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Aim: This study aimed to review the scientific literature to describe the main care and hygiene protocols for different types of maxillofacial prostheses (MFP). Methods: A bibliographic search on the PubMed / Medline database using the following keywords: ["maxillofacial prosthesis" OR "ocular prostheses" OR "palatal obturators"] AND ["Cleaning" OR "disinfection"] AND ["care"] AND ["color stability"] OR ["denture cleansers" OR "cleansing agents"]. Articles addressing materials, cleaning and disinfection protocols, and care related to MFP were included. The following exclusion criteria were applied: no adequate methodology, incompatibility with the area of interest, and unavailability for reading in full. Results: The papers were grouped into the following topics: facial prostheses, ocular prostheses, maxillofacial intraoral prostheses, and retention systems. Conclusion: Despite the MFP changes over time, its degradation decreases upon following the recommendations and post-adaptation care. The guidelines for cleaning and disinfection must be individualized to guarantee the longevity of the prosthesis and the patient health

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Introducción: Las personas con una deformación facial comúnmente están expuestas a las críticas o presión, colocando al individuo en situaciones embarazosas. El uso de prótesis es una solución eficiente a las deformidades faciales ya que evita complicaciones quirúrgicas y produce un buen resultado estético cuando no es posible la reconstrucción quirúrgica o se prefiere por el paciente. Objetivo: Caracterizar clínica y epidemiológicamente los pacientes con alteraciones bucomaxilofaciales en la provincia Camagüey. Métodos: Se realizó un estudio descriptivo de serie de casos en el periodo comprendido entre marzo y diciembre de 2022. Se tomó la información existente en las bases de datos y en los trabajos de terminación de la especialidad de Prótesis Estomatológica, realizados entre los años 2001 al 2019. Se utilizó para el análisis de la información, estadística descriptiva para distribución de frecuencias y los resultados finales se incluyeron en tablas. Resultados: La mayoría de los casos fueron pacientes masculinos, de edades entre 46 y 60; los defectos más frecuentes encontrados fueron los oculares. En cuanto al sexo fue evidente una mayor necesidad de prótesis bucomaxilofacial en los hombres y dentro de estas las prótesis oculares. Entre las principales causas de pérdida de estructuras se encontraron los traumatismos y las lesiones oncológicas. Conclusiones: Los defectos bucomaxilofaciales repercuten de forma negativa en la calidad de vida de quienes los padecen; las causas que generan los mismos, las regiones donde más se presentan, el sexo y la edad en que aparecen son elementos a tener en cuenta para un correcta prevención de dichas lesiones pero también permiten establecer pautas de trabajo encaminadas a brindar una atención multidisciplinaria para su rehabilitación protésica e integral.

Introduction: People with a facial deformity are commonly exposed to criticism or pressure, placing the individual in embarrassing situations. The use of prostheses is an efficient solution to facial deformities since it avoids surgical complications and produces a good aesthetic result when surgical reconstruction is not possible or is preferred by the patient. Objective: To characterize clinically and epidemiologically patients with oral and maxillofacial alterations in Camagüey province. Methods: A case report type study was carried out taking the results of the databases, completion works of the Dentistry Prosthesis specialty between the years 2001 and 2019. The study was carried out in the period between March and December 2022. The results were reflected in tables using descriptive statistics for them. Results: Most of the cases were male patients, aged between 46 and 60; the most frequent defects found were the ocular ones. Regarding gender, a greater need for oral and maxillofacial prostheses was evident in men, and within these, ocular prostheses. Among the main causes of loss of structures were traumatisms and oncological lesions. Conclusions: Oral and maxillofacial defects have a negative impact on the quality of life of those who suffer from them; the causes that generate them, the regions where they occur most, the sex and the age in which they appear are elements to take into account for a correct prevention of said injuries but also allow the establishment of work guidelines aimed at providing multidisciplinary care for their prosthetic and integral rehabilitation.

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ABSTRACT Purpose: to investigate the effectiveness of a pharyngeal bulb prosthesis to eliminate hypernasality in patients with operated cleft palate presenting with diagnosis of hypodynamic velopharynx. Methods: twenty patients with cleft palate, ages 11-40 years, presenting hypodynamic velopharynx participated in the study. Patients had their speech audio recorded twice, with and without prosthesis, simultaneously with nasometry. Three speech-pathologists rated the presence and absence of hypernasality. Perceptual and nasometric data without and with prosthesis were compared, using the McNemar Test (p<0.05). Results: three (15%) patients presented hypernasality without prosthesis and normal resonance with prosthesis, 3 (15%), normal resonance without prosthesis and hypernasality with prosthesis, 9 (45%), hypernasality without and with prosthesis, and 5 (25%), normal resonance in both conditions. Nasometry (≤27% cut off): 1 (5%), presented scores >27% without prosthesis and <27% with prosthesis, 2 (10%), scores <27% without prosthesis and >27% with prosthesis, 17 (85%), scores >27% in both conditions, and 1(5%), scores <27% in both conditions. The comparisons between the results were not significant (p=1.000). Conclusion: the pharyngeal bulb prosthesis alone is insufficient to eliminate hypernasality of patients presented with hypodynamic velopharynx. To this purpose, the combination between the prosthesis and speech therapy is required.

