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What is an obturator?

Did you know that Sigmund Freud wore an obturator? Diagnosed in 1923 with oral cancer, the father of psychoanalysis underwent a maxillectomy (his upper jaw was removed) and subsequently wore a palatal obturator.

So what is an obturator?

A palatal obturator is a removable dental prosthetic device which fills a fistula or cavity such as one that might be created after a maxillectomy. After a maxillectomy, the wall between the oral cavity and maxillary sinuses is lost. A palatal obturator restores this boundary. By restoring the separation between the sinuses and oral cavity, obturators aid with speech, often for hypernasality, and eating. They are also often fabricated for cleft palates.

What are the steps for fabricating an obturator?

Prior to the surgery, a thorough dental evaluation should be conducted. At this visit, active dental or periodontal infections should be addressed and a detailed discussion on oral hygiene instruction, the side effects associated with the proposed cancer treatment and compliance with frequent follow-up visits should be emphasized. Active communication and coordination with the patient’s head and neck surgeon and oncology team must be established. At the pre-surgical visit, initial impressions of the maxilla and mandible should be taken for fabrication of a surgical obturator. Due to the fact that surgical obturators are placed at the time of surgery, their fabrication should be discussed with the head and neck team. Approximately two weeks after surgery, surgical dressings are removed, and an interim obturator is fabricated while the patient is healing. The obturator is constantly modified and relined throughout the healing process. Finally, after the defect has healed and remodeled, a definitive obturator is fabricated and delivered.

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