Brief reports of clinical procedures in treatment of individual patients

Clinical Reports
Light-cured interim palatal augmentation
A clinical report

prosthesis.

Jack B. Meyer, Jr., D.M.D.,* Rodney C. Knudson, D.M.D., M.S.,** and

Karen M. Myers, M.A., C.C.C.***
Wilford Hall [T.S. Air Force Medical Center, San Ant,,nio, Tex.

P a r t i a l glossectomy patients, especially those with

base of tongue resections, often have dysphagia. The
inability to initiate an effective swallowing reflex may result in aspiration or regurgitation. T r e a t m e n t atten pts
permit stronger lingual propulsion by artificially lowering
the palatal vault to provide increased linguot)alatal (ontact. If deficient contact cannot be corrected, a non~,ral
means of feeding must be established or continued.
Present techniques for making an interim palatal augmentation prosthesis include the use of incremental addi-

tions of wax, 1 modeling compound, '',:~ or tissue-conditioning material 4 to an acrylic resin base. The completed
palatal contour is processed in polymethacrylate resin.
These techniques require an additional visit before the
prosthesis can be evaluated by the prosthodontist and the
speech specialist.
This article describes an interim palatal augmentation
prosthesis made by using a light-cured resin that can be
added incrementally to a prepared acrylic resin baseplate
and functionally molded. After curing, the prosthesis can
be evaluated immediately, which makes adjustments or
additions possible during the same appointment.

PATIENT REPORT
The views expressed herein are those of the authors and d~, not
necessarily reflect the views of the United States Air Force the
United States Army, or the Department of Defense.
*Lieutenant Colonel, U.S. Army, DC; Fellow, Maxillotacial t'rosthetics.
**Lieutenant Colonel, U.S. Air Force, DC; Assistant Chairma:~ for
Maxillofaeial Prosthetics.
***Speech Pathoh)gist, Department of Audiology and Spee, h.
10/1/14822

Fig. 1. Lowered palatal configuration of prosthesis permits tongue contact during deglutition. Note radiopaque
string embedded in cameo surface to reveal outli~,e of
prosthesis during videoflouroscopic analysis.

T H E J O U R N A L OF P R O S T H E T I C D E N T I S T R Y

The patient, a 69-year-old man with partial tongue

resection for the removal of squamous cell carcinoma, was
referred from the speech therapy service with the chief

Fig. 2. Modified barium swallow reveals tongue-to-prosthesis contact during swallow of radiopaque medium and
stasis (arr~)u') at crio)pharyngeal level.

MEYER, KNUDSON, AND MYERS

Fig. 3. Increased tongue-to-prosthesis contact produces faster swallow and minimal

pooling of barium liquid (arrow).

'%: L ~

Fig. 4. Aspiration is not evident during final barium

swallow with prosthesis in place.

Fig. 5. Aspiration of barium (arrow) is evident without

prosthesis.

complaint of dysphagia. Examination revealed reduced

strength and mobility of the remaining tongue mass, with
reduced sensation especially to the posterior aspect. The
patient was unable to swallow his own secretions, resulting

in significant anterior pooling. He required a nasogastric

tube for feeding because he was unable to swallow without
aspiration and regurgitation. Speech was intelligible but
impaired.

JANUARY 1990

VOLUME 63

NUMBER 1

PALATAL AUGMENTATION PROSTHESIS

TREATMENT

A wire clasp-retained acrylic resin baseplate (TRIAD,

Dentsply, York, Pa.) was made with maximum palatal
coverage and clinically adjusted. During the insertion appointment, a small amount of uncured acrylic resin was
added to the posterior half of the baseplate. The patient
was asked to repeat the linguovelar s o u n d s / k / a n d / g / a n d
to swallow, thus functionally molding the uncured resin.
The reshaped addition was polymerized with the lightcuring unit (Dentsply). Incremental addition of resin was
continued until linguopalatal contact was adequate to produce a swallowing reflex (Fig. 1). Evaluation with pressure
indicator paste revealed a uniform surface contact on completion.
To objectively assess the swallowing reflex and degree of
linguopalatal contact, videoflouroscopic studies were completed with the prosthesis. During the first Study, pooling
at the vallecullae and stasis at the level of the cricopharyngeal muscle was observed (Fig. 2). Successive portions of
barium paste could not be ingested without regurgitation
and expectoration. A forward head tilt allowed more efficient movement of the material and minimized aspiration.
An additional increment of uncured acrylic resin was
added, functionally molded, and polymerized. The subsequent modified barium swallow study revealed an increased speed of swallowing as a result of greater linguopalatal contact. Comfortable, rapid swallows were possible.
Extraneous head movements were not required to aid
deglutition. A significant reduction of pooling (Fig. 3) of the
barium liquid and paste was noted and there was no aspiration of barium liquid (Fig. 4). Without the prosthesis,
aspiration of barium was evident (Fig. 5).
Evaluation by the speech therapist revealed improved
speech quality without the prosthesis because the added

THE JOURNAL OF PROSTHETIC DENTISTRY

bulk interfered with articulatory movements of the residual tongue. This finding confirms that of Cantor et aL 6 I t
is anticipated that tongue hypertrophy and improvement
in neuromuscular coordination will permit reduction in the
size of the definitive augmentation to minimize speech
impairment.1
At the 3- and 6-week follow-up appointments, efficient
swallows could not be completed without the prosthesis.
SUMMARY

The interim palatal augmentation prosthesis produced a

significant improvement in function within a short period
of time. With the visible light-curing system, modifications
of the prosthesis were made quickly and easily. The methods described enable the treatment team to immediately
assess the results of prosthesis modifications.
REFERENCES

1. RobbinsKT, BowmanJB, Jacob RF. Postglossec~omydeglutitoryand

articulatory rehabilitation with palatal augmenta~;ionprostheses. Arch
Otolaryngol Head Neck Surg 1987;113:1214-8.
2. GroetsemaWM. An overviewof the maxillofacialprosthesis as a speech
rehabilitation aid. J PROST!4ETDENT1987;57:204-8.
3. LaucielloFR, VergoT, SchaafNG, ZimmermanR. Prosthodontie and
speech rehabilitation after partial and complete glossectomy.J PROSTHETDENT1980;43:204-11.
4. KnowlesJC, Chalian VA, Shanks JC. A functional speech impression
used to fabricatea maxillaryspeechprosthesis for a partial glossectomy
patient. J PROSTHETDENT1984;51:232-7.
5. CantorR, Curtis TA, ShippT, BeumerJIII, VogelBS. Maxillaryspeech
prosthesis for mandibular surgical defects. J PROSTI4ETDENT1969;
22:253~60.
Reprint requests to:

DE. JACKB. MEYER,Ja.

487 WHEATON
FT. SAMHOUSTON,TX 78234