Volume 11
Issue 4
Article 8
Hollow Bulb Definitive Obturation of a Post-Covid Mucormycosis
Maxillectomy Defect – A Case Report.
Ravi M B
Dept of Prosthodontics JSS Dental college and Hospital, JSS Academy of Higher Education and Research, Mysore
Karnataka-570015
Prakash P
Dept of Prosthodontics JSS Dental college and Hospital, JSS Academy of Higher Education and Research, Mysore
Karnataka-570015
Sai Pranathi Putta
Clinician at Sri Sai Super Speciality Dental Hospital Hyderbad, Telangana-500038
Anupama Aradya
Dept of Prosthodontics JSS Dental college and Hospital, JSS Academy of Higher Education and Research, Mysore
Karnataka-570015, dranupamavenu@gmail.com
Rashmi S
Dept of pedoodntics JSS Dental college and Hospital, JSS Academy of Higher Education and Research, Mysore
Karnataka-570015
See next page for additional authors
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Recommended Citation
M B, Ravi; P, Prakash; Putta, Sai Pranathi; Aradya, Anupama; S, Rashmi; and M R, Dhakshaini (2022) "Hollow Bulb
Definitive Obturation of a Post-Covid Mucormycosis Maxillectomy Defect – A Case Report.," International Journal of
Health and Allied Sciences: Vol. 11: Iss. 4, Article 8.
DOI: 10.55691/2278-344X.1050
Available at: https://rescon.jssuni.edu.in/ijhas/vol11/iss4/8
This Case Report is brought to you for free and open access by Research Connect. It has been accepted for inclusion in
International Journal of Health and Allied Sciences by an authorized editor of Research Connect.
Hollow Bulb Definitive Obturation of a Post-Covid Mucormycosis Maxillectomy
Defect – A Case Report.
Authors
Ravi M B, Prakash P, Sai Pranathi Putta, Anupama Aradya, Rashmi S, and Dhakshaini M R
This case report is available in International Journal of Health and Allied Sciences: https://rescon.jssuni.edu.in/ijhas/
vol11/iss4/8
CASE REPORT
Hollow Bulb Definitive Obturation of a Post-covid
Mucormycosis Maxillectomy Defect e A Case Report
M.B. Ravi a, P. Prakash a, Sai P. Putta b, Anupama Aradya a,*, S. Rashmi c,
M.R. Dhakshaini a
a
Department of Prosthodontics, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka,
570015, India
b
Sri Sai Super Speciality Dental Hospital, Hyderabad, Telangana, 500038, India
c
Department of Pedoodntics, JSS Dental College and Hospital, JSS Academy of Higher Education and Research, Mysore, Karnataka,
570015, India
Abstract
The novel Coronavirus, also known as SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), causes
COVID-19. In the wake of COVID-19, incidences of mucormycosis were rising alarmingly, especially rhino-orbitalcerebral mucormycosis. Most cases required surgical intervention followed by the fabrication of obturators. A hollow
obturator is the most practical, convenient, and cost-effective solution for prosthodontic rehabilitation.
A patient with pain over the maxillary region (left) reported to the department of Prosthodontics and Crown & Bridge.
His past medical history revealed that he tested and recovered from SARS-CoV-2. Clinical, radiographic, and smear tests
confirmed rhino-cerebral mucormycosis with post-covid pneumonia. Surgical left partial maxillectomy performed 4
months back. His intra-oral examination revealed a large maxillary defect extending from the left-sided alveolar bone,
along with a missing base of the maxilla and palatal bone. The case report presents a hollow bulb definitive obturator
fabrication for the treatment of acquired maxillary defects after COVID-19-caused mucormycosis.
Keywords: Mucormycosis, Definitive prosthesis, Obturators, Hollow bulb
1. Introduction
T
he previously known novel coronavirus, also
known as SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), is the cause of
COVID-19, an infection of the upper airways [1].
The major clinical signs of SAR-CoV-2 include
fever, cough, exhaustion, and anosmia, with some
patients also suffering conjunctivitis as a result of
the virus migrating to the ocular region [2].
Mucormycosis, often known as black fungus, is a
non-septate filamentous fungal infection that can be
fatal. The maxillary sinus is often affected by rhinoorbital-cerebralmucormycosis, which may also
infect the orbits and ethmoidal sinuses [3].
