Intraoperative fabrication of palatal prosthesis for maxillary resection.

BACKGROUND: Immediate placement of a palatal prosthesis has become the standard of care after maxillectomy or palatectomy, except when free-flap reconstruction is used. Palatal prostheses are usually fabricated preoperatively. Infrequently, the surgeon may face a situation where upper jaw resection has been performed and a prefabricated prosthesis is not available.

OBJECTIVE: To describe a method of rapid intraoperative fabrication of a palatal prosthesis, which allows immediate oral intake and excellent speech.

PROCEDURE: Two sheets of thermoplastic dressing (Aquaplast; WFR/Aquaplast Corporation, Wyckoff, NJ) were immersed in hot water. As they became soft and pliable, they were applied to the remaining hard palate and alveolar ridge. As the material cooled, it hardened, with its shape conforming to the remaining hard palate, alveolar ridge, and teeth. The rigid stent was then removed, trimmed, and fashioned to cover the palatal and maxillary defect. The stent was then wired to the remaining alveolar ridge and to the ipsilateral zygomatic buttress or lateral orbital rim. Removal of the stent was easily accomplished in an office setting.

PATIENTS: Twelve patients required partial upper jaw resection without available prefabricated prostheses. Of these, 3 patients underwent emergency surgery for mucormycosis and 2 for bleeding malignant tumors; 3 underwent bone resection more extensive than that anticipated preoperatively; and 4 did not have prefabricated prostheses for other reasons.

RESULTS: The thermoplastic prosthesis achieved its goals in all 12 patients. Eleven patients achieved oral food intake within 24 hours. One patient remained in a coma after extensive maxillary, orbital, and skull base resection for mucormycosis. The prosthesis was removed after 4 to 12 weeks and replaced with a permanent implant in 11 of the 12 patients.

CONCLUSIONS: This simple, quick, and inexpensive intraoperative fabrication of palatal prosthesis requires no special expertise and equipment. It allows immediate oral intake and excellent speech.