For the recovery from functional disorder and deteriorated QOL in maxillectomy patients, prosthetic rehabilitation should be started soon after an operation. We apply an Early Stage Prosthesis （ESP）, which was fabricated from a pre-surgical impression, to maxillectomy patients while hospitalized. The purpose of this study was to investigate the outcome of ESP on the recovery of patients' QOL. A questionnaire survey using EORTC QLQ-H&N35 was carried out for 18 maxillectomy patients （12 males and 6 females, average age 60.9 yrs.）, in which 10 patients were applied an immediate surgical obturator （ISO） and ESP （ESP group）, and eight were applied ISO and ordinary dent-maxillary prosthesis （Ordinary group）. The QOL relating to speech, eating and social contact in the ESP group was significantly better than that in the Ordinary group. The results indicate that the ESP could be effective for improving QOL in maxillectomy patients.
Patients with head and neck tumors, congenital defects and trauma require multidisciplinary team management. The team develops comprehensive treatment plans for surgical eradication of disease and rehabilitation of patients. Maxillofacial prosthodontists focus on presurgical assessment of oral health and postsurgical prosthodontic rehabilitation to restore the acquired defect and recover the functions of swallowing, speech, and mastication. The Tohoku University Hospital Dental Center was consolidated into the Tohoku University Hospital in 2010. To improve the multidisciplinary team management, a clinical survey was conducted at the Maxillofacial Prosthetic Clinic, Tohoku University Hospital from 2010 to 2013.
Introduction: A patient with severe dysphagia following cerebellar and brain stem infarction was able to achieve a complete return to oral intake with direct and indirect swallowing therapy, use of a prosthetic appliance for swallowing disorder, and botulinum toxin （BOTOX） injection in the cricopharyngeal muscle. Case report: The patient was a man in his 60s with a chief complaint of being unable to swallow despite wanting to eat after right cerebellar and brain stem infarction. Course: He began attending the rehabilitation unit at our institution 1 year and 2 months after the infarction. Initial videofluorography revealed weak elevation of the back of the tongue and regurgitation of the food bolus from the pharynx into the oral cavity. Use of a custom-made palatal augmentation prosthesis （PAP） improved food transfer to the pharynx; however, insufficient opening of the upper esophageal sphincter resulted in difficulty in swallowing. BOTOX was injected into the cricopharyngeal muscle and upper esophageal sphincter opening improved. However, he was unable to develop an effective swallowing pattern and regurgitation of the food bolus into the nasal cavity was still observed. Construction of a palatal lift prosthesis （PLP） to extend the PAP reduced regurgitation into the nasal cavity. Results: Oral intake was achieved about 2 years post-infarction due to swallowing therapy, use of PAP and PLP, and BOTOX injection for severe eating impairment and dysphagia.
The patient was a 49-year-old female, who initially visited the Department of Otolaryngology, Iwate Medical University Hospital, for an evaluation of oral complaints in January 2002. She was subsequently diagnosed with adenoid cystic carcinoma of the mouth floor. A total glossectomy, bilateral radical neck dissection, segmental resection of the mandible, and immediate reconstruction using a rectus abdominal muscle flap were performed in February 2002. In May 2002, the patient consulted the Clinic of Maxillofacial Prosthodontics for functional and esthetic recovery of the introverted lower lip. We devised and applied a mandibular prosthesis to extend the denture border which was placed on the free skin graft to establish stability of the prosthesis, and improve the masticatory and swallowing functions by placing the maxillary appliance. The patient was very satisfied with the mandibular prosthesis which restored lip-support, masticatory and swallowing functions with the placement of the maxillary appliance. This case report shows that placement of a mandibular prosthesis on the free skin graft area as supplemental equipment in order to extend the denture border, together with placement of a maxillary appliance, is an effective strategy for assisting the movement of food towards the pharynx by masticatory motion.