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A prótese obturadora constitui o principal método para a reabilitação de grandes defeitos maxilares. Tem como objetivo fechar o defeito, separar a cavidade oral da cavidade nasal, prevenir a fala anasalada e a regurgitação nasal de alimentos e líquidos e dar sustentação ao perfil facial. Este artigo visa relatar um caso de reabilitação com prótese obturadora maxilar após maxilectomia parcial. Paciente do gênero feminino, 72 anos, diagnosticada com carcinoma adenoide cístico na região de palato, foi submetida a maxilectomia parcial que resultou em extenso defeito maxilar e comunicação bucosinusal. Após anamnese, exames extra, intraorais e radiográfico, foi planejado para o período cicatricial e de uso da sonda nasogástrica, a confecção de uma placa obturadora para melhorar a deglutição e fala. Em seguida, confecção de uma prótese total obturadora superior e prótese parcial removível inferior. A placa obturadora foi confeccionada e utilizada até a remoção da sonda e instalação das próteses. Após moldagem das duas arcadas, foram obtidos modelos funcionais que foram montados em articulador após os ajustes dos planos de orientação e registro das relações intermaxilares. Foram realizadas provas estéticas e funcionais dos dentes artificiais e ajustes necessários. Posteriormente à acrilização, as próteses foram instaladas e o ajuste oclusal executado. Para obter retenção e estabilidade satisfatórias durante a utilização da prótese obturadora superior foi sugerido o uso de adesivo para dentadura. Três proservações foram realizadas. A prótese obturadora reabilitou a estética, fonética, função mastigatória e deglutição restabelecendo a autoestima e a ressocialização da paciente(AU)

The obturator prosthesis is the main method for the rehabilitation of large maxillary defects. With the purpose to closethe defect, separate the oral cavity from the nasal cavity, prevent hypernasal speech, nasal regurgitation of food and liquids and provide support for the facial profile. This article aims to report a case of rehabilitation with maxillary obturator prosthesis after partial maxillectomy. A 72-year-old female patient, diagnosed with adenoid cystic carcinoma in the palate region, underwent partial maxillectomy that resulted in extensive maxillary defect and bucco-sinus communication. After anamnesis, extra, intraoral and radiographic exams, the construction of a palatal plate was planned to be used with the nasogastric tube and during the healing process, to improve swallowing and speech. Then, the manufacture of a maxillary obturator prosthesis and a lower removable partial prosthesis. The palatal plate was made and used until the tube was removed and the insertion of the prostheses. After the impressions, master casts were made and mounted on an articulator after adjustment of wax occlusion rims and registration of the maxillo-mandibular relations. Functional elements of speech, occlusion, and appearance were evaluated during the try-in of the provisional set-up and adjusts were made.After the acrylization, the prostheses were inserted and the occlusal adjustment performed. To obtain satisfactory retention and stability when using the maxillary obturator prosthesis, it was suggested to use denture adhesive. Three post-insertions visits were carried out. The obturator prosthesis rehabilitated aesthetics, phonetics, masticatory function and swallowing, restoring the patient's self-esteem and improving social life(AU)

La prótesis obturadora es el método principal para la rehabilitación de grandes defectos maxilares. Tiene por objetivo cerrarel defecto, separar la cavidad bucal de la cavidad nasal, prevenir el habla nasal, la regurgitación nasal de alimentos y líquidos,dando apoyo al perfil facial. Este artículo tiene objetivo de reportar un caso de rehabilitación con prótesis obturadora maxilar tras maxilectomía parcial. Una paciente de 72 años, diagnosticada de carcinoma adenoide quístico en región del palato, fué sometida a maxilectomía parcial que resultó en extenso defecto maxilar y comunicación bucosinusal. Después de anamnesis, exámenes extra, intraorales y radiográficos, se planificó para el período de cicatrización y el uso de la sonda nasogástrica,la construcción de una placa obturadora para mejorar la deglución y el habla. Luego, la fabricación de una prótesis obturadora total superior y una prótesis parcial inferior removible. La placa obturadora se hizo y se utilizó hasta que se retiró la sonda y se instalaron las prótesis. Se realizón la impresión de ambos arcos, obtuvieron modelos funcionales que se montaron en articulador, tras ajustes de los planos de orientación y registro de relaciones intermaxilares. Se realizaron pruebas estéticas y funcionales en dientes artificiales y ajustes necesarios. Después de la acrilización se instalaron las prótesis y se realizó ajuste oclusal. Para obtener una retención y estabilidad satisfactoria al utilizar la prótesis obturadora superior, fue sugirió utilizar un adesivo para prótesis. Se realizaron tres proservaciones. La prótesis obturatriz rehabilitó estética, fonética, función masticatoria y deglución, devolviendo autoestima y resocialización al paciente(AU)

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RESUMEN Introducción: Las fracturas por lesión traumática, la resección quirúrgica de tumores y los defectos congénitos exponen al maxilar a agresiones, y para la rehabilitación están las prótesis obturatrices que recuperan algunas funciones como la deglución y la fonación, así como la estética. Objetivo: Resumir los beneficios del uso de prótesis obturatriz como forma de rehabilitación en los servicios de Prótesis Bucomaxilofacial. Métodos: Estudio de revisión bibliográfica en 25 publicaciones entre 2015-2020 sobre el uso de prótesis obturatriz. Se consultaron y tamizaron 153 documentos de las bases de datos de los sistemas referativos MEDLINE, PubMed y SciELO e indexadas en la Web of Sciences, Scopus, Redalyc y Latindex, con el uso de los descriptores: obturador bucal, prótesis obturatriz, cáncer bucal. Desarrollo: Los obturadores protésicos o palatinos, se indican para sellar los tejidos de la cavidad bucal expuestos de forma quirúrgica o congénita, y constituyen un sustituto fundamental del paladar duro, del hueso alveolar y de los tejidos blandos circundantes. Durante la rehabilitación, el profesional en prótesis bucomaxilofacial realizará nuevas modificaciones, a medida que el lecho quirúrgico madura. La prótesis final contará con dientes similares a una prótesis dental; el paciente la puede extraer y limpiar, además de ocuparse de la higiene del defecto. Conclusiones: Los obturadores protésicos corrigen defectos palatinos o maxilares, con varios diseños y aditamentos a aplicar, lo cual logra recuperar un alto nivel de calidad de vida de los pacientes, pues se separa la cavidad bucal de la nasal o sinusal, con una consecuente rehabilitación dental y oclusal satisfactoria. Palabras clave: obturadores palatinos; prótesis maxilofacial; rehabilitación bucal.

