Initiation of prosthetic service and complex rehabilitation for patients after extensive operations for head and neck tumors, congenital disease and traumatic injuries, maxillofacial prosthetics in pmsi oncologic hospital, Chisinau

Proiectul reprezintă prima etapă de creare a unui centru pentru protezele maxilo-faciale în Republica Moldova. Proiectul de asemenea va asigura integrarea Institutului Oncologic în programele internaţionale pentru protezele maxilo-faciale

The Reproducibility and Applicability of an EFD(®) Dispenser in the Prosthetic Technology of Maxillofacial Prostheses

A reproducible method of dosing pigments can be beneficial and more efficient in the current colour matching procedure in maxillofacial prosthetics. In this study the reproducibility and applicability for pigment dosing of a commercial available EFD(®) dispenser were tested. The reproducibility of a Performus™ II type EFD(®) dispenser was tested by repeating dosing experiments with a set of eight syringes filled with pigment pastes (Factor 2; Flagstaff, USA). To evaluate conventional colour matching, four conventionally colour matched samples were polymerized and compared to the original ones. To investigate the reproducibility of the dispenser in practice, a fifth recipe was dispensed 10 times and colour differences were evaluated visually and as well calculated from measurements with a colour and translucency meter (CTM, PBSensortechnology bv). All dispensed amounts of pigment pastes showed a coefficient of variation in weight of less than 10 %. Evaluating the reproductions of four skin batches compared to the original batches, a ∆E2000 colour difference of 3–7 was measured. Evaluating ten reproductions of one skin coloured batch made with the dispenser, color difference ∆E2000 values compared to the average L*a*b* values, were less than 2 and no visual colour differences could be estimated. Conform these results, low colour differences could be measured with the CTM, indicating no visually observable consequences. Despite the estimated coefficient of variation, the reproducibility of the EFD(®) dispenser in terms of colour difference ∆E2000 of successive dispensing is applicable for colour reproduction in facial prosthetics. Segregation of the current color pastes in due time needs to be taken into consideration

Paradigm shift in head and neck oncology patient management

Objective  This article describes a paradigm shift in what is considered to be good care for patients living with and after (head and neck) cancer. HNO patients often experience severe and difficult physical and psychosocial problems due to the nature and location of the disease. Many disciplines are involved in their treatment, so their voice is only one amongst many others in the decision making process. For this patient group it seems complicated to put the concept of Shared Decision Making into practice. As a step in this direction, patient reported outcomes which ask patients to select the disconcerting issues and symptoms can be used as a basis for referral, supportive care and treatment decision making. We need to provide more tailored and personalized information that is specific to individual circumstances, preferences and concerns and focuses more on the impact of treatment and access to help and support. Follow up of these patients should be concentrated on both medical and emotional aspects.  Practice implications  A shift in the way caregivers provide their information contributes to a more profound involvement of patients in treatment decisions.Output Type: Lette

Prosthodontic rehabilitation of head and neck cancer patients-Challenges and new developments

Head and neck cancer treatment can severely alter oral function and aesthetics, and reduce quality of life. The role of maxillofacial prosthodontists in multidisciplinary treatment of head and neck cancer patients is essential when it comes to oral rehabilitation and its planning. This role should preferably start on the day of first intake. Maxillofacial prosthodontists should be involved in the care pathway to shape and outline the prosthetic and dental rehabilitation in line with the reconstructive surgical options. With the progress of three-dimensional technology, the pretreatment insight in overall prognosis and possibilities of surgical and/or prosthetic rehabilitation has tremendously increased. This increased insight has helped to improve quality of cancer care. This expert review addresses the involvement of maxillofacial prosthodontists in treatment planning, highlighting prosthodontic rehabilitation of head and neck cancer patients from start to finish

The use of stretching devices for treatment of trismus in head and neck cancer patients:a randomized controlled trial

PURPOSE: To compare the effects of two stretching devices, the TheraBite® Jaw Motion Rehabilitation System™ and the Dynasplint Trismus System®, on maximal mouth opening in head and neck cancer patients. METHODS: Patients were randomly assigned to one of two exercise groups: the TheraBite® Jaw Motion Rehabilitation System™ group or the Dynasplint Trismus System® group. Patients performed stretching exercises for 3 months. During the three study visits, maximal mouth opening was measured and the patients completed questionnaires on mandibular function and quality of life. RESULTS: In our study population (n = 27), five patients did not start the exercise protocol, eight patients discontinued exercises, and two patients were lost to follow-up. No significant differences regarding the change in mouth opening between the two devices were found. Patients had an increase in MMO of 3.0 mm (IQR - 2.0; 4.0) using the TheraBite® Jaw Motion Rehabilitation System™ and 1.5 mm (IQR 1.0; 3.0) using the Dynasplint Trismus System®. Exercising with either stretching device was challenging for the patients due to the intensive exercise protocol, pain during the exercises, fitting problems with the stretching device, and overall deterioration of their medical condition. CONCLUSIONS: The effects of the two stretching devices did not differ significantly in our study population. The factors described, influencing the progression of stretching exercises, need to be taken into account when prescribing a similar stretching regimen for trismus in head and neck cancer patients. TRIAL REGISTRATION: NTR - Dutch Trial Register number: 5589

The initiation of an outreach Service for Oromaxillofacial Prosthetics in PMSI Institute of Oncology.

