John F. Wolfaardt

Functional Outcomes After Primary Oropharyngeal Cancer Resection and Reconstruction With the Radial Forearm Free Flap

Objective To report prospectively collected aeromechanical, acoustical, and perceptual speech outcomes, as well as preliminary swallowing data, in patients having reconstruction with radial forearm free flaps after primary resection for oropharyngeal cancer.

Maxillary obturators: the relationship between patient satisfaction and speech outcome.

Patient satisfaction with a maxillary obturator has been studied in relation to extent of surgical defect, sociodemographic characteristics, scores on mental health inventories, and psychosocial adjustment to illness scales. However, review of the literature reveals limited study of the relationship between patient satisfaction with an obturator and clinical speech outcome measures. The purpose of this study is to relate patient satisfaction scores obtained by questionnaire with those obtained by means of clinical speech measurements.

Effects of disinfecting irreversible hydrocolloid impressions on the resultant gypsum casts. Part II : Dimensional changes

This study evaluated the effect of disinfection time (10, 30 and 60 minutes) on the dimensional changes of stone casts poured against an irreversible hydrocolloid impression material (Jeltrate). Impressions were made of a stainless steel analog of a maxillary arch. The impressions were sprayed with bleach, iodophor, phenol, and water and were stored for designated times before poured in a type IV stone (Vel-mix). The arch width, length, and depth of the vault of the resultant casts were measured by use of a contact measuring device (MicroVal) capable of measuring to 0.0001 mm. Data were analyzed with two-way analysis of variance at the 95% confidence level. Results indicated that disinfection treatment of alginate impressions with surface disinfectants did not cause significant dimensional changes in the resultant stone casts from statistical and clinical points of view.

Swallowing function in patients with base of tongue cancers treated with primary surgery and reconstructed with a modified radial forearm free flap.

OBJECTIVE To report swallowing outcomes and biomechanical properties of the base of the tongue (BOT) and the posterior pharyngeal wall (PPW) in patients who undergo surgical reconstruction with the beavertail modification of radial forearm free flap after primary resection of BOT cancer. DESIGN Prospective cohort study with a 1-year minimum follow-up performed between October 1, 2001, and August 31, 2005. SETTING Tertiary care facility. PATIENTS Patients diagnosed as having primary carcinoma of the BOT were treated with primary surgical resection and reconstruction followed by radiotherapy. Inclusion criteria were collection of videofluoroscopic swallowing study (VFSS) data before and 1 year after surgery. Forty-one patients were treated during a 5-year period, and 20 were included in the final analysis. INTERVENTIONS Reconstruction of BOT defects with the beavertail modification of radial forearm free flap followed by postoperative radiation. MAIN OUTCOME MEASURES Aspiration score, pharyngeal residue score, and biomechanical analysis of BOT and PPW mobility were performed using images from VFSSs. Both the BOT and PPW positions were measured from 2 static bony landmarks. RESULTS Of the 20 patients in the final analysis, 19 (95%) were able to swallow safely at 1 year. Mobility of the BOT after surgery was reduced in all postoperative VFSS data. Anteroposterior dimension or bulk of the BOT was preserved. No significant difference was found in PPW mobility. CONCLUSIONS The beavertail modification of the radial forearm free flap is a good reconstructive option after BOT cancer extirpation. The procedure preserves the bulk of the BOT after cancer treatment and maintains adequate BOT-PPW apposition. This allows structures such as the pharyngeal, oral, and suprahyoid musculature to contract and generate the necessary force to propel the food bolus through the oropharynx, resulting in a safe swallow.

Effects of disinfecting irreversible hydrocolloid impressions on the resultant gypsum casts. Part I : Surface quality

This study evaluated the effects of disinfection time (10, 30, and 60 minutes) on the surface quality of stone casts poured against an alginate impression material (Jeltrate). Five antimicrobial agents were tested: Sporicidin spray, sodium hypochlorite, and iodophor for spray; and Sporicidin cold sterilization solution and Cidexplus glutaraldehyde solution for immersion. Impressions, flushed with water and stored for 0, 10, 30, and 60 minutes before pouring, served as untreated controls. On completion of the disinfection treatments, the impressions were rinsed and poured in Velmix stone. The effects on cast surface were evaluated under a stereomicroscope by three experienced raters. A 1-to-4 scoring system was developed to rate the surface quality in terms of smoothness and detail reproduction. Both immersion disinfectants proved to be unacceptable for treating alginate impressions. The mean scores of other disinfectant-time combinations were compared with the use of the Tukey-Kramer method with a 95% confidence interval. The results indicated that treatment time had statistically significant effects on the quality of cast surface in Sporicidin spray, sodium hypochlorite, and untreated control groups but not in the iodophor spray group.

