RU2567366C1 - Method for sealing between oral and nasal cavities using prosthesis obturator - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: teeth, dental arches and upper jaw defect are imprinted. Working models are made. A prosthesis obturator is made. A sloppy adhesive composition is applied on the final prosthesis obturator and along the perimeter of the upper jaw defect; the composition is re-filled domiciliary as the speech quality decreases.

EFFECT: method enables repairing postoperative speech as much as possible at the stage of patient's orthopaedic rehabilitation.

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Description

The invention relates to medicine, in particular to orthopedic dentistry, and is intended for the rehabilitation of patients with acquired defects of the upper jaw of various etiologies by eliminating a speech defect and can be used to modify an existing obturator prosthesis.

Known maxillary prosthesis-obturator, which is made integrally of structural material and has a basis with artificial teeth (RF patent No. 2489113 from 06.16.2011). The lower border of the obturator is tightly adjacent to the mucous membrane of the anastomosis of the surgical field. The upper border of the obturator is oval and has a different thickness and length, programmed depending on the elasticity of the mucous membrane of the oral cavity, the “fibrous ring” of the anastomosis, achieved by thinning or thickening the edges of the obturator, makes up for undercuts in the nasal cavity and / or maxillary sinus, formed by a postoperative defect . This, according to the authors, leads to a tight fit and fixation of the prosthesis, which leads to the restoration of the phonetics of patients. The design defects of this prosthesis can be considered the presence of an obturator that penetrates the nasal cavity or maxillary sinuses, obstructing the movement of air in the nasal cavity, as well as the absence of the outer wall of the prosthesis, which acts as a support for the soft tissues of the prosthetic bed. In addition, the obturator design is voluminous and heavy. All this prevents an adequate separation of the air flow during speech and leads to the emergence of nasal.

Known denture denture obturator, consisting of a metal base, a system of supporting-retaining clasps and a supporting perforated plate with a monolithic hollow obturator made of rigid plastic located on it (RF patent No. 2480180 from 12/13/2011). Such a design allows you to restore phonetics due to the hollow bowl-shaped form of the obturator, which compensates for the resonator properties of the accessory cavities of the nose and does not impede the passage of air flow. The disadvantages of this design of the prosthesis include the lack of a tight fit of the solid base of the prosthesis to the compliant mucous membrane due to the mismatch of the density of the contacting surfaces, as well as its invasiveness, since rigid elements of the obturator injure soft tissues in the retention zones; Also, this prosthesis does not create a sufficiently complete tightness between the oral cavity and the nasal cavity.

Known jaw prosthesis-obturator, consisting of a rigid polyurethane base, a system of support-holding clasps and a hollow bowl-shaped obturator (RF patent No. 2477103 from 12/13/2011). The disadvantages of this design of the prosthesis include the lack of a tight fit of the solid base of the prosthesis to the compliant mucous membrane due to the mismatch of the density of the contacting surfaces, which does not ensure a tight separation of the oral cavity from the nasal cavity.

Known forming a denture denture obturator made by casting from polyurethane (RF patent No. 2426517 from 04.12.2009). Moreover, the basis of the prosthesis is made of hard polyurethane, and the obturator is made of soft. The restoration of the patient’s phonetics and intelligible speech is ensured by the high congruence of the prosthesis base and prosthetic bed. The disadvantages of this prosthesis can be considered the volume and severity of the structure, which leads to the appearance of the space between the prosthesis and the prosthetic bed during its operation. This, in turn, does not prevent the leakage of an air stream from the oral cavity into the nasal cavity, which leads to the appearance of nasal and illegible speech.

Known denture denture obturator made by casting from polyurethane (RF patent No. 2452431 from 11/18/2010). The base and hollow obturator are made of hard polyurethane, the outer layer of the latter is covered with a layer of soft polyurethane. The restoration of the patient’s phonetics and intelligible speech is ensured by the high congruence of the prosthesis base and prosthetic bed. The disadvantages of the design of this prosthesis include the presence of a rigid base, which, despite the high congruence, does not create adequate tightness between the oral cavity and the nasal cavity due to compliance of the mucous membrane of the prosthetic bed and the scar ring of the defect. In addition, there is no tight-fitting soft tissue along the lateral border of the defect due to the absence of the highest lateral wall of the prosthesis. The presence of an obturator in the nasal cavity or paranasal sinuses leads to obstructed passage of air through the nose. All this leads to nasal and illegibility of speech.

