Robert Cantor

Prosthetic management of edentulous mandibulectomy patients. Part I. Anatomic, physiologic, and psychologic considerations

Abstract Part I of this series of articles dealing with the prosthetic treatment of mandibulectomy patients presents some general physiologic considerations pertinent to mandibulectomy patients discussed in terms of functional adaptability to surgical insult. Deglutition, speech, mandibular movement and mastication, saliva control, respiration, and psychosocial factors are characterized. A classification of mandibulectomy patients is suggested, and the anatomic and physiologic oral conditions of the patients in each group are described. Part II will present a step-by-step discussion of clinical procedures specifically designed for the anatomic and physiologic alterations of these patients. Part III will present an evaluation of these suggested procedures by means of a clinical research study of 30 mandibulectomy patients.

Maxillary speech prostheses for mandibular surgical defects

Abstract Speech distortion is one of the debilitating consequences of radical surgery of the tongue, floor of the mouth, and mandible. The major cause of this speech impairment is restricted motion of the tongue and lack of lingual-palatal contact. Since contact between the tongue and the posterior part of the palate is anatomically impossible, a prosthesis is functionally formed to lower the palatal vault. The sounds “k” and “g” require this palatal contact. A series of test words beginning with these consonants was, therefore, used to evaluate possible speech improvement. The results indicated significant improvement in speech intelligibility for those patients with severely restricted tongues with the use of the prosthesis.

Psychosocial aspects of maxillofacial rehabilitation. Part I. The effect of primary cancer treatment

Abstract One-hundred thirty-nine patients at the University of California Maxillofacial Rehabilitation Clinic were given a psychosocial questionnaire. The items of the questionnaire covered a variety of significant areas and were tabulated by computer. The results helped to define this patient population in terms of social stability, income and occupation, drinking and smoking habits, age, sex, and educational background. Aspects of the patients self-imge before and after his primary cancer treatment were presented.

Prosthetic management of edentulous mandibulectomy patients. Part II. Clinical procedures

Abstract This article is concerned with prosthetic principles relevant to the postsurgical conditions of radical mandibular surgery, and it demonstrates clinical procedures designed especially for these problems. Clinical observations concerning the value of this prosthetic technique have been made. A controlled clinical study of 30 mandibulectomy patients was undertaken in order to make an objective assessment of the procedures. The results will be discussed in Part III of this series.

Prosthetic management of edentulous mandibulectomy patients. Part III. Clinical evaluation

Abstract Thirty edentulous mandibulectomy patients participated in a clinical study to compare functionally developed prosthetic procedures with the more traditional techniques. The 30 patients were classified as to type of mandibular defect and were given both types of prostheses on a controlled basis. Anatomic and psychologic data, the adjustment problems, and denture preferences were recorded. Twenty-two patients could successfully use lower dentures. Fifteen (50 per cent) of the test patients preferred the “swallowing” prosthesis. Three (10 per cent) of the test patients preferred the conventionally constructed lower dentures. Six of the seven Class III mandibulectomy patients (the most difficult to treat prosthetically) were unable to use either denture. The remaining patients could use either lower denture and had no significant preference. This data is presented in the hope that these new prosthetic techniques will be accepted as possible alternatives when treating certain types of edentulous mandibulectomy patients and can, thereby, be studied, developed, and evaluated more extensively.

Prosthetic management of terminal cancer patients.

E &mates of the survival rates of patients with head and neck cancer in the United States are less than 30 per cent.l Radical surgery and radiation are the usual modes of treatment. Many articles have been published dealing with the prosthetic management of the tissue defects and the resulting dysfunction caused by these procedures.‘-” However, a special group of patients is made up of those for whom surgery and radiation have failed to retard or eliminate the tumor. Often these patients are left with gross orofacial defects and severe functional impairment. Even when cancer therapy fails, rehabilitation remains essential. This article will deal Ivith the prosthetic management of these terminal cancer patients. The rehabilitation objectives of swallowing, mastication, acceptable appearance, intelligible speech, and psychologic health are modified when dealing with terminal patients. The primary aim is to allow the patients to live out the remaining portion of their lives in as comfortable and productive a manner as possible. Oral and reconstructive plastic surgery are rarely indicated for these patients because of the poor prognosis. However, a life expectancy of only 1 to 2 years should not preclude prosthetic therapy. Many terminal cancer patients return to work and family for a meaningful period of time before becoming incapacitated. They require the ability to speak intelligibly and to swallow food without the embarrassment of liquid escaping through the nose. In many patients, there is a need to camouflage a large defect