An appliance based approach to the management of palatopharyngeal incompetency: A clinical pilot project

The palatal lift appliance has been described in the dental literature for more than 30 years, yet its efficacy remains controversial in the management of palatopharyngeal incompetency during speech. A pilot project was undertaken to develop a clinical research protocol. In the pilot project, 32 patients had palatopharyngeal incompetency managed with a palatal lift appliance. The results of the treatment were that 21 of the 32 patients experienced reduction programs but, of these, seven still required surgery. Before firm conclusions on the use of the palatal lift appliance can be made, objective, measurable assessment of speech through well-designed clinical protocols is required.

A comparison of various removable partial denture clasp materials and fabrication procedure for placing clasps on canine and premolar teeth

There is no established protocol for selection among the different retentive material-attachment combinations for clasps other than tradition or laboratory preference. Various wrought-wire, cast-metal, and thermoplastic materials were subjected to several fabrication procedures and tested in a custom-designed force displacement apparatus. The wrought wires included ADA Spec. No. 7 type I and type II alloys and other precious and nonprecious alloys. A graphic means was devised to allow the rational selection of wrought-wire clasp-arm combinations for placing clasps on canine and premolar teeth. Guidelines for using straight wire data for curved wire applications are indicated.

Social perception of speech in individuals with oropharyngeal reconstruction.

Abstract Oral cancer affects approximately 5% of the Canadian population every year. One option for treatment of oropharyngeal cancer includes resection of the diseased tissue with primary reconstruction of the defect using a microvascular free flap, followed by post-operative adjuvant radiation therapy. The aim of reconstructive surgery is to maintain functional speech and swallowing. While the literature provides support for the maintenance of speech intelligibility following reconstructive procedures, certain aspects of resonance may be altered when the palatal structures are involved. Little is known about the effect of such alterations on the perception of speakers who have been treated with microvascular free flap reconstruction. Social perception is a process in which we infer attributes of others, with the speech signal playing an integral part in attribution. The purpose of this study was to explore the social perceptions formed about speakers both before and after surgery for oropharyngeal cancer. The results of this study revealed that positive perceptions of speakers significantly diminished as a result of surgery and negative perceptions increased. Certain variables, such as degree of resection of the soft palate and base of tongue, and sex of the speaker, had influence on the results. This research suggests that intelligibility measurements of speech, although useful, do not provide a complete indication of the social impact of reconstructive surgery on patients with oropharyngeal resections.

Craniofacial osseointegration: Technique for bar and acrylic resin substructure construction for auricular prostheses

Retention of auricular prostheses with adhesives is frequently problematic. Craniofacial osseointegrated implants have become an accepted biotechnique used in auricular reconstruction. This article describes a procedure for bar and acrylic resin substructure construction that allows for the incorporation of desired features. The most common means of retaining auricular prostheses is with bar and clip systems. For auricular prostheses, two implants are placed with the bar designed to minimize torquing on the implants and to facilitate hygiene. Additionally, the bar should not have to be removed from the patient when new prostheses are to be constructed. The procedure provides for a more biomechanically effective bar construction and efficient means of constructing replicate acrylic resin substructures.

An impression and cast construction technique for implant-retained auricular prostheses

Implant-retained auricular prostheses present a challenge with regard to the esthetic placement of the margins of the prosthesis. A technique for the impression and master cast fabrication to produce an implant-retained auricular prosthesis is described. This technique allows control of the esthetic margin, fabrication of a durable master cast with planned blockout, and inclusion of a replica of the retentive bar, which allows processing duplicate prostheses without returning the retentive bar to the mold.