ABSTRACT Introduction: Fractures due to traumatic injury, surgical resection of tumors and congenital defects expose the maxilla to aggressions, and for rehabilitation there are obturator prostheses that recover some functions such as swallowing and phonation, as well as aesthetics. Objective: To summarize the benefits of the use of an obturator prosthesis as a rehabilitation form in Oral Maxillofacial Prosthesis services. Methods: Study of bibliographic review in 64 publications between 1978-2019 on the use of obturator prosthesis. 153 documents from the MEDLINE, PubMed and SciELO reference systems databases were consulted, screened and indexed on the Web of Sciences, Scopus, Redalyc and Latindex, with the use of the following descriptors: oral obturator, obturator prosthesis, oral cancer. Development: Prosthetic or palatal obturators are indicated to seal the surgically or congenitally exposed tissues of the oral cavity, and are a fundamental substitute for the hard palate, alveolar bone and surrounding soft tissues. During rehabilitation, the buccomaxillofacial prosthesis professional will make new modifications as the surgical site matures. The final prosthesis will have teeth similar to a dental prosthesis; the patient can remove and clean it, in addition to taking care of the hygiene of the defect. Conclusions: Prosthetic obturators correct palatal or maxillary defects, with various designs and attachments to be applied, which manages to recover a high level of quality of life for patients, since the oral cavity is separated from the nasal or sinus cavity, with a satisfactory dental and occlusal rehabilitation.

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Palatal malformations rarely occur in small animals. Palatal clefts can affect the upper lip, hard palate, and soft palate, and may be congenital or acquired in origin. The most common acquired forms result from the excision of oral neoplasia, teeth extraction, perforating lesions, automobile accidents, and electric accidents. Clinical signs of a fissured palate are sneezing, purulent nasal discharge, salivary secretion in nasal discharge, difficulty feeding and drinking, and pneumonia due to aspiration, which are the most severe alterations and can lead to death. The treatment of palatal clefts consists of occlusion of the oronasal communication, which can be performed using mucoperiosteal grafts, pedicled flaps, or palatal obturators. Herein, we report a case of an acquired palatal cleft treated with a palatal obturator in a feline patient who bit a high-tension wire. Two attempts of surgical correction had been unsuccessful, resulting in suture dehiscence and perpetuation of the oronasal fistula. After fixation of the obturator, the animal showed remission of all clinical signs. The animal has survived for over one year with improved quality of life.(AU)

Os defeitos de palato são ocorrências raras na clínica de pequenos animais. As fendas palatinas podem afetar o lábio superior, palato duro e/ou palato mole, cuja origem pode ser congênita ou adquirida. As formas adquiridas mais comuns são excisão de neoplasias orais, exodontias, lesões perfurantes, acidentes automobilísticos e acidentes com choques elétricos. Os principais sintomas sinais clínicos são espirros, secreção nasal purulenta e salivar, dificuldade de alimentação e ingestão de água sendo a pneumonia por aspiração a alteração mais grave, podendo levar o animal a óbito. O tratamento das fendas consiste na oclusão da comunicação oronasal, que pode ser feita por meio de enxertos mucoperiosteias, flaps pediculados ou com uso de obturadores palatinos. O presente trabalho tem como objetivo relatar o uso de do obturador palatino como método de tratamento de fenda palatina adquirida, em um paciente felino, como causa foi por acidente com fio de alta tensão. Já haviam sido realizadas duas correções cirúrgicas que resultou em deiscência dos pontos e perpetuação da fistula oronasal. Após a fixação do obturador palatino o animal apresentou melhora de todos os sinais clínicos, e da qualidade de vida, e o período de avaliação já superou um ano.(AU)

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ABSTRACT: There has been little discussion about the quality of life of patients with maxillary defects. This article evaluates the issues related to the condition. We performed a cross-sectional study of patients with maxillary defects from referral centers in Brazil. To avoid subject burden, a questionnaire was developed, based on questions from seven instruments, which dealt with domains and conclusions that were similar to those from other studies. The predictor variable was the patients' score for each question. The outcome measure was the presence of the best-ranked items on the questionnaire as the impact factor. Six experts assessed these items and suggested which questions to include or exclude. Patients scored each item according to its occurrence and importance. Descriptive statistics and the items' rank according to the impact factor were computed to determine whether there is a comprehensive instrument available. Thirteen patients and six professionals were included in this study. The patients' age ranged from 24 to 72 years (mean (standard deviation, SD), 50.41 (14.46) years). We obtained a 60-item instrument from the selected questionnaires and subject interviews. Only 12 (37.5 %) out of the 32 best-rated items were verified by the existing instruments, two (6.25 %) were suggested by professionals and 18 (56.25 %) were conclusions from other studies. To the best of our knowledge, this is the first study to provide many features related to the quality of life in patients with maxillary defects.

