This article summarizes a current consensus about clinical managements for dysphagia with palatal augmentation prosthesis （PAP） in Japan. These days, clinical managements for dysphagia with PAP increased not only in post head and neck cancer patients but also in the patients associate with motility disturbance of tongue, such as cerebrovascular and neurogenic diseases.
With PAP in place, majority experience decreased oral transit time and reduced oral residue. These are the results of improvements of tongue-to-palate contacts pressure and duration, which cause better bolus manipulation and transport. Furthermore, other effects of decreased pharyngeal transit time and reduced pharyngeal residue could be observed in the patients with reduced tongue base to post pharyngeal wall contacts. As the same biomechanical effect of effortful swallow, emphasizing tongue-to-palate contact with PAP is likely to lead larger movement amplitudes in the posterior tongue and higher pharyngeal pressure.
In the strategy of PAP intervention, we also need to know the limitation of its effects and cooperate with Speech-language pathologists and other specialists.
Patients who have disorder of swallowing are increasing in aged society. Dysphagia causes aspiration, dehydration, malnutrition, and decrease of quality of life. For the dysphagic patients because of the functional disability of tongue, palatal augmentation prosthesis （PAP） may be applied to compensate the deteriorated contact between the tongue and hard palate and propulsion of the bolus into the pharynx. The dysphagia rehabilitation which may be included the prosthodontic approach should be planned multi-disciplinarily. The maxillofacial prosthodontist should understand these rehabilitation program and may participate in the rehabilitation team.
This article provides the efficacy of palatal augmentation prosthesis（PAP） regarding speech．Treatment with PAP provides to reconstruct articulation points, to make new articulation points and manner. That is efficient for training tools. The patients with articulation disorders will be satisfied to use it. Though with PAP, acoustic changes were observed for formant frequency （F1） of some vowels. The effect of the augmentation prosthesis was less in utterance speed. Thus PAP improved articulation and intelligibility, might be very useful treatment tools.
Recently, the participation of dental hygienists in maxillofacial rehabilitation has increased as the importance of perioperative oral care has become recognized. Dental hygienists require knowledge about maxillofacial prosthetics and appropriate oral care for patients who have maxillary defects. In our conventional education, instructors showed casts to the students and explain maxillofacial prosthetics for about twenty minutes. The aims of this study were to assess the effects of dental hygienist education for maxillofacial prosthetics and to improve our curriculum.
The students were asked several questions before and after two weeks of the practical course in two consecutive years. The first-year results showed that they gained knowledge but could not understand how to deal with patients with maxillary defects. Based on the first-year results, we modified our lecture and focused on oral-care techniques. The second-year results showed that the students gained not only knowledge but also motivation. The survey suggests that modification of the course improved their interest in maxillofacial prosthetics, but was not enough to change their future aspects.
In perioperative oral management, we investigated the effect of an oral appliance for preventing tooth injury during intubation or extubation. Our hospital has a Center for Perioperative Medicine, to which dental hygienists are temporarily transferred from the Department of Oral Surgery. The hygienists check the oral condition of each patient, assess and advise the necessity of tooth protection, and refer patients to our clinic. When a patient visits our clinic, an oral appliance for tooth protection （called a “tooth-guard”） is made and delivered to the patient before general anesthesia. As a result of introducing the perioperative oral management system, the number of incidents was reduced from 4 to 0, confirming the effectiveness of the system for safety management.
A team approach for patients who have head, neck, and maxillofacial tumors has been the standard process for treatment and care, so we need to construct and utilize a maxillofacial rehabilitation team consisting of staff from related fields, including co-medical staff for mental and/or social support. However, cooperation between surgical staff and maxillofacial prosthetic staff is not yet sufficient. The Head and Neck, Maxillofacial Medical Treatment Center of Seirei Hamamatsu General Hospital was founded in April 2010. The aim of this center is to provide high-quality medical treatment for cases that require interdisciplinary cooperation among the fields of otolaryngology, ocular and orbital plastic surgery, and oral surgery. The Department of Dentistry has also participated in these activities as a subgroup of the center. Professional oral care and maxillofacial prosthetic treatment should be useful as comprehensive treatment for head and neck cancer patients. Of cases with malignant tumor, 74.0％ received such treatment in 2010 and 2011. It is suggested that a team approach improved the efficiency and quality of treatment, and was useful for maintenance and improvement of the patients’ QOL. This article describes a trial of the new team approach and how to solve clinical problems that occur within different departments.