The patient is more likely to have hypernasal
speech, fluid leaks into the nasal cavity, and poor
masticatory performance as a result of palatal deformities. Such deformities necessitate the use of a
customized prosthesis to produce an oronasal seal,
which can be given by an obturator prosthesis [4].
The open hollow obturator has disadvantages, such
as the accumulation of food, debris, and mucus inside the hollow part, which leads to malodor and
increased weight of the prosthesis. Obturators with
a closed hollow design prevents water and food
retention, enable cleaning, and are lighter and
extend further [5].
This case report features the fabrication of a hollow bulb obturator to treat a maxillary deformity for
Received 24 June 2023; revised 14 July 2023; accepted 8 August 2023.
Available online 28 September 2023
* Corresponding author at: Department of Prosthodontics, JSS Dental college and Hospital, JSS Academy of Higher Education and Research,
Mysore, Karnataka, 570015, India.
E-mail address: dranupamavenu@gmail.com (A. Aradya).
https://doi.org/10.55691/2278-344X.1050
2278-344X/© 2023 JSS Academy of Higher Education and Research. This is an open access article under the CC-BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).
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a patient with post-Covidmucormycosis. Such
maxillary deformities require a multidisciplinary
approach and prosthodontic recovery by method for
hollow bulb obturator is the most down-to-earth,
convenient treatment mode [6].
2. Case report
2.1. Patient information
A 46-year-old male patient reported to the
Department of Prosthodontics with a chief
complaint of pain over the left maxillary region for
five days. The patient tested positive for COVID-19
and recovered in 2 months. Further medical tests
revealed Type 2 DM and he is undergoing medication for it.
2.2. Clinical findings
Clinical examination shows tenderness over the
left maxillary region and the septum deviated towards the left with mucoid discharge in the left
nasal cavity.
2.3. Diagnostic assessment
Radiographic (MRI PNS & ORBIT) examination
features the sign of invasive fungal sinusitis
involving the left nasal cavity, left maxillary and
ethmoid sinuses with extension to the left pterygoid
palatine and infratemporal fossa [Fig. 1(b) (c)&(d)].
Sputum smear analyses were performed and he was
diagnosed with rhino-cerebralmucormycosis with
post-covid pneumonia.
Fig. 1. (a) A 46-year-old male patient who presented with facial asymmetry after left maxillectomy procedure. (b)&(c) Axial and coronal section of
MRI examination features the sign of invasive fungal sinusitis involving the left nasal cavity, left maxillary and ethmoid sinuses with extension to the
left pterygoid palatine and infratemporal fossa.
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The patient received a surgical obturator immediately following surgery, which he wore for 7 days.
After that, an interim obturator was made and worn
by the patient for 4 months [Fig. 2]. An extraoral
examination indicated left-sided facial asymmetry
[Fig. 1(a)]. Upon intra-oral examination, the base of
the maxilla, the palatal bone, and a large maxillary
defect were all seen in [Fig. 3]. On the lateral side of
the skin graftemucosa interface, a scar band was
shown. Accordingly, it was identified as it had aramany Class II defect and a partly edentulous
maxillary arch [7].
The patient's aesthetic and mastication difficulties
were his major concerns, hence it was decided to
fabricate a hollow bulb maxillary definitive obturator prosthesis for him.
2.4. Fabrication of definitive obturator
The defect should be dried mucus crusts and
cleaned before making a first impression. The
remaining maxilla morphology was taken into
consideration while choosing the edentulous stock
tray. The medial and anterior borders of the defect's unfavorable undercuts were gauze-blocked
before the impression was taken. Using a stock
tray and irreversible hydrocolloid impression, a
primary impression was made. After the primary
cast, a custom tray was fabricated using self-curing
acrylic resin. Two-stage putty wash technique was
used (addition silicone putty as tray material and
light body polyvinyl siloxane as syringe material).
[Fig. 4].