RESUMEN: Existe escasa discusión en la literatura sobre la calidad de vida de los pacientes con defectos maxilares. Este artículo evalúa los problemas relacionados con esta condición. Realizamos un estudio transversal de pacientes con defectos maxilares de centros de referencia en Brasil. Se desarrolló un cuestionario basado en preguntas de siete instrumentos, que trataba sobre dominios y conclusiones similares a las de otros estudios. La variable de estimación fue la puntuación de los pacientes para cada pregunta. La medida de resultado fue la presencia de los elementos mejor clasificados en el cuestionario como factor de impacto. Seis expertos evaluaron estos ítems y sugirieron qué preguntas incluir o excluir. Los pacientes puntuaron cada ítem según su ocurrencia e importancia. Se calcularon las estadísticas descriptivas y la clasificación de los ítems según el factor de impacto, para determinar si existe un instrumento completo. Trece pacientes y seis profesionales fueron incluidos en este estudio. La edad de los pacientes osciló entre 24 y 72 años [media (desviación estándar), 50,41 (14,46) años]. Obtuvimos un instrumento de 60 ítems de los cuestionarios y entrevistas de temas seleccionados. Solo 12 (37,5 %) de los 32 ítems mejor calificados se verificaron de acuerdo a los instrumentos existentes, dos (6,25 %) fueron sugeridos por profesionales y 18 (56,25 %) fueron conclusiones de otros estudios. De acuerdo a nuestro conocimiento, este es el primer estudio que proporciona características relacionadas con la calidad de vida en pacientes con defectos maxilares.

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Palatal malformations rarely occur in small animals. Palatal clefts can affect the upper lip, hard palate, and soft palate, and may be congenital or acquired in origin. The most common acquired forms result from the excision of oral neoplasia, teeth extraction, perforating lesions, automobile accidents, and electric accidents. Clinical signs of a fissured palate are sneezing, purulent nasal discharge, salivary secretion in nasal discharge, difficulty feeding and drinking, and pneumonia due to aspiration, which are the most severe alterations and can lead to death. The treatment of palatal clefts consists of occlusion of the oronasal communication, which can be performed using mucoperiosteal grafts, pedicled flaps, or palatal obturators. Herein, we report a case of an acquired palatal cleft treated with a palatal obturator in a feline patient who bit a high-tension wire. Two attempts of surgical correction had been unsuccessful, resulting in suture dehiscence and perpetuation of the oronasal fistula. After fixation of the obturator, the animal showed remission of all clinical signs. The animal has survived for over one year with improved quality of life.

Os defeitos de palato são ocorrências raras na clínica de pequenos animais. As fendas palatinas podem afetar o lábio superior, palato duro e/ou palato mole, cuja origem pode ser congênita ou adquirida. As formas adquiridas mais comuns são excisão de neoplasias orais, exodontias, lesões perfurantes, acidentes automobilísticos e acidentes com choques elétricos. Os principais sintomas sinais clínicos são espirros, secreção nasal purulenta e salivar, dificuldade de alimentação e ingestão de água sendo a pneumonia por aspiração a alteração mais grave, podendo levar o animal a óbito. O tratamento das fendas consiste na oclusão da comunicação oronasal, que pode ser feita por meio de enxertos mucoperiosteias, flaps pediculados ou com uso de obturadores palatinos. O presente trabalho tem como objetivo relatar o uso de do obturador palatino como método de tratamento de fenda palatina adquirida, em um paciente felino, como causa foi por acidente com fio de alta tensão. Já haviam sido realizadas duas correções cirúrgicas que resultou em deiscência dos pontos e perpetuação da fistula oronasal. Após a fixação do obturador palatino o animal apresentou melhora de todos os sinais clínicos, e da qualidade de vida, e o período de avaliação já superou um ano.

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Palatal malformations rarely occur in small animals. Palatal clefts can affect the upper lip, hard palate, and soft palate, and may be congenital or acquired in origin. The most common acquired forms result from the excision of oral neoplasia, teeth extraction, perforating lesions, automobile accidents, and electric accidents. Clinical signs of a fissured palate are sneezing, purulent nasal discharge, salivary secretion in nasal discharge, difficulty feeding and drinking, and pneumonia due to aspiration, which are the most severe alterations and can lead to death. The treatment of palatal clefts consists of occlusion of the oronasal communication, which can be performed using mucoperiosteal grafts, pedicled flaps, or palatal obturators. Herein, we report a case of an acquired palatal cleft treated with a palatal obturator in a feline patient who bit a high-tension wire. Two attempts of surgical correction had been unsuccessful, resulting in suture dehiscence and perpetuation of the oronasal fistula. After fixation of the obturator, the animal showed remission of all clinical signs. The animal has survived for over one year with improved quality of life.