Known denture prosthetic obturator made of polyurethane with intramucosal implants (RF patent No. 2454200 from 02.25.2011). At the base of the prosthesis adjacent to the hard palate, in the area of the unresected jaw, there are two intra-mucous polyurethane implants made with a hemispherical head on the neck. The restoration of the patient’s phonetics and intelligible speech is ensured by the high congruence of the prosthesis base and prosthetic bed. The disadvantage of this prosthesis can be considered the presence of an obturator, which prevents the movement of air in the paranasal sinuses, as well as its invasiveness, since hard elements of the base injure soft tissues in the retention zones; this prosthesis does not create a sufficiently complete tightness between the oral cavity and the nasal cavity.

A known method of dentofacial prosthetics (RF patent No. 2452430 from 02.25.2011) by casting, in which the prosthesis is made of polyurethane, which has a high congruence of the base and prosthetic bed. In addition, fixation based on the implant is used to securely fix the denture. All this leads to the restoration of the phonetics of the patient. This method is selected for the prototype.

The disadvantages of this method include the lack of hermetic separation of the oral cavity from the nasal cavity, because during speech formation, a periodic increase in pressure in the oral cavity occurs, which leads to air leakage into the nasal cavity from the oral cavity, despite the absence of leakage during calm breathing.

The objective of the invention is to restore the speech of patients with acquired defects of the upper jaw.

The technical result is to ensure complete tightness between the oral cavity and the nasal cavity, which makes it possible to restore speech in the postoperative period at the stage of orthopedic rehabilitation of the patient.

This is achieved due to the fact that a fluid adhesive composition is applied to the final prosthetic obturator around the defect perimeter, regularly replenishing its layer at home when performing hygiene procedures.

For adequate speech in the oral cavity is constantly changing air pressure. As a result of the complex process of articulation, one or another sound is obtained at the exit from the mouth. Some sounds are associated with increased pressure in the oral cavity, which leads to the flow of part of the air flow from the oral cavity into the nose through an leaky prosthesis. Appears open nasal. Leakage occurs, as a rule, at the border of the prosthesis and the mucous membrane of the prosthetic bed, because often the boundary of the defect is the movable mucosa, which, when breathing, adheres tightly to the prosthesis, forming a kind of valve, however, when the air pressure in the oral cavity increases, this valve opens, and applying a fluid adhesive composition in the form of a cream on the prosthesis around the defect ensures complete tightness between the cavity mouth and nasal cavity. A study of the speech of 20 patients was conducted, along with subjective research methods (questionnaires and tables of nasal and speech intelligibility), objective research methods (spectral and amplitude analysis) were used. The study of speech was carried out in the preoperative period and at the stage of manufacturing the final prosthetic obturator. The data of spectral and amplitude analyzes in the preoperative period were similar to those at the stage of the final prosthetic obturator, on which the cream was applied. The speech became intelligible and legible, with minimal signs of nasal. While the data of spectral and amplitude analyzes in the preoperative period differed from those at the stage of the final prosthetic obturator without cream. Sound markers of violation of the tightness of the oral cavity are explosive ([b]; [p] and others), since their formation is accompanied by a short-term blockage of the air flow to create a slight increase in air pressure in the oral cavity and subsequent sharp opening of the lips. In the absence of tightness of the oral cavity, an increase in pressure is difficult.

The method is as follows.

At the stage of the final prosthetic obturator, an impression is taken from the prosthetic bed of a patient having an acquired upper jaw defect, after which working models are cast on which the final prosthesis is made. The resulting prosthetic obturator is fitted and fixed to the patient. After that, a fluid adhesive composition in the form of a cream (for example, “Korega”) is applied along the perimeter of the defect, while its layer is replenished already at home as the phonetics worsen.

The proposed method almost completely restores the patient’s speech while preserving all the pronunciation features inherent in this person in the preoperative period. In addition, the application of a fluid adhesive composition in the form of a cream can be carried out on any design of the prosthetic obturator.

Clinical example

Orthopedic rehabilitation of patient R. with an acquired maxillary defect after maxillectomy on the left due to neoplasm of the maxillary sinus on the left was performed. In the postoperative period, the patient’s speech was illegible and was a set of hardly distinguishable sounds. At the first stage, the patient intraoperatively recorded a post-resection plate made in the preoperative period. The second stage was the manufacture of the forming prosthesis. It was made in the 4th week after surgery. The last step was the manufacture of the final prosthetic obturator. The manufactured prosthetic obturator significantly improved the patient's phonetics, however, some sounds were still difficult to distinguish. A fluid adhesive composition — Korega cream — was applied to the prosthesis-obturator along the defect perimeter, and the existing speech disorders were practically eliminated.

Claims (1)

A method of providing a complete tightness between an oral cavity and a nasal cavity by an obturator prosthesis, which consists in obtaining impressions of teeth, dentitions and a defect of the upper jaw, manufacturing a working model and a final prosthetic obturator, characterized in that the final prosthetic obturator and the perimeter of the upper defect the jaws apply a fluid adhesive composition, replenishing its layer as the quality of speech decreases at home.