Spontaneous closure of partial maxillectomy defects using an acrylic removable partial dental prosthesis - A case series

Sep 23, 2026

This case series describes prosthodontic management of five patients who, after surgical resection of maxillary neoplasms (with or without flap reconstruction), had persistent oronasal fistulas following partial maxillectomy. Spontaneous closure occurred in all five patients after use of a maxillary protective removable dental prosthesis that did not engage the fistula. The report frames fistula burden, reviews conventional surgical and obturator approaches, and presents a simple, cost-effective alternative strategy.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Case Series

Patient #1

DOI: 10.1111/jopr.70113 CLINICAL REPORT Spontaneous closure of partial maxillectomy defects using an acrylic removable partial dental prosthesis: A case series Caroline T. Nguyen DMD, MS1,2,3,4 Eitan Prisman MD5 1Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada 2Provincial Practice Leader in Prosthodontics, BC Cancer, Vancouver, BC, Canada 3The National Dental Examining Board of Canada, Ottawa, ON, Canada 4The Ottawa Hospital, Ottawa, ON, Canada 5Department of Surgery, Faculty of Medicine, University of British Columbia, British Columbia, Canada Correspondence Caroline T. Nguyen, The National Dental Examining Board of Canada, 340 Albert Street, 12th Floor, Ottawa, ON, K1R 7Y6, Canada. Email: [cnguyen@ndeb-bned.ca](cnguyen@ndeb-bned.ca) Abstract This case series describes the prosthodontic treatment of ﬁve patients who were treated with surgical resection, with or without ﬂap reconstruction, and had remaining oronasal ﬁstulas following their maxillary neoplasms. All ﬁve patients obtained spontaneous closure of their partial maxillectomy defects following the use of a maxillary protective removable dental prosthesis that did not engage the ﬁstula. KEYWORDS ﬁstula, maxillectomy, oronasal, partial, protective removable dental prosthesis, RPD, surgery Maxillary neoplasms have an annual incidence of 0.5–1.0 per 100,000 people. The ﬁrst line of treatment for oral and maxillofacial neoplasms remains surgical resection. Malignant neoplasms are often treated with surgical resection accompanied by radiation therapy and/or chemotherapy.1–3 Maxillectomy can result in severe anatomical changes secondary to tumor resection and reconstruction, including decreased soft tissue envelope and skeletal support.3–9 Resections commonly involve the alveolar and palatal processes of the maxilla, along with the palatal mucoperiosteum, frequently leading to oroantral or oronasal ﬁstulas. Persistent ﬁstulas result in multiple challenges for patients, including impaired mastication and swallowing, speech difﬁculties, oral discomfort, and nasal regurgitation.10 According to the literature, the deﬁnitive management of oronasal ﬁstula is either by surgical reconstruction or prosthodonticobturators.11 Surgical reconstructions offer various possibilities and range from using a skin graft to close a defect, to using a free ﬂap from the leg to restore the partition between the nasal and oral cavities. Surgical reconstructions generally allow for better speech and deglutition, eliminate the long-term need fora prosthesis in some patients, and can improve the patient’s quality of life.3,5,12 However, they lengthen the recovery period, and the cost of surgery can range from $20,000 to $100,000 depending on the complexity of the surgery, the added hospitalization time, and the country of treatment. 13,14 Meanwhile, an obturator prosthesis generally ﬁts into and closes a defect within the oral cavity.15 Restoring patients with obturator prostheses can facilitate oral access for hygiene procedures and visibility to the area in the case of recurrence; however, support and retention of theobturator can become problematic and uncomfortable to the patient.3,5,6,9,16 Additionally, for the prosthodontist, a smaller ﬁstula defect can be difﬁcult to impress and obturate due to the possibility of fracture of material stalk into the defect. An acrylic obturator bulb supported with a cast metal framework would generally cost between $2,500 and $3,500 in Canada, with a wider range between $1,000 and $6,000 internationally, depending on the country and the level of complexity of the prosthesis.17 However, recent approaches used at our institution have demonstrated that a simple acrylic protective removable dental prosthesis that does not engage the defect and costs about $500–$700 to fabricate can offer an alternative management option for facilitating spontaneous closure and reducing the This is an open access

FAQs

What was the purpose of this case series?

To describe a simple, cost-effective acrylic protective removable dental prosthesis design that could lead to spontaneous closure of partial maxillectomy defects without further surgery.

How did the prosthesis used in these cases differ from conventional obturators?

It was a protective removable dental prosthesis that did not engage the fistula, with a flat intaglio surface and no reline material entering the defects.

What was the clinical outcome for the five patients?

All five patients achieved spontaneous closure of their partial maxillectomy defects after using the protective removable dental prosthesis.

Sep 23, 2026

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