Department of Prosthodontics, Army Medical College, National University of Sciences & Technology (Nust) Islamabad
Received: 22 July, 2015; Accepted: 30 July, 2015; Published: 31 July, 2015
Dr. Bilal Ahmed, Associate Professor, Department of Prosthodontics, Army Medical College, Abid Majeed Road, Rawalpindi Cantt, Tel: +923216008263; E-mail:
Ahmed B (2015) Rehabilitation of Surgically Resected Soft Palate with Interim Velopharyngeal Obturator. Int J Oral Craniofac Sci 1(2): 031-033. DOI: 10.17352/2455-4634.000006
© 2015 Ahmed B. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Prosthodontic rehabilitation; Soft palate; Obturator
Rehabilitation of surgical resection defects is always a challenging clinical scenario. These defects pose a major physiological and psychological threat not only to the patients, but to the entire family. A multidisciplinary team approach, thorough investigation, long term follow up, proper counselling and sympathetic attitude may help to bring these suffering patients back to normal life stream. Recent advancements in Dental Materials, CAD CAM, Laser Technology and Ossseo integrated Implants have revolutionized the treatment outcomes. However in certain clinical case scenarios, conventional prosthodontic principles and routinely available materials are still the gold standards. This case report presents the prosthodontic rehabilitation of soft palate after surgical resection due to adenoid cystic cell carcinoma.
The morphology of jaws are made in such way that they aid in both function and aesthetics of a person. The main function of the soft palate is that it separates the nasal and oral part of pharynx that in turn aids in speech and swallowing. The velophayngeal (VP) valve consists of soft palate, lateral walls of pharynx and posterior walls of pharynx. During speech, the soft palate is raised that controls the airflow through the nose and mouth and lateral and posterior walls of pharynx constricts to produce speech . Variation in the contribution of each of these components produces several patterns of sphincteric closure or attempted closure of the VP portal that were described by Skolnick et al. . Adequate VP closure is required during swallowing and production of all consonants except for the nasal ones .
VP impairment can be due to inadequacy and insufficiency. VP inadequacy is caused by neuromuscular disorder of an anatomically intact VP sphincter .
VP insufficiency can be either congenital as in cleft palate cases, or acquired as in surgical removal of a part of palate due to palatal carcinoma resection  or due to some infections. Malignant tumors of the hard palate account for 1-5% of the tumors of the oral cavity. Adenoid cystic carcinoma being one of the malignant tumors of oral cavity is a salivary gland tumor which most commonly occurs in the minor salivary glands . It most commonly occurs in males than in females . Most of these tumors are diagnosed late and the final option left is aggressive surgical resection . This treatment accounts for velopharyngeal insufficiency resulting in nasal regurgitation of liquids, hyper nasal speech, nasal escape, disarticulations and impaired speech intelligibility. In addition normal mechanism of swallowing is also disturbed [6-8].
A soft palate or velopharyngeal obturator (speech and feeding aid device) replaces the missing part of muscles, fills the defects and either can be a metal framework or all plastic (acrylic) prosthesis . In each case the patient will require some functional adjustments to the prosthesis as this is an area that moves every time the patient speaks or swallows. Adjustment of these prostheses is a fine balance between swallowing and speaking. If the valve is closed too tightly then swallowing is very good but speaking will sound as if the patient has a cold or stuffy nose (hypo nasality). If the valve is left more open then speech will sound better but food/liquid leakage when swallowing may be increased. In addition, healing from surgery or radiation treatment will alter this area and require frequent adjustments until all healing is completed .
These obturators can have mobile distal extensions or bulbs with a flexibility to have synchronized movements during functional opening and closure of the adjacent soft tissues around a customized hinged joint. However, fixed or stable distal extensions with balanced functional adjustments are more recommended as these are less complicated, easily fabricated and adequately functional for successful outcomes. Caring for the prosthesis is relatively easy. Simply brushing the prosthesis or rinsing with soap and water when cleaning the teeth is adequate. Effervescent partial denture cleaning tablets can be used as well when the prosthesis is soaking while the patient is sleeping. These prostheses aid in improving a complex muscular valve dysfunction. With patience and time these prosthetic devices can be fine-tuned to be very functional and comfortable .
A 23 Year old female was referred from Department of Oral and Maxillofacial Surgery with a history of surgical resection of soft palate area three months earlier due to a sudden development of nodular mass which was later diagnosed to be Adenoid cystic cell carcinoma of soft palate. The patient was followed up for any recurrence or swelling and later sent for rehabilitation of the lost intra oral structures as her major complaint was difficulty in swallowing, nasal regurgitation of food and intelligible hyper nasal voice. Otherwise, she had no pain or swelling. On examination, patient was found to have a big defect in the soft palate area up to the nasal septum. There was no uvula present and no velopharyngeal closure was possible. The dental status was intact with no missing teeth (Figure 1).
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