AIPMED

ANNALS OF IBADAN POSTGRADUATE MEDICINE

PROSTHODONTIC REHABILITATION OF MAXILLOFACIAL DEFECTS IN A NIGERIAN TEACHING HOSPITAL: A 9-YEAR REVIEW

T.J. Ogunrinde1,2 D.M. Ajayi1,2 O.O. Dosumu1,2 O.F. Olawale2 and A.A. Olusanya2, 3

  1. Department of Restorative Dentistry, Faculty of Dentistry, College of Medicine, University of Ibadan, Ibadan.
  2. Department of Restorative Dentistry, University College Hospital, Ibadan.
  3. Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ibadan, Ibadan.

SUMMARY

Objectives: The objective was to review patients treated with maxillofacial prostheses in a Nigerian teaching hospital to assess the types of prostheses provided for them.

Methodology: This was a retrospective study of patients treated with maxillofacial prostheses over a period of nine years. The socio-demographic data of the patients, types of defect, causes of defects, location of defect, types of maxillofacial prostheses and the indications for prostheses were obtained from the patients’ case records. Case records with incomplete information were excluded. All data generated were analysed using the IBM SPSS version 20. Fisher’s exact test was used to test for statistical significance.

Result: Case records of eighty-two patients treated with maxillofacial prostheses were reviewed. Forty-three (52.4%) of the patients were males while 39 (47.6%) were females. The age ranged from 6 to 76 years with the mean age being of 38.76 (SD±18.3) years. The majority, 58 (70.7%) of the patients were of lower social-economic class. Sixty-six (80.5%) patients had prostheses for maxillary defects, while only one (1.2%) patient had prosthesis for nasal defect. Twenty (30.3%) of the 66 patients that had maxillary defects had definitive obturators, while only three (4.5%) had all the three types of obturator. Surgical recession of tumours of the jaw was the major cause (85.4%) and mastication (70.7%) was the major indication for the prescription of obturators.

Conclusion: The majority of the patients were of the lower social class and maxillary obturator was the major form of maxillofacial prostheses provided for patients in this study. Most of the defects are caused by surgical recession of tumours of the jaw and mastication was the major indication for the prescription of obturators.

Keywords: Management, Oral and maxillofacial defects, Obturator, Prosthetic

Correspondence

Dr. T.J. Ogunrinde

Dept. of Restorative Dentistry,

Faculty of Dentistry,

University of Ibadan,

Oyo State, Nigeria.

Email: tunde_ogunrinde2001@yahoo.com


INTRODUCTION

The face is an anatomical structure in front of the head and span from the hairline to the chin, with certain characteristics and details that confer unique features to each individual.1 These features proffer unique aesthetic look and allow acceptance of the individual within and outside a group or race.2Any alteration in the shape and form of the face usually draws attention and this affects the individual social and psychology wellbeing.3 Alteration of the face can result from trauma, tumour, congenital malformation, infection and surgical resection of tumour.4 The most common cause of alteration or defect of the maxillofacial region is head and neck tumour.4 The annual incidence of head and neck tumour is on the increase and oral and pharyngeal cancer, grouped together is the sixth most common cancer worldwide.5

The standard treatment of head and neck tumour depends on whether it is malignant or benign. Usually surgical resection alone is adequate for benign lesion while for malignant lesion other adjunct treatment such as chemotherapy or radiotherapy is necessary. Surgical resection leads to tissue loss or facial defects with attendant loss of aesthetics and function such as speech, mastication and swallowing.

The tissue loss or facial defect can be replaced by plastic reconstruction or prosthetic rehabilitation. The prostheses help to improve the patients’ social life after surgical resection of tumour. It has the following advantages over surgical management: It is less invasive, helps patients to avoid complications associated with surgery, less expensive and may provide better aesthetic result. In addition, it provides predictable and a reasonable level of functional restoration to the patients. 6,7

Maxillofacial prostheses can be classified into several categories: based on the location as intra oral and extra oral prostheses.8 The extra oral prostheses include nasal, ocular, ear and composite prostheses, while the intra oral can be sub classified into maxillary and mandibular prostheses.7 The maxillary prostheses include obturator for hard palate defects, speech bulb and palatal lift appliances for soft palate defects.6 The maxillary obturators can be classified based on the time of placement into surgical, interim/provisional and definitive obturator. The surgical obturator is fitted immediately after surgery while the provisional is usually fitted between 10 days to two weeks after surgery. The definitive obturator is usually fitted about six months post operatively. 9, 10 

Several studies11, 12 carried out in our country are limited to prosthetic rehabilitation of patients with palatal or maxillary defects. Furthermore, there are few and old clinical audits of patients managed with maxillofacial prostheses especially in the few centres where such facilities exist in Nigeria and it is imperative that such data are continuously updated for proper planning and review of our clinical protocol. Therefore, this study sought to review patients treated with maxillofacial prostheses at the Prosthetic clinic of the University College Hospital, Ibadan to assess their demographic characteristics, causes of defects, types of maxillofacial prostheses and the indications for the prostheses. The study also aimed to compare the results with the report obtained about a decade ago from a study 11 at the centre to see if there is any change in the maxillofacial prosthetic treatment provided.