OBTURATOR PROSTHESES FOR MAXILLECTOMY PATIENTS: …
1
Projeto Gráfico: Servi o de Edi o e Informa o Técnico-Científica / CEDC / INCA OBTURATOR PROSTHESES FOR MAXILLECTOMY PATIENTS: CURRENT STATUS OF THE TECHNOLOGY AND NECESSITIES FOR IMPROVEMENT INTRODUCTION The aim of this study was to analyze the state of the art of different molding techniques as well as the manufacture of obturation prostheses utilized in the rehabilitation process of maxillectomized patients in Brazil, as well as the number and distribution of the required human resources in the country, trying to generate recommendations for the implementation of necessary improvements. This theoretical-exploratory study has used two complimentary methodologies: (1) Review of the national and international peer reviewed academic literature published as articles, theses, and dissertations, using the MEDLINE and LILACS databases, in addition to the CAPES, a database kept by the Brazilian Ministry of Education (2 ) Identification and mapping of the distribution of training centers for the capacitation of human resources for the manufacture of obturation prostheses in Brazil, using data obtained from the Brazilian Ministry of Education and different professional societies related to the subject. The results are a historical analysis of the evolution of the technology used in the manufacture of these devices. Different techniques and devices are presented and their advantages and drawbacks discussed, alongside with their benefits and impact on the quality of life of the users. We also identified the technical limitations to be overcome for the improvement of the rehabilitating technology. The time of molding, pre-, trans- or post-surgical, was identified as the critical phase for the successful manufacture of the obturation device, impacting on its adaptability and quality of functional recovery of the patient. The data also reveals that the access to the technology is limited by the skewed regional distribution of oral maxillofacial prosthetists in the Brazilian territory, as well as the small numbers of training centers, scarce human resources, and limited financial support of education and research in the field. 1;2 2 3 Sonia Perez de Sá ; Rosângela Caetano ; Fernando Luiz Dias 1 - Social Medicine Institute, UERJ; Nacional Institute, 2 - Instituto de Medicina Social, UERJ, 3 - Instituto Nacional del Câncer / Brasil e-mail: [email protected] y [email protected] Graphic presentation of the allocation of human resources able to deal with the demand for surgical treatment and manufacture of obturation prosthesis for the rehabilitation of maxillectomized patients Dry mouth Difficulties with the use of the prostheses (%) Item Problems with food ingestion Difficulty swallowing Scape of fluids Scape of solid food Problems with speech Different voice (before surgery) Difficulties talking in public Nasal voice Difficulties pronouncing words Speech difficult to be understood Other problems Esthetical dissatisfaction Clamps on frontal teeth Superior lip numbness Embarrassment in social and family Difficulties using the device Superior lip with bad appearance Some difficulty 28 23 21 17 19 09 13 06 34 30 19 21 4 2 2 Very / extreme difficulty 08 06 04 09 04 11 02 00 17 13 14 04 02 02 02 64 70 75 75 77 81 85 94 49 57 67 75 94 96 96 None / Ulty / very little diffic Source: KORNBLITH et al, 1996, p. 328 BRASIL, Ministério da Saúde. Instituto Nacional de Câncer, Falando sobre o câncer de boca, Rio de Janeiro: INCA, 2002. CUNNINGHAM R., A laboratory technique for the production of immediate surgical appliances and “one stage” obturators for the hemi-maxillectomy patient, British Journal of Oral and Maxillofacial Surgery (1990) 28,59-61 DÖBROSSY L. Epidemiology of head and neck cancer: magnitude of the problem. Cancer metastasis Rev 2005; 24(1):9-17 GOIATO MC., et al, Fatores que levam à utilização de uma prótese obturadora, Rev Odont de Araçatuba,2006; 27(2), 101-106 KEYF F., Obturator protheses for hemimaxillectomy patients, J ofm Oral Rehabilitation 2001; 28:821-829 KORNBLITH A., et al, Quality of life maxillectomy patients using an obturator prosthesis, Head & Neck 1996; 18: 323-334 SÁ SP. Próteses obturadoras para pacientes maxilarectomizados: estado atual da tecnologia e necessidades de aprimoramentos, Dissertação de Mestrado IMS/UERJ 2010 SILVA DP. et al, Reabilitação protética de pacientes maxilarectomizados uma contribuição da odontologia e um convite à reflexão, Pesq Brás Odontoped Clin Integr, João Pessoa, 4(2): 125-130 maio/ago 2004. Bearers of an oronasal communication due to removal, loss, or absence of the maxilla, require the use of an obturation device to restore function, for esthetical reasons, and for improving their quality of life. Lately, the development of new techniques and materials has allowed significant advances in this technology making possible the manufacture of more effective and adapted devices. However, it is a customized technology strongly dependent on the mastery of advanced laboratorial and handcrafts skills. The scarcity of trained professionals limits its use and dissemination through all economic groups in society. Conclusion OBJECTIVE METHODOLOGY OBTURATOR PROSTHESES
Transcript of OBTURATOR PROSTHESES FOR MAXILLECTOMY PATIENTS: …
Proj
eto
Grá
fico:
Ser
viço
de
Ediçã
o e
Info
rmaç
ão T
écn
ico-
Cien
tífic
a / C
EDC
/ IN
CA
OBTURATOR PROSTHESES FOR MAXILLECTOMY PATIENTS: CURRENT STATUS OF THE TECHNOLOGY
AND NECESSITIES FOR IMPROVEMENT
INTRODUCTION
The aim of this study was to analyze the state of the art of different molding techniques as well as the manufacture of obturation prostheses utilized in the rehabilitation process of maxillectomized patients in Brazil, as well as the number and distribution of the required human resources in the country, trying to generate recommendations for the implementation of necessary improvements.
