Himanshi Aggarwal

Assessment of the quality of life in maxillectomy patients: A longitudinal study

PURPOSE To longitudinally assess the quality of life in maxillectomy patients rehabilitated with obturator prosthesis. MATERIALS AND METHODS Thirty-six subjects were enrolled in the span of 16 months, out of which six were dropouts. Subjects (age group 20-60 years) with maxillary defects, irrespective of the cause, planned for definite obturator prosthesis, were recruited. The Hindi version of European Organization for Research and Treatment of Cancer, Head and Neck version 1 of Quality of Life Questionnaire was used before surgical intervention and one month after definitive obturator. Questionnaire includes 35 questions related to the patients physical health, well being, psychological status, social relation and environmental conditions. The data were processed with statistical package for social science (SPSS). Probability level of P<.05 was considered statistically significant. RESULTS The quality of life after rehabilitation with obturator prosthesis was 81.48% (±13.64) on average. On item-level, maximum mean scores were obtained for items problem with teeth (1.87 ± 0.94), pain in mouth (1.80 ± 0.92), trouble in eating (1.70 ± 0.88), trouble in talking to other people (1.60 ± 1.22), problems in swallowing solid food (1.57 ± 1.22) and bothering appearance (1.53 ± 1.04); while minimum scores were obtained for the items coughing (1.17 ± 0.38), hoarseness of voice (1.17 ± 0.53), painful throat (1.13 ± 0.43), trouble in having social contacts with friends (1.10 ± 0.40) and trouble having physical contacts with family or friends (1.10 ± 0.31). CONCLUSION Obturator prosthesis is a highly positive and non-invasive approach to improve the quality of life of patients with maxillectomy defects.

A Multidisciplinary Approach for Management of Postenucleation Socket Syndrome with Dermis‐Fat Graft and Ocular Prosthesis: A Clinical Report

A contracted eye socket is a cosmetic blemish to the patient. It not only renders patients unable to wear an eye prosthesis, but also becomes a source of chronic discharge and irritation. Orbital implants allow for cosmesis and volume replacement of an enucleated or eviscerated eye. Alloplastic orbital implants are associated with potential complications, including exposure and extrusion. A dermis-fat graft offers the advantages of relative availability and an autologous nature. This article reports on a patient suffering from severe postenucleation socket syndrome after enucleation of the bulbus with postoperative irradiation of the orbit due to retinoblastoma and its subsequent management by a dermal-fat graft and ocular prosthesis. The purpose of this article is to emphasize the usefulness of dermal-fat grafting as a safe and stable orbital volume replacement following enucleation.A contracted eye socket is a cosmetic blemish to the patient. It not only renders patients unable to wear an eye prosthesis, but also becomes a source of chronic discharge and irritation. Orbital implants allow for cosmesis and volume replacement of an enucleated or eviscerated eye. Alloplastic orbital implants are associated with potential complications, including exposure and extrusion. A dermis-fat graft offers the advantages of relative availability and an autologous nature. This article reports on a patient suffering from severe postenucleation socket syndrome after enucleation of the bulbus with postoperative irradiation of the orbit due to retinoblastoma and its subsequent management by a dermal-fat graft and ocular prosthesis. The purpose of this article is to emphasize the usefulness of dermal-fat grafting as a safe and stable orbital volume replacement following enucleation.

Prosthetic Rehabilitation Following Socket Reconstruction with Blair‐Brown Graft and Conformer Therapy for Management of Severe Post‐Enucleation Socket Syndrome – A Clinical Report

One of the most common tumors of the eye diagnosed in childhood is retinoblastoma, which mandates enucleation with adjunctive chemotherapy and radiotherapy to save the patients life. The most common late enucleation complication is post-enucleation socket syndrome (PESS), which poses a management dilemma for the prosthodontist and surgeon, along with being a major esthetic concern for the patient. The reconstruction of such sockets is complex. The purpose of this clinical report is to describe the rehabilitation of such a pediatric patient with severe PESS. The patient was successfully rehabilitated by presurgical conformer therapy, socket reconstruction surgery with non-meshed intermediate split thickness skin graft (STSG)/Blair-Brown graft, and postsurgical conformer stent. This was followed by fabrication of a custom ocular prosthesis, to achieve favorable functional, physical, and psychological effects.

Lost salt technique for severely resorbed alveolar ridges: An innovative approach

The success of a complete denture relies on the principles of retention, stability and support. The prosthodontist skill lies in applying these principles efficiently in critical situations. Severely resorbed maxillary edentulous ridges that are narrow and constricted with increased inter ridge space provide decreased support, retention and stability. The consequent weight of the processed denture only compromises them further. This article describes a case report of an edentulous patient with resorbed ridges where a simplified technique of fabricating a hollow maxillary complete denture using lost salt technique was used for preservation of denture bearing areas. The hollowing of the denture reduces the weight of the denture, thereby enhancing stability and retention, reducing the further resorption of the jaws.

