2016 Annual Meeting: http://www.aaoms.org/meetings-exhibitions/annual-meeting/98th-annual-meeting/

The Use of a Custom-Made Ethylene Vinyl Acetate Interim Obturator for Sub-Total and Total Maxillectomies: A Report of 4 Cases

Jeanette M. Johnson DDS Houston, TX, USA
Rachel Bishop DDS Houston, TX, USA
Blake D Maida DDS, MD Houston, TX, USA
Mathieu S Carrier DMD Houston, TX, USA
Simon W Young DDS, MD, PhD Houston, TX, USA
Jonathan W. Shum DDS, MD Houston, TX, USA
Issa Hanna DDS Houston, TX, USA
Mark E Wong DDS Houston, TX, USA
James C. Melville DDS Houston, TX, USA
Total and subtotal maxillectomy (Brown Classification)1 resulting in large oro-antral defects have been traditionally reconstructed with a maxillary obturator. With the advances in free microvascular surgery, immediate reconstructions of these defects have become routine. There is however a large debate over which option is best.2 For those patients unable to have an immediate microvascular transfer for reconstruction, the surgical obturator is the only means of reconstruction. It has been noted when well made, obturators provide adequate function and phonetics, and are well tolerated by patients.2 However with total and subtotal maxillectomies retention can be a major issue since there may be no dentition to adequately stabilize with wires. In such cases, screws and wires have been used to engage the remaining midface for obturator retention. The inevitable problem to this method of retention is the obturator cannot be removed by the patient for cleansing, and must come as an outpatient to have it cleaned, repacked and or relined. This abstract details our experience with a custom-made ethylene vinyl acetate (EVA) interim obturator, first described by Nakamori.3This allowed patients to have a retaining removable obturator that enabled them to effectively swallow and phonate after surgery. Due to the ease of insertion and removal, patients were able to keep a hygienic wound site and permitted ease of surveillance. All patients were planned for a definitive permanent obturator or microvascular reconstruction.

Patients and Methods: This retrospective study was a review of patients who underwent sub-total or complete maxillectomy without microvascular reconstruction or revisional maxillary reconstruction at the University of Texas Health Sciences Center Houston Department of Oral and Maxillofacial Surgery from June 2015 to January 2016. Two patients had maxillectomies due to SCCa, and one patient had osteoradionecrosis of a free fibula from a previous maxillary reconstruction. The most appropriate immediate reconstruction for all three patients was determined to be an immediate acrylic obturator relined with Coe-Soft and or Xerofoam packings. The obturators were all retained by combination of screws and wires. After 10 days the acrylic obturators were removed, surgical defects cleaned and an impression was taken with alginate for the fabrication of the obturator. Type IV stone was poured to make the model and sever undercuts blocked out. A 3 mm sheet of EVA was heated and formed to the impression using a vacuum form machine. A second sheet of 1.5 mm EVA was added on top of the first sheet using the same process. Both sheets formed the “hollow bulb” portion of the obturator. Mechanically the “hollow bulb” model maintains its stability and retention by engaging the undercut portion of the surgical defect.

Results: We report satisfactory results from all three patients after insertion of our EVA flexiable obturator. Good seal of the oro-antral communication was demonstrated in all subjects as well as ability to clean the surgical defect. All three patients agreed that the temporary EVA obturator provided better function for speaking and eating compared with the immediate acrylic surgical obturator.

Conclusion: The EVA flexible obturator provides a useful and comfortable temporary prosthesis for patients waiting definitive reconstruction or prosthesis. Ease of fabrication, patient tolerance, and the ability to keep the post surgical site clean are the attributes of this device. The EVA flexible obturator should be considered as a temporary obturator in patients who are awaiting definitive reconstructive treatment after total or subtotal maxillectomy.


[1]BrownJS,et al: Vascularized iliac crest with internal oblique muscle for immediate reconstruction after maxillectomy. Br J Oral Maxillofac Surg. 2002;40:183–90.

[2] BrandãoTB: Obturator prostheses versus free tissue transfers:.016 Feb;115(2):247-253

[3]NakamoriK: Effectiveness of a custom-made temporary obturator after bilateral total maxillectomy Surgical Science, Vol.4 No.7, 2013

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