A Primer on Maxillary Defects

Dr. John O’Keefe spoke with Dr. Angela Wong and Dr. Ruth Aponte Wesson, maxillofacial prosthodontists, about maxillary defects.

• Dr. Angela Wong, DMD, MS, FRCD(C) is a Maxillofacial Prosthodontist currently in private practice in Calgary, Alberta.
• Dr. Ruth Aponte Wesson, DDS, MS, FACP is a Maxillofacial Prosthodontist and Associate Professor at the University of Texas MD Anderson Cancer Center.

Highlights

Etiology

Maxillary defects can present at birth as with cleft lip and palate or they can be acquired during life. Most acquired maxillary defects are caused by cancer, other causes include infection, trauma or other diseases.

Oral cancer makes up about 3% of all cancers worldwide and has the lowest relative survival rates compared to other cancers. Early detection leads to better outcomes. Oral cancer screening is an important part of examinations in the general dental office.

Maxillary Defects

A maxillectomy is the removal of all or part of the maxilla. This surgical procedure creates an opening between the oral and nasal cavities. The goals of treatment are to close the defect and separate the oral and nasal cavities to restore speech, swallowing, mastication and aesthetics. The defect can be closed with a removable obturator prosthesis or with surgical reconstruction.

Prosthetic vs. Surgical Restoration of Maxillary Defects

Advantages of obturator prostheses include immediate restoration, the ability to remove the prosthesis to screen for disease recurrence, less surgery and lower overall treatment cost. However, it can be difficult for the patient to clean the defect and retention of the prosthesis can be problematic in certain cases. Additionally, there may be a psychological burden associated with having an open defect.

Surgical closure of the defect can make patients less self-conscious and allow for better speech and swallowing. Use of osteocutaneous free flaps allow for implant placement and provision of fixed prostheses. However, treatment time is prolonged with multiple surgical interventions. Closure may also prohibit detection of disease recurrence.

The decision to treat in one way or another requires a team approach taking into account the etiology of the lesion, size and type of defect, the need for radiation therapy and patient preference. The treatment team is multidisciplinary and is ideally comprised of maxillofacial prosthodontists, head and neck surgeons, radiation oncologists, medical oncologists and speech pathologists.

Post-treatment

After treatment, patients are encouraged to return to their general dentist for regular examinations, cleanings and routine dental treatment. However, before considering any surgical procedures or orthodontics, one should consult with the patient’s oncologist regarding previous radiation, bisphosphonate or other targeted therapy treatment. Prostheses may require revisions or remakes as tissues change and mature over time.