Three-dimensional Quantitative Analysis of the Bone Density of Mandibular Condyle in Dentulous and Edentulous Jaws: An In Vivo Study

Studies have reported that masticatory function and occlusal force are low in edentulous patients, which brings about a change in the density, thickness, and alignment of bony trabeculae. However, studies that have quantitatively measured the differential cortical and medullary bone densities of the mandibular condyle in vivo remain rare. This study determined and compared the cortical and medullary bone density of the mandibular condyle in dentulous and edentulous jaws, using multidetector computed tomography (CT). Forty mandibular condyles with no clinical signs of temporomandibular disorders were investigated in 2 groups with 10 subjects (aged 50-80 yr) in each group (group I: dentulous subjects with maintained occlusion; group II: completely edentulous patients) with multidetector CT. The density of condylar cortical and medullary bone was determined by using bone density analysis algorithms available within the proprietary software. Data were analyzed statistically with the 1-way analysis of variance test (p<0.05). The mean cortical bone density of the right and left condyles of group I was 686.11±102.78 Hounsfield unit (HU) and 775.91±89.62 HU, respectively and that of group II was 531.33±289.73 HU and 648.53±294.39 HU, respectively. The mean medullary bone density of the right and left condyles was maximum in group I subjects (429.69±102.62 HU and 486.62±108.60 HU, respectively) than in group II subjects (214.89±104.37 HU and 205.36±90.91 HU, respectively) with a statistically significant decrease in the mean scores (p<0.001). Within the limitations of this study, it can be concluded that the cortical and medullary densities of the mandibular condyle are more in dentulous than the edentulous jaws.

A Simplified Method to Fabricate a Pneumatic Ocular Prosthesis for Large Ocular Defects.

When an enucleation or exenteration procedure removes the entire orbital contents but not the eyelids, an abnormally large orbital socket is created that would require an equally sized volume enhancing, flush fitting ocular prosthesis. The solid acrylic prosthesis would rest on or in the lower fornix and owing to its weight, causes distortion of the lower eyelid and/or asymmetrical alignment of the entire palpebral fissure. The aim of this article was to describe a method of fabricating a pneumatic light weight custom ocular prosthesis using lost wax technique to overcome the deteriorating effects of conventional solid ocular prosthesis.

Prosthetic guidelines for ocular rehabilitation in patients with phthisis bulbi: A treatment-based classification system

Prosthetic rehabilitation of phthisis bulbi defects is the only treatment option for cosmetic rehabilitation of patients with such defects. Currently, there is no treatment-based classification for prosthetic rehabilitation of patients with phthisis bulbi. Phthisical ocular defects and/or prosthetic rehabilitation were evaluated in an attempt to establish prosthetic guidelines that could be organized into a classification system. Fifty patients who received rehabilitation for phthisis bulbi were reviewed. Phthisis bulbi defects were divided into 4 classes. All the patients had rehabilitation, depending upon the class to which they were assigned. The aim of this treatment-oriented classification system was to organize and define the complex nature of the restorative decision-making process for patients with phthisis bulbi.

Surgical reconstruction or prosthetic rehabilitation following orbital exenteration: The clinician's dilemma

Sir, I commend the authors of the article entitled “Total upper and lower eyelid reconstruction using deltopectoral flap,”[1] for their courageous attempt of utilizing deltopectoral flap for eyelid reconstruction following orbital exenteration. The aesthetic outcome achieved in this case by painstaking reconstructive surgery is fairly good. However, being a prosthodontist, actively involved in the prosthetic rehabilitation of patients with ocular and orbital defects, I would like to discuss another treatment modality that is prosthetic rehabilitation.

Oral appliances: A successful treatment modality for obstructive sleep apnea category

Sir, I have read two articles published in your esteemed journal (obstructive sleep apnea [OSA] and metabolic disorders. 2006;8:51‐52 and OSA: Diagnosis and Treatment in an Endocrine Clinic. 2006;8:53‐55) with great interest. Both of them are very informative and provide immense knowledge about OSA. It is very true that OSA has implications beyond disturbed sleep and yet this disorder remains undiagnosed in a substantial portion of the population especially in developing countries like India. Sir, I would like to bring to your kind notice that although continuous positive airway pressure (CPAP) remains to the gold standard treatment modality for OSA, oral appliances are now gaining popularity.

A palliative approach for rehabilitation of a pediatric patient with retinoblastoma

Retinoblastoma is a highly malignant neoplasm. Most of the cases are usually far advanced at the time of detection, requiring enucleation to salvage the childs life. However, the cosmetic rehabilitation of these patients should always be an integral part of their treatment, which helps in their re-integration in the society. This paper presents a case of 5-year-old patient who had undergone enucleation of her left eye due to retinoblastoma. A multidisciplinary approach, including ophthalmologist, psychotherapist, and a prosthodontist, was adopted to meet her physical, psychological, functional, emotional, social, and cosmetic demands. The patient was rehabilitated cosmetically with precisely fabricated ocular prosthesis. An ocular prosthesis is a highly positive and non-invasive approach to improve the cosmetic appearance and psychological well-being of patient.