Os defeitos de palato são ocorrências raras na clínica de pequenos animais. As fendas palatinas podem afetar o lábio superior, palato duro e/ou palato mole, cuja origem pode ser congênita ou adquirida. As formas adquiridas mais comuns são excisão de neoplasias orais, exodontias, lesões perfurantes, acidentes automobilísticos e acidentes com choques elétricos. Os principais sintomas sinais clínicos são espirros, secreção nasal purulenta e salivar, dificuldade de alimentação e ingestão de água sendo a pneumonia por aspiração a alteração mais grave, podendo levar o animal a óbito. O tratamento das fendas consiste na oclusão da comunicação oronasal, que pode ser feita por meio de enxertos mucoperiosteias, flaps pediculados ou com uso de obturadores palatinos. O presente trabalho tem como objetivo relatar o uso de do obturador palatino como método de tratamento de fenda palatina adquirida, em um paciente felino, como causa foi por acidente com fio de alta tensão. Já haviam sido realizadas duas correções cirúrgicas que resultou em deiscência dos pontos e perpetuação da fistula oronasal. Após a fixação do obturador palatino o animal apresentou melhora de todos os sinais clínicos, e da qualidade de vida, e o período de avaliação já superou um ano.

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Palatal malformations rarely occur in small animals. Palatal clefts can affect the upper lip, hard palate, and soft palate, and may be congenital or acquired in origin. The most common acquired forms result from the excision of oral neoplasia, teeth extraction, perforating lesions, automobile accidents, and electric accidents. Clinical signs of a fissured palate are sneezing, purulent nasal discharge, salivary secretion in nasal discharge, difficulty feeding and drinking, and pneumonia due to aspiration, which are the most severe alterations and can lead to death. The treatment of palatal clefts consists of occlusion of the oronasal communication, which can be performed using mucoperiosteal grafts, pedicled flaps, or palatal obturators. Herein, we report a case of an acquired palatal cleft treated with a palatal obturator in a feline patient who bit a high-tension wire. Two attempts of surgical correction had been unsuccessful, resulting in suture dehiscence and perpetuation of the oronasal fistula. After fixation of the obturator, the animal showed remission of all clinical signs. The animal has survived for over one year with improved quality of life.

Os defeitos de palato são ocorrências raras na clínica de pequenos animais. As fendas palatinas podem afetar o lábio superior, palato duro e/ou palato mole, cuja origem pode ser congênita ou adquirida. As formas adquiridas mais comuns são excisão de neoplasias orais, exodontias, lesões perfurantes, acidentes automobilísticos e acidentes com choques elétricos. Os principais sintomas sinais clínicos são espirros, secreção nasal purulenta e salivar, dificuldade de alimentação e ingestão de água sendo a pneumonia por aspiração a alteração mais grave, podendo levar o animal a óbito. O tratamento das fendas consiste na oclusão da comunicação oronasal, que pode ser feita por meio de enxertos mucoperiosteias, flaps pediculados ou com uso de obturadores palatinos. O presente trabalho tem como objetivo relatar o uso de do obturador palatino como método de tratamento de fenda palatina adquirida, em um paciente felino, como causa foi por acidente com fio de alta tensão. Já haviam sido realizadas duas correções cirúrgicas que resultou em deiscência dos pontos e perpetuação da fistula oronasal. Após a fixação do obturador palatino o animal apresentou melhora de todos os sinais clínicos, e da qualidade de vida, e o período de avaliação já superou um ano.

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RESUMEN La insuficiencia velofaríngea (IVF) corresponde a cualquier defecto estructural del paladar blando o de las paredes de la faringe, caracterizado por la ausencia de tejido suficiente para lograr un cierre adecuado del mecanismo velofaríngeo durante el habla, lo que genera resonancia hipernasal y emisión nasal. En los casos de fisura con compromiso de paladar, el tratamiento para corregir la IVF puede ser quirúrgico o protésico, acompañado de intervención fonoaudiológica, pues la corrección física no elimina las alteraciones funcionales. Se presentan los resultados de habla obtenidos en un adulto hablante chileno diagnosticado con IVF secundaria a fisura palatina, rehabilitado en Fundación Gantz con prótesis de paladar obturadora y tratamiento fonoaudiológico. La evaluación mediante análisis perceptivo auditivo y nasometría evidencia una mejora del mecanismo velofaríngeo durante el habla.

ABSTRACT The velopharyngeal insufficiency (IVF) corresponds to any structural defect of the soft palate or the walls of the pharynx, where there is not enough tissue to achieve an adequate closure of the velopharyngeal mechanism during speech, generating hypernasal resonance and nasal emission. In cases of cleft palate, the treatment to correct IVF may be surgical or prosthetic, accompanied by speech therapy. The speech results obtained in a native speaker of Chilean Spanish diagnosed with IVF secondary to cleft palate, rehabilitated in Fundación Gantz with a palatal obturator (speech bulb) and speech therapy are presented. The evaluation by auditory perceptual analysis and nasometry show an improvement of the velopharyngeal mechanism during speech.

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Este trabalho tem como objetivo apresentar o protocolo de reabilitação por meio de prótese obturadora palatina, preconizado pela Universidade Federal de Alfenas (UNIFAL-MG), através do relato de um caso clínico de paciente maxilectomizada. A paciente apresentava comunicação buco-sinu-nasal e ausência parcial de dentes maxilares e mandibulares. Foi realizada moldagem de estudo, obtenção do modelo de trabalho, delineamento, planejamento das armações metálicas, preparos específicos, moldagem de trabalho e obtenção das armações; que foram provadas, os registros intermaxilares tomados, modelos montados em articulador e selecionados os dentes artificiais. Foi realizada prova estética e funcional com ênfase na pronúncia em função da existência de comunicação. Foi selecionada a cor da base e as próteses foram instaladas. Conclui-se que a prótese obturadora constitui um método satisfatório para a reabilitação de defeitos palatinos, pois proporcionou o vedamento da comunicação, proteção aos tecidos da área afetada, melhoras funcionais e estéticas, favorecendo a reintegração da paciente ao convívio social(AU)