To record the defect region, the patient was
instructed to make swift head movements to the
right and left while keeping their head level, as well
as to flex and stretch their necks. Before asking the
patient to swallow, the mouth should be opened and
Fig. 3. Intraoral examination, the base of the maxilla, the palatal bone,
and a large maxillary defect were all seen.
closed and the jaw should be adjusted laterally. The
master cast was obtained with type III gypsum, and
undercuts are blocked out with modeling wax. The
master cast was surveyed, designed, and cast using
titanium alloy. A framework trial was done, and
then a trial framework with an occlusal rim was
fabricated on the master cast. [Fig. 5(a) and (b)&(c)]
Casts were mounted on the semi-adjustable
articulator once bite registration was completed.
The teeth arrangement and try-in procedure were
also completed in [Fig. 6(a)&(b)]. Aesthetics and
phonetics were evaluated at the time of try-in occlusion and deemed to be acceptable by the patient.
Flasking and dewaxing were done using a conventional method to produce hollow bulbs. Using lost
salt technique to create a hollow in the bulb of the
obturator [8]. After finishing and polishing the cured
Fig. 2. Maxillary interim obturator made up of heat cure acrylic denture base and acrylic teeth worn by the patient for up to 4 months.
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denture was inserted into the patient's mouth.
[Fig. 7(a) and (b)&(c)] and post-insertion instructions
were given. The patient expressed satisfaction and
happiness with his improved function, speech, and
appearance [Fig. 8].
Fig. 4. Two-stage putty wash technique was used with self cure custom
tray.
Fig. 7. Insertion of definitive cast partial denture with hollow bulb
obturator.
Fig. 5. (a) and (b): A framework trial was done, and then a trial framework with an occlusal rim was fabricated on the master cast.
Fig. 6. (a)&(b): Teeth arrangement and try-in procedure done.
INTERNATIONAL JOURNAL OF HEALTH AND ALLIED SCIENCES 2023;11:363e368
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extension section from moving away from its terminal location, stabilization and indirect retention
components must be positioned appropriately [14].
In the conventional obturator prosthesis, different
types of retentive aids are used, including magnets,
Snap-On attachments (friction-type attachments),
acrylic buttons, retentive clips, and implants. Implants are an advancement in maxillofacial prosthodontics. They improve the retention of the
prosthesis without using other appliances. Nonetheless, implants are limited by their cost, patient
health, and bone quality [15]. In addition to
longevity, a metal framework obturator prosthesis
can be sensitive to temperature changes due to its
thermal conductivity [5,16].
4. Conclusion
Fig. 8. Extraoral image after insertion of definitive cast partial denture.
3. Discussion
Obturator prosthesis is crucial for people who
have undergone surgical maxillectomy to recover
oral function. Framework designs for obturators
may vary based on the defect classification. All
removable obturator prostheses are based on prosthodontic principles which include cross-arch stabilization, broad stress distribution with the use of a
rigid major connector, and stabilizing and retaining
components at locations within the arch to best
minimize dislodging functional forces [9]. Support
for the prosthesis was provided by the remaining
teeth, palate, and rest. Rest was prepared on the
right first and second premolars, first and second
molars of the right quadrant of the maxilla. The
complete palate was designed to ensure maximum
distribution of the functional load to the tissue. An
indirect retainer was planned on the anterior
remaining teeth (central, lateral, and canine). Direct
retention was provided by the I-bar clasp placed on
the right central incisor, embrasure circumferential
clasp between the right first and second (premolars,
molars) [10e12].
The advantage of using titanium alloy in rehabilitating maxillary defect is its exceptional corrosion
resistance, appropriate mechanical Properties, less
metal allergy, lightweight, and better fitness accuracy [13]. In dentulous patients, the remaining teeth
play an important role in providing support, retention, and stability to the obturator. The remaining
teeth or ridge, the lateral part of the defect, the
soft tissue undercut, and the scar band could all
help with retention. To avoid the defective
The greatest challenge in the rehabilitation of a
Hemi-maxillectomy patient is to achieve adequate
retention, stability, and support. Successful rehabilitation of these patients requires thorough
knowledge and skills, as well as an understanding of
their needs.
A definitive obturator prosthesis with maximum
extension and proper design rehabilitates patients
in a variety of ways by improving masticatory efficiency, enhancing speech clarity, and improving
quality of life.
Conflict of interest
The authors declare that there are no conflicts of
interest regarding the publication of this paper.
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