This theoretical-exploratory study has used two complimentary methodologies: (1) Review of the national and international peer reviewed academic literature published as articles, theses, and dissertations, using the MEDLINE and LILACS databases, in addition to the CAPES, a database kept by the Brazilian Ministry of Education (2 ) Identification and mapping of the distribution of training centers for the capacitation of human resources for the manufacture of obturation prostheses in Brazil, using data obtained from the Brazilian Ministry of Education and different professional societies related to the subject. The results are a historical analysis of the evolution of the technology used in the manufacture of these devices. Different techniques and devices are presented and their advantages and drawbacks discussed, alongside with their benefits and impact on the quality of life of the users. We also identified the technical limitations to be overcome for the improvement of the rehabilitating technology.
Obturadores / bulbos Palatinos Velopalatinas Velofaríngeos
Tiempo de ejecución de la moldura pré trans pós pós
Perennes
Quirúrgica / inmediata X X
Interino / temporal X X X
Final X X
Los profesionales involucrados CD+TPD CD +TPD+ Logopedia
The time of molding, pre-, trans- or post-surgical, was identified as the critical phase for the successful manufacture of the obturation device, impacting on its adaptability and quality of functional recovery of the patient. The data also reveals that the access to the technology is limited by the skewed regional distribution of oral maxillofacial prosthetists in the Brazilian territory, as well as the small numbers of training centers, scarce human resources, and limited financial support of education and research in the field.
1;2 2 3Sonia Perez de Sá ; Rosângela Caetano ; Fernando Luiz Dias
1 - Social Medicine Institute, UERJ; Nacional Institute, 2 - Instituto de Medicina Social, UERJ, 3 - Instituto Nacional del Câncer / Brasil
e-mail: [email protected] y [email protected]
Graphic presentation of the allocation of human resources able to deal with the demand for surgical treatment and manufacture of obturation prosthesis for the rehabilitation of maxillectomized patients
Dry mouth
Difficulties with the use of the prostheses (%)
Item
Problems with food ingestionDifficulty swallowingScape of fluidsScape of solid food
Problems with speechDifferent voice (before surgery)Difficulties talking in publicNasal
voiceDifficulties pronouncing wordsSpeech difficult to be understood
Other problems
Esthetical dissatisfactionClamps on frontal teeth Superior lip numbness Embarrassment in social and family Difficulties using the deviceSuperior lip with bad appearance
Some difficulty
282321
1719091306
34301921422
Very / extreme difficulty
080604
0904110200
17131404020202
647075
7577818594
49576775949696
None / Ulty / very little diffic
Source: KORNBLITH et al, 1996, p. 328
BRASIL, Ministério da Saúde. Instituto Nacional de Câncer, Falando sobre o câncer de boca, Rio de Janeiro: INCA, 2002.CUNNINGHAM R., A laboratory technique for the production of immediate surgical appliances and “one stage” obturators for the hemi-maxillectomy patient, British Journal of Oral and Maxillofacial Surgery (1990) 28,59-61 DÖBROSSY L. Epidemiology of head and neck cancer: magnitude of the problem. Cancer metastasis Rev 2005; 24(1):9-17GOIATO MC., et al, Fatores que levam à utilização de uma prótese obturadora, Rev Odont de Araçatuba,2006; 27(2), 101-106KEYF F., Obturator protheses for hemimaxillectomy patients, J ofm Oral Rehabilitation 2001; 28:821-829KORNBLITH A., et al, Quality of life maxillectomy patients using an obturator prosthesis, Head & Neck 1996; 18: 323-334SÁ SP. Próteses obturadoras para pacientes maxilarectomizados: estado atual da tecnologia e necessidades de aprimoramentos, Dissertação de Mestrado IMS/UERJ 2010SILVA DP. et al, Reabilitação protética de pacientes maxilarectomizados uma contribuição da odontologia e um convite à reflexão, Pesq Brás Odontoped Clin Integr, João Pessoa, 4(2): 125-130 maio/ago 2004.
Bearers of an oronasal communication due to removal, loss, or absence of the maxilla, require the use of an obturation device to restore function, for esthetical reasons, and for improving their quality of life. Lately, the development of new techniques and materials has allowed significant advances in this technology making possible the manufacture of more effective and adapted devices. However, it is a customized technology strongly dependent on the mastery of advanced laboratorial and handcrafts skills. The scarcity of trained professionals limits its use and dissemination through all economic groups in society.
Conclusion
OBJECTIVE
METHODOLOGY
OBTURATOR PROSTHESES