The purpose of this study was the proposal of the clinical therapy and treatment of prosthetic patient under the Federal University of Alfenas (UNIFAL-MG), using a clinical report of a maxilectomized patient. The patient presented buco-sinu-nasal communication and partial absence of maxillary and mandibular teeth. It was made the study impression, obtaining the working model, designing, planning of metal frames, specific preparation, working impression and obtaining frames were carried out; which were tested, taken intermaxillary records, articulator mounted models and selected artificial teeth. Aesthetic and functional tests were performed with emphasis on pronunciation as a function of the existence of communication. The color of the base was selected and the prostheses were installed. It was concluded that the obturator prosthesis is a satisfactory method for the rehabilitation of palatal defects, since it provided the seal of communication, protection to the tissues of the affected area, functional and aesthetic improvements, favoring the reintegration of the patient to social interaction(AU)

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Patients who have maxillectomy can be rehabilitated with reconstructive surgery or obturator prostheses with or without osseointegratable implants. To identify studies on possible treatments in this group, we systematically searched the Scopus, Embase, PubMed/Medline, and Cochrane databases to collect data on patients' characteristics, radiotherapy, and results related to speech, swallowing, mastication or diet, chewing, aesthetics, and quality of life. Of the 1376 papers found, six were included, and one other was included after an additional search of references. A total of 252 patients were included, and of them, 86 had reconstructive surgery, 91 were treated with obturator prostheses, 39 had reconstructive surgery or obturator prostheses associated with implants, and 36 had reconstruction plus an obturator prosthesis. Data on radiotherapy were incomplete. There is a lack of consensus about the indication for rehabilitation, as the treatment must be based on the individual characteristics of each patient.

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Abstract: We report a 42-year-old cocaine addicted female patient referred for evaluation of hard palate ulceration resulting in oro-sinus communication with difficulties in swallowing and phonation, an rhino-sinusitis. Acrylic and removable silicone prosthesis was prescribed to relieve severe functional disorders. It is essential that the patient permanently abandons cocaine use to perform surgical reconstruction.

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Fundamento: el tratamiento protético con obturadores en pacientes con defectos maxilares, ya sea por causa oncológica, traumática o por defectos congénitos, debe estar dirigido a devolver las funciones básicas. Separar la cavidad bucal de la nasal para devolver al paciente la deglución, fonación, masticación, además de una estética aceptable. Objetivo: describir la confección de una prótesis obturadora palatina de resina acrílica. Caso clínico: paciente masculino de raza blanca de 69 años de edad residente del municipio de Minas, remitido al Servicio de Cirugía Maxilofacial del Hospital Oncológico de Camagüey con el propósito de cambiar la prótesis obturatriz en uso. En el interrogatorio el paciente refiere haber sido intervenido de forma quirúrgica de un carcinoma en el maxilar, le quedó como secuela un orificio en la boca que le comunica la cavidad bucal con la nasal, que le compromete funciones tan importantes como la deglución, respiración, estética y fonación. El plan de tratamiento consistió en la elaboración de una nueva prótesis obturatriz rígida acrílica. Conclusiones: al utilizar una prótesis obturatriz rígida se logró la estética deseada por el paciente y su rehabilitación morfofuncional donde se le devolvió las funciones perdidas y elevar su autoestima.

Background: the prosthetic treatment with chokes in patients with maxillary defects, either for oncological, traumatic cause, or for congenital defects, should be intended to give back the basic functions. Separating the oral cavity from the nasal is aimed at giving back the swallowing, phonation, chewing to the patient, in addition to an acceptable esthetics. Objective: to describe the confection of an obturating prosthesis of the palate of acrylic resin. Clinical case: a 69-year old white man from Minas shows up at Julio Antonio Mella clinic in Camaguey in order to change the protrusive prosthesis in use. In the interrogation the patient referred having been intervened surgically of a carcinoma in the jawbone in which an orifice in the mouth was left as consequence that communicates the oral cavity with the nasal one, which put at risk important functions such as the swallowing, breathing, aesthetics and phonation. The treatment plan consisted in the elaboration of a new protrusive rigid acrylic prosthesis. Conclusions: when using a protrusive rigid prosthesis the aesthetics desired by the patient and his morfofunctional rehabilitation were achieved, giving back to him the lost functions and bolstering up his self-esteem.

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Objetivo: este estudo investigou a incidência da adesão de Candida albicans e Staphylococcus aureus em próteses superiores obturadoras com materiais de reembasamento macio utilizados por protesistas. Material e Métodos: entre os anos 2013 e 2014, foram avaliados clinicamente, pacientes com defeitos maxilares devido a cirurgia para remoção de tumores e usuários de próteses obturadoras (n = 21, grupo de estudo) e, as consequências microbiológicas foram comparadas com usuários de prótese total superior (n = 21, controle grupo). Os dados foram coletados sobre características demográficas, tipo histológico de câncer, emprego de quimioterapia ou radioterapia, identificação dos materiais reembasamento macio utilizados e métodos de limpeza praticados nas próteses obturadoras e totais. A presença de Candida albicans foi determinada nos materiais de reembasamento macio ou nas superfícies de polimetilmetacrilato e na cavidade bucal e, Staphylococcus aureus na mucosa nasal e na saliva. Os dados foram analisados utilizando os testes Kruskal Wallis, Fisher-Freeman-Halton (p<0,05). Resultados: A maior quantidade de Candida albicans foi encontrada nas superfícies das próteses, na saliva, nos defeitos no palato duro e no material de reembasamento macio definitivo com 90%, 90% e 70%, respectivamente. A maior quantidade de Staphylococcus aureus foi observada na saliva e na cavidade nasal no grupo de material de reembasamento macio definitivo (50%). Conclusão: o curto período de renovação dos materiais de revestimento pode causar menos colonização de Candida albicans e estomatite protética na cavidade bucal. Os pacientes que sofreram maxilectomia foram mais propensos à colonização de Staphylococcus aureus.(AU)

