Dear Katie, Jerry knew I would want to weigh in here. There are not many people on the forum with SCC of the maxilla and/or hard palate. Mine sounds very similar to your father's and to Joy's father's. I had not quite half of my right maxilla removed and the equivalent part of the adjacent hard palate. I still have my own teeth, including the four front incisors, exdept for the five teeth I lost with the maxillectomy.

I was very, very fortunate that I did not require radiation. My surgeon feels that his aggressive approach achieved complete removal of the cancer. I am now 20 months cancer-free.

I wear an obturator, though I have been tempted by the reconstructive surgery. I agree with Joy, that I sure would love to have my own mouth back again, but honestly, this is not much worse than having full dentures, and lots of people have those. I do have my own maxilla and teeth on the other side, and part of my palate is still exposed, so that I get some sensation there.

Of course, an obturator is dependent on remaining structures to secure it, so if too much structure had to be removed, the obturator will not be stable or functional.

The process for the use of an obturator is that as tissues heal and change, the obturator must change also, with either new appliances made from new impressions, or with relining the old appliance with moldable material, both processes being difficult, I imagine, for an irradiated mouth.

I have discussed....and seriously considered....reconstructive surgery. Here is what I know about the free-flap surgeries for our problem: If one simply closes the opening with a graft of skin, the openingn is closed, which is nice, but there is no way to then secure an obturator, and the patient is actually worse off than before. The three-dimensional portion of the obturator (the "bulb") that inserts into the opening in the palate is an important part of the retention system. The more teeth a person has remaining, the better luck he will have with an obturator.

The surgery that was suggested for me was the harvest of the fibula (the smaller of the two bones in the lower leg) along with muscle, skin, and blood vessels. All would be installed into the mouth, with the bone serving as a maxillary replacement, and the skin and muscle serving as a tough covering for the palatal opening. The blood vessels would be connected to vessels in the neck.

The failure rate of some part of this process, I was told, is around 10-15%.

There is a long healing period. The bone must heal for about 6 months. Then some implants can be installed,but they must ossify for about 6 months before they can bear any load. In the meantime, one can wear some sort of appliance that is wired in, for appearance's sake. The implants are not for the permanent installation of teeth but to be secure attatchments for a dental appliance that is more like a bridge. The palate, with the grafted portion, would no longer be covered by a plate of any sort.

I was very tempted by this surgery, exc. that I am now 64, and this is a stressful time for my family for other reasons, and I did not feel that such a long time of healing was the way I should be spending my time right now.

My surgeon said that he could go either way.....that I have such a good result with my obturator that perhaps I should just stay with it. He said that this large surgery is primarily for those who can't get good results with an obturator.

My advice.....based only on my own experience: There is no time frame that necessitates your doing another surgery at this time. It can be done later, after all healing has been accomplished. You might want it then, or you might be quite satisfied with the obturator. Nothing will be lost by waiting.

One other option for securing an obturator is implants farther up into the bony structure of the face, either into the pterygoid process near the jaw joint, or into the zygoma (the cheekbone.) These implants are said to offer firm support for an obturator, especially when there are not enough remaining teeth to provide satisfactory support for the appliance.

Have I throughly confused you? Please let me know and don't hesitate to ask more questions.

One question I have is how many teeth does your father have left after his surgery? If he has enough teeth to support an obturator, I would think twice about allowing the doctors to close the opening without discussing how he will secure a denture appliance.

I wish I could snap my fingers and be all fixed up....don't we all....but the reconstructive surgery is a really big deal, and I just can't do it to my family right now.

Here is another thing to consider: If you don't close up the opening in your palate, the dr. can visually inspect the area for the next year to be certain that all is well, rather than closing it up.

Also....after going through all the surgery..and the failure...that you have experienced, I can't imagine subjecting you to more surgery right now. I would let this heal, get a temporary obturator, and learn to use it.

I talk, sing, eat corn on the cob and McDonald's hamburgers....I don't chew on that side, but most people are one-sided chewers anyway, I'm told. Of course, I am fortunate to have my incisors........makes a huge difference. My teeth look totally normal to the casual observer.

I am considering having my teeth crowned to install a better clip on the backside of those front teeth. The tension on the lateral incisor, which has a small wire around it to hold that side of the appliance, is not a strong tooth, having a single root. I hate to get my teeth crowned, but compared to what some of my friends here have undergone, I can't complain about crowns!

Your lower teeth need something to "oppose" them, even if you don't chew on them. The fake teeth on the obturator provide this.

I had fake teeth in my obturator nearly from the beginning. Improving our appearance improves our outlook. Ask about teeth. There is no reason you can't have fake teeth in your obturator, at any stage, exc. perhaps immediately after surgery.

Ask me some questions. I seldom get to write about my experiences, and I am glad to help. It makes me realize how lucky I am and how far I have come since those first terrible days.