The scope of the project was starting a new Service of Oromaxillofacial Prosthetics for care in the PMSI Institute of Oncology. A health care team for rehabilitation and reconstruction of Head and Neck cancer consists of specialists cooperating in a team. The success of the project was stated at the beginning by the following metrics and resulted in two years time into a prosthetic team which is formed by qualifi ed professionals. The medical and dental professionals of the PMSI Institute of Oncology have performed, in a short period of time, a magnifi cent task to understand and learn the modern multidisciplinary treatment concept for rehabilitation and the need of care for patients with mutilated faces. Continuous improvement of cure and care is one of the following tasks to help these patients in an effi cient way

Maxillofacial prosthodontics practice profile:A survey of non-United States prosthodontists

Abstract Background This study surveyed non-United States maxillofacial prosthodontists (MFP) to determine their practice profile and rationale for pursuing an MFP career. Methods Email addresses for the MFP were obtained from the International Society for Maxillofacial Rehabilitation, American Academy of Maxillofacial Prosthetics, and International Academy for Oral Facial Rehabilitation. Emails with a link to the electronic survey program were sent to each participant. Chi-square and Mann–Whitney-U tests were used to investigate the influence of formal MFP training on professional activities and type of treatments provided. Results One hundred twelve respondents (response rate 39%) from 33 nationalities returned the survey. The top three reasons for pursuing an MFP career were personal satisfaction, prosthodontics residency exposure, and mentorship. The predominant employment setting was affiliation with a university (77%). There were significant differences between respondents with and without formal MFP training regarding provision of surgical treatments (P = 0.021) and dental oncology (P = 0.017). Most treatments were done together with otolaryngology, oral surgery (68%) and head and neck surgery (61%). Practitioners not affiliated with a university spent significantly more time in clinical practice (P = 0.002), whereas respondents affiliated with universities spent significantly more time in teaching/training (P = 0.008) and funded research (P = 0.015). Conclusions Personal satisfaction is the most important factor in a decision to choose an MFP career. Most of the MFPs work at a university and within a multidisciplinary setting. There were differences regarding type of treatments provided by respondents with and without formal MFP training

Dynasplint Trismus System exercises for trismus secondary to head and neck cancer:a prospective explorative study

The Dynasplint Trismus System (DTS) can be used to treat trismus secondary to head and neck cancer. We conducted a prospective study with the following aims: (1) to determine the effects of DTS exercises on changes in mouth opening, pain, mandibular function, quality of life (QoL), and symptomatology and (2) to analyze the patients' perception on DTS exercises, including user satisfaction, experiences, comfort, and compliance. The patients were instructed to exercise with the DTS for at least 16 weeks. Changes in mouth opening, pain, mandibular function, QoL, and symptomatology were evaluated, as well as the patients' perception of DTS exercises. Eighteen consecutive patients were included. Baseline mouth opening was 22.6 mm (sd 7.6). After the patients completed the DTS exercise program, mouth opening increased (7.1 mm, sd 4.7) and perceived difficulty of opening the mouth improved significantly (p <0.05). No significant effects were found in mandibular function, QoL, and overall symptomatology. The patients' perception was diverse. They reported effectiveness and positive feelings of the results and would recommend DTS exercises to other patients. About half of them thought DTS exercises were burdensome. Mouth opening increased significantly after the DTS exercise program, relative to baseline. About one third of the gained increase was lost in the follow-up period. In general, the patients were satisfied about the effects and the DTS exercise program

Three-Dimensional Guided Zygomatic Implant Placement after Maxillectomy

Zygomatic implants are used in patients with maxillary defects to improve the retention and stability of obturator prostheses, thereby securing good oral function. Prosthetic-driven placement of zygomatic implants is even difficult for experienced surgeons, and with a free-hand approach, deviation from the preplanned implant positions is inevitable, thereby impeding immediate implant-retained obturation. A novel, digitalized workflow of surgical planning was used in 10 patients. Maxillectomy was performed with 3D-printed cutting, and drill guides were used for subsequent placement of zygomatic implants with immediate placement of implant-retained obturator prosthesis. The outcome parameters were the accuracy of implant positioning and the prosthetic fit of the obturator prosthesis in this one-stage procedure. Zygomatic implants (n = 28) were placed with good accuracy (mean deviation 1.73 ± 0.57 mm and 2.97 ± 1.38° 3D angle deviation), and in all cases, the obturator prosthesis fitted as pre-operatively planned. The 3D accuracy of the abutment positions was 1.58 ± 1.66 mm. The accuracy of the abutment position in the occlusal plane was 2.21 ± 1.33 mm, with a height accuracy of 1.32 ± 1.57 mm. This feasibility study shows that the application of these novel designed 3D-printed surgical guides results in predictable zygomatic implant placement and provides the possibility of immediate prosthetic rehabilitation in head and neck oncology patients after maxillectomy