Objective: This study investigated on the incidence of Candida albicans and Staphylococcus aureus adhesion onto maxillary obturator prostheses with soft lining materials placed by prosthodontists. Material and Methods: Between years 2013 and 2014, patients with maxillary defects due to maxillary tumor surgery and acquired obturator prostheses (n = 21, study group) were clinically evaluated and microbiological outcomes were compared with complete maxillary denture wearers (n = 21, control group). Data were collected on demographic features, histological type of cancer, presence of chemotherapy or radiotherapy, identification of soft lining materials used on obturator prostheses, cleansing methods practiced for obturator and maxillary complete prostheses. The presence of Candida albicans was determined on soft lining materials or polymethylmethacrylate surfaces and in the oral cavity, and Staphylococcus aureus in nasal mucosa and saliva. Data were analyzed using Kruskal Wallis, Fisher-Freeman-Halton tests (p<0.05). Results: The highest amount of Candida albicans was found on surfaces of prostheses, in the saliva and on maxillary defects on the hard palate and on definitive soft lining material with 90%, 90%, and 70%, respectively. The highest amount of Staphylococcus aureus was observed in the saliva and nasal cavity in the definitive soft lining material group (50%). Conclusion: Short renewal period of lining materials may cause less Candida albicans colonisation and denture stomatitis in the oral cavity. Patients who have undergone maxillectomy were more prone to Staphylococcus aureus colonisation.(AU)

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O Ameloblastoma é uma neoplasia composta por epitélio odontogênico, sendo tumor de crescimento lento, localmente invasivo, e com grande capacidade de destruição e expansão, clinicamente persistente. O tratamento de escolha, na maioria dos casos, é a intervenção cirúrgica radical, que consiste na ressecção em bloco. A reabilitação protética é uma das alternativas de tratamento para solucionar defeitos faciais congênitos ou adquiridos. Este artigo irá relatar a reabilitação de paciente com prótese obturadora após ter passado por cirurgia de maxilectomia com sequelas de comunicação buco antral. A prótese obturadora foi confeccionada de forma que formaram-se bolsas pneumáticas para alívio do peso da mesma. A paciente compareceu à Clínica Odontológica Universitária de Universidade Estadual de Londrina (COU-UEL) usando prótese obturadora desadaptada e que causava desconforto. Após analise da prótese, planejou-se a reabilitação protética com prótese obturadora superior, e prótese parcial removível inferior, para melhor adequação do sistema estomatognático. Utilizou-se a técnica de dupla moldagem do arco superior e inferior com silicone de adição de consistência pesada. Foram confeccionadas zonas de alívio nos moldes obtidos da primeira moldagem e em seguida foram realizadas as moldagens com silicone de adição de consistência leve. Foi registrada a relação intermaxilar que possibilitou a adequada montagem dos dentes que, após prova e ajustes adequados, foi acrilizada. A prótese obturadora proporcionou melhor qualidade de vida devido a melhora na fonação, deglutição, estética, melhorando sua autoestima e reintegrando o indivíduo à sociedade

Ameloblastoma is a slow growing tumor of odontogenic epithelium, locally invasive, and with great capacity for tissue destruction and is clinically persistent. The treatment of choice in most cases is the radical surgical intervention, which constitutes of bloc resection. The prosthetic rehabilitation is an alternative treatment to solve congenital facial defects or acquired. Another treatment option is the reconstructive plastic surgery, but it depends on patient’s age, medical history, financial condition and defect extension. This clinical case will report the patient rehabilitation with obturator prosthesis after maxillectomy surgery with antral buco communication. The patient attended the COU / UEL using an obturator prosthesis. The prosthesis was poorly fitting and causing discomfort. After prosthesis analysis, prosthetic rehabilitation was planned with a maxillary obturator prosthesis and mandible removable partial dentures. Double impression technique was performed for both arches with heavy consistency addition silicone. Relief areas were prepared in the first impression and then another impression was performed with mild consistency silicone addition. The molds were cast in plaster type IV, for dies and production of evidence bases in clear acrylic resin with wax rollers for intermaxillary records. Intermaxillary relationship was recorded and allowed adequate teeth positioning. The obturator prosthesis provided a better quality of life due to improvement in speech, swallowing, aesthetics, and patient self-esteem

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To compare the three-dimensional changes occurring in the maxillary arch during the use of modified pre-surgical nasoalveolar moulding (PNAM) and Hotz's plate. A clinical trial including 32 children with unilateral cleft lip and palate (UCLP), 16 treated with Hotz's plate and 16 with PNAM, was performed. Impressions of the maxillary arches were taken: A. prior to pre-surgical orthopaedics, B. before cheiloplasty and C. after cheiloplasty. Models were digitised using a stereophotogrammetric instrument, and geodesic distances were calculated: anterior, canine and posterior widths of the arch, and lengths and cleft depths of the larger and shorter segments. The time and treatment effects were assessed by two-factor anova. A significant effect of treatment was found for cleft depth at the larger segment: children treated with Hotz's plate had significantly deeper cleft than children treated with PNAM. All distances significantly changed during time: the anterior and canine widths decreased, while the posterior width, the lengths and depths of the cleft segments increased. Significant treatment per time interactions was found. The anterior and canine widths reduced more with PNAM between time points A and B while Hotz's treatment was more effective between B and C. The shorter segment depth increased more between B and C with PNAM, and between A and B with Hotz's plate. During pre-surgical orthopaedics, therapy with PNAM obtained the best results in reducing the width at the anterior segment of the cleft. This treatment gave a lower increase in cleft depth than treatment with Hotz's plate.

