Restorative approaches in the early and definitive management of the maxillectomy patient

Dr James Owens

12th February 2014

BDS (Wales), MSc (Bristol) , FDSRCS (Edin), FDS (REST DENT), MRDRCS (Edin), FHEA.

James qualified from Cardiff in 1990. After VT and associate jobs in dental practice he returned to the Hospital Service in 1992. He completed SHO posts in Maxillofacial Surgery and Restorative Dentistry in South Wales before completing an MSc in Periodontology at Bristol. He was then appointed Lecturer / Hon SpR in Restorative Dentistry at Cardiff from 1996-2003. In 2003 he was appointed as Consultant in Restorative Dentistry at Morriston Hospital Swansea. He is the Lead for Restorative Dentistry on the South West Wales Head and Neck Oncology Clinic and attends the weekly MDT meeting and clinic. The majority of James' working week is spent in the treatment and rehabilitation of this patient group. He works closely with a large team of surgeons, maxillofacial technologists, hygienists and other dental colleagues in the care of these patients.
James is also involved with the development of dental services within the ABMU Health Board. He is Specialty Advisor to the Royal College for Restorative Dentistry in Wales and is Educational Supervisor to SHO and SpRs in training. He presents frequent postgraduate courses and lectures locally. This is his first (and maybe last) attempt at Web based learning and 'Webinars'. After discussing the concept of a Webinar with his eldest son he asked if it 'may go viral'. This left James, while having no idea what this meant, extremely worried and confused.

Aims:

• To outline the care pathway for patients requiring resective surgery to the maxilla for cancer.
• To understand the multidisciplinary treatment approach to maxillectomy patients.
• To discuss the different treatment modalities available for maxillectomy patients
• To review the literature in relation to rehabilitation of maxillectomy patients
• To outline the role of the extended dental team in the rehabilitation of maxillectomy patients
• To outline the stages in pre-surgical and surgical obturator fabrication and insertion.
• To describe the postoperative care and follow-up of maxillectomy patients.
• To discuss the design of definitive maxillary obturators
• To discuss the use of dental implants and zygomatic implants in the retention of maxillary obturators
• To outline the rehabilitation of maxillectomy patients with orbital and nasal defects also.

Objectives:

• To understand how patients with maxillary cancers are treated in a multidisciplinary team approach.
• To know the treatment options available to maxillectomy patients
• To have an insight into the evidence base for the rehabilitation of maxillectomy patients and how this informs treatment decisions.
• To understand the clinical and technical stages in pre, peri and post operative rehabilitation of these patients with maxillary obturators.
• To be aware of the different design options available for definitive maxillary obturators.
• To understand the role that dental and zygomatic implants can have in the retention of maxillary obturators.
• To realize the potential