This report describes a patient who required maxillofacial prosthetic service in order to transfer to a terminal care facility.
In general, the indication for a patient to transfer to a terminal care unit is decided by the doctor in charge, without changing the conditions concerning the patient’s daily-use prosthesis.
In spite of understanding the usefulness of a maxillary defect prosthesis, our patient could not wear it because of changes in the anatomical shape of the maxillofacial defect caused by a recurrent disease, which could not be treated radically. It was known that this disease would certainly cause him to pass away in a certain number of days. The patient could control himself and express his clear will to his family as well as to his health care providers that he wished to move to a terminal care facility after having had his maxillary prosthesis revised or re-fabricated in order to ameliorate his articulation and deglutition disorder.
Such treatment could only be provided because the patient and his family could express their clear will, just shortly before his departure, to accept his destiny. Maxillofacial prosthetics can thus be a vital, life-supporting treatment.

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A maxillary defect due to cancer resection often involves serious dysfunctions, so that prosthetic restoration should be required to obturate the defect. Since patients who received maxilla resection have various confounded factors that might affect their oral function, a definite index of masticatory performance with an obturator prosthesis has not been established. The purpose of this study was to assess contributing factors for the masticatory performance with an obturator prosthesis. Twenty patients who had a maxilla defect and treated in our institution were investigated. The masticatory performance was investigated using gummy jelly and wax cubes. The contributing factor involved the remaining teeth, occlusal support and defect classification. A questionnaire was conducted covering the measurements of the occlusal force, occlusal contact points, occlusal contact area as well as food intake. Pearson correlation coefficients of the masticatory performance and the contributing factors were analyzed. As a result, the increased surface area of the gummy jelly had significantly higher correlations with the masticatory scores that were calculated from the questionnaire as well as the occlusal contact points, occlusal contact area. Whereas the mixing ability score from the wax cubes had no significant correlation with any factors. In conclusion, these results suggested that occlusal contact points and occlusal contact area of the prosthesis strongly affected the masticatory function in post-maxillectomy patients. Further study on other contributing factors should be conducted in a larger sample size.

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Most glossectomy patients suffer from speech disability, chewing disability, bolus forming dysfunction, swallowing dysfunction and so on because of limited tongue movement after tongue resection.
This case report describes the comprehensive management of a glossectomy patient including mandibular alveoplasty and prosthetic treatment with removable dentures. To evaluate the treatment outcome, objective assessments by videofluorography （modified barium swallowing） and tongue movement by tongue pressure; speech assessments by a speech therapist; semi-subjective scoring of chewing; and the patient’s subjective degree of satisfaction were evaluated while wearing definitive dentures.
The subjective and objective assessments showed that this patient’s oral functions while wearing dentures after the reshaping operation had improved sufficiently to lead an ordinary life, and the patient was satisfied with oral function and prostheses.
It is suggested that the secondary reshaping operation can improve limited tongue movement and make space for dentures, and that comprehensive management including secondary surgical reshaping of the alveolar ridge and prostheses should be performed to improve oral function, chewing, swallowing, speech, and the patient’s overall satisfaction.

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Oral functions such as mastication, swallowing and speech can be impaired after surgical resection due to oral carcinoma. To rehabilitate these functions, removable maxillofacial prostheses can be fabricated. However, to our knowledge, there have been no studies tracing the course of adaptation in mandibulectomy patients with such a prosthesis. To this end, we used the surface electromyographic （EMG） technique to evaluate a 36 year-old male who underwent a marginal mandibular resection due to squamous cell carcinoma and was fitted with a conventional maxillofacial prosthesis. We also assessed mixing ability using the mixing ability test over a 12-week period. Surface EMG activities were recorded. The activity index （ACI） changed from negative to positive, while the asymmetry index （ASI） value approached zero as the new prosthesis was adjusted. The mixing ability index of the defect side increased at every adjustment. After 12 weeks, the patient was completely satisfied with the prosthesis.

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I had a chance to join the Maxillofacial Residency Program at UCLA Maxillofacial Prosthodontic Clinic （Los Angeles, California） from December 2008 to December 2009. I felt their clinical treatment concept is very systematic and conservative. On the other hand, they change to do very challengingly treatment for patients who require it.

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Rapid prototyping devices have been developed and used around the world for creating three-dimensional solid models from computer-aided design data. In the medical field, these devices are used for making skull models for surgical simulation, and are also used for creating maxillofacial prosthesis. Assuming use for maxillofacial prosthetics, we investigated the trends of rapid prototyping devices based on information published on the Internet. As a result, we consider that a model should have a work area of at least 250×250×200mm, and that resin or wax in the most suitable modeling material.

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