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Introducción: los pacientes con fisura labiopalatina requieren un plan terapéutico a largo plazo para garantizar un crecimiento armónico del sistema estomatognático. Objetivo: determinar el efecto de la utilización del activador abierto elástico Klammt III modificado sobre las relaciones oclusales anteroposteriores y transversales, en pacientes con fisuras labiopalatinas en la etapa de crecimiento activo posquirúrgica. Métodos: se realizó un estudio analítico prospectivo de intervención poscirugía en niños con fisura labiopalatina, en el Hospital Pediátrico Provincial «José Luis Miranda¼ de Villa Clara, Cuba. La muestra estuvo constituida por 30 niños de ambos sexos entre 6 y 9 años de edad, los cuales fueron tratados con el activador abierto elástico de Klammt III modificado; se evaluaron aspectos morfológicos de la oclusión, como resalte, relación molar, ancho transversal, antes de dos años y medio de la intervención terapéutica y después de transcurrido este tiempo. Resultados: luego del tratamiento, se produjeron cambios positivos en la relación molar: se incrementaron el resalte incisivo y el ancho transversal. Conclusiones: con la utilización del activador abierto elástico de Klammt III modificado, se produjeron cambios positivos en todas las variables morfológicas oclusales estudiadas.

Introduction: patients with labiopalatal fissures require a long-term therapeutic plan in order to guarantee a total growth of the stomatognathic system. Objective: to determine the effect of using the modified Klammt's elastic open activator class III on transverse and anteroposterior occlusal relationships in patients with labiopalatal fissures in the phase of postsurgical active growth. Methods: a prospective analytical study of postsurgical intervention was carried out in children with labiopalatal fissure at the «José Luis Miranda¼ Pediatric Hospital from Villa Clara, Cuba. Sample was constituted by 30 children of both sexes between 6 and 9 years of age, who were treated with the modified Klammt's elastic open activator class III; morphological aspects of the occlusion such as overjet, molar relationship, and transversal width were evaluated two and a half year before and after therapeutic intervention. Results: positive changes in molar relationship occurred after the treatment: incisal overjet and transversal width were increased. Conclusions: positive changes occurred in all the morphological variables studied after using the modified Klammt's elastic open activator class III.

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Avaliar a ação de obturadores palatinos auxiliares da fala em pacientes com insuficiência velofaríngea devido à fissura palatina. Método: Participaram do estudo, dez pacientes com fissuras palatinas transforame ou pós-forame com diagnóstico de insuficiência velofaríngea, a partir da análise da hipernasalidade e da emissão de ar nasal. A hipernasalidade foi avaliada durante amostra de fala espontânea e repetição de vocábulos e frases. A emissão de ar nasal foi classificada de acordo com a quantidade de escape aéreo nasal, detectada no teste do espelho, durante o sopro, a emissão prolongada de fonemas, vocábulos e frases com fonemas plosivos e fricativos. As avaliações foram feitas em três tempos: T0, T1 e T2. Resultados: Para as variáveis hipernasalidade do fonema /i/ e emissão de ar nasal, observou-se diferença estatisticamente significante para T2, não sendo observada diferença entre T0 e T1. Considerando-se as variáveis hipernasalidade do fonema /u/ e função velofaríngea, não foi observada diferença estatisticamente significante entre T0, T1 e T2. Conclusão: Com os resultados obtidos, pode-se afirmar que o emprego de obturadores palatinos auxiliares da fala, em pacientes de fissuras palatinas com insuficiência velofaríngea, aumentou a hipernasalidadedo fonema /i/ e a emissão de ar nasal. A hipernasalidade do fonema /u/ e a função velofaríngea não sofreram alterações significantes... (AU)

Objective: To evaluate the action of speech-aid palatal obturators in patients with velopharyngeal insufficiency due to cleft palate. Methods: Ten transforamen or post-foramen cleft palate patients with a diagnosis of velopharyngeal insufficiency, based on the analysis of hypernasality and nasal air emission, participated in the study. Hypernasality was assessed during spontaneous speech samples and repetition of words and phrases. Nasal air emission was classified according to the amount of nasal air escape detected by the fogged-mirror test during oral breath and prolonged emission of phonemes, words and phrases with plosive and fricative sounds. Assessments were performed at three time points: T0, T1, and T2. Results: As for hypernasality of the vowel /i/ and nasal air emission, there was a statistically significant difference at T2, but no difference between T0 and T1. Regarding hypernasality of the vowel /u/ and velopharyngeal function, there was no statistically significant difference between T0, T1, and T2. Conclusion: These results indicate that the use of speech-aid palatal obturators in cleft palate patients with velopharyngeal insufficiency increased hypernasality of the vowel /i/ and nasal air emission. Hypernasality of the vowel /u/ and velopharyngeal function showed no significant changes... (AU)

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