all dental functions, was designed to close the oronasal communication, preventing the exchange of fluids between the two cavities and remodeling and reconstructing the patient’s palatal contour. It also improves the breathing condition, stabilizing the pressure of air during speech, which reduces the hypernasal voice, improves swallowing, provides support and protection to the remaining tissues and, later, the facial prosthesis, which will directly reflect on the quality of maintaining the patient’s interpersonal relationships.4,7,12

The complete mandibular denture provides dental rehabilitation, completely returning the functions of swallowing, chewing, speaking, and contouring the middle third of the face. The results favored nutrition, which in addition to reducing weight loss that causes a negative psychological impact on the individual, is also important to minimize the risk of bronchoaspiration, which can endanger the patient’s life.9

The facial prosthesis was designed to restore shape and anatomy and protect the area against trauma and residues, in addition to restoring acceptable facial esthetic standards, thus bringing the patient back to social and family life, which directly reflected on his self-esteem.4,7 It was decided to use silicone as the material and adhesive as a retainer in the facial prosthesis. In addition to having a more affordable cost, the material has good physical properties such as tensile strength, flexibility, ability to accept intrinsic and extrinsic coloring, and similarity with skin elasticity.4,7 The adhesive was chosen because of its good retention, comfort, appearance, fit, and nonirritation.4 Adhesive-retained silicone prostheses provide esthetics and comfort, can adapt to the patient’s constant movement, and improve speech and swallowing.4,7,13 Facial prosthesis has provided an accurate reproduction of colors, with a natural and realistic appearance, and helped the patient in improving the psychological impact suffered and favored his reintegration into social life.

ORCID

Lorraynne dos S Lara https://orcid.org/0000-0002-5082-4185

Luiz ER Volpato https://orcid.org/0000-0002-2969-1963

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