Quality of Life of Hemi-Maxillectomy Patients Rehabilitated with Obturator Prosthesis: A Critical Narrative Review

Abstract

Hemi-maxillectomy, most commonly performed for the ablative management of maxillary sinus and hard palate malignancies, produces an oronasal defect that compromises mastication, deglutition, speech and facial aesthetics. Prosthetic rehabilitation with an obturator remains the principal non-surgical strategy for restoring oronasal separation and function in patients who are unsuitable for, or who decline, microvascular free flap reconstruction. This review synthesises the available clinical literature concerning the quality of life of hemi-maxillectomy patients rehabilitated with obturator prostheses, drawing on cross-sectional, longitudinal and comparative studies published across general prosthodontic, oral and maxillofacial surgery, and head and neck oncology journals. The review examines classification systems for maxillary defects, the functional principles underlying obturator design, the instruments used to capture health-related quality of life in this population, and the clinical, demographic and psychosocial determinants that shape patient-reported outcomes. It further considers comparative evidence contrasting obturator rehabilitation with surgical reconstruction, and appraises the contribution of digital workflows, computer-aided design and manufacture, and novel framework materials to contemporary obturator practice. The synthesis indicates that a well-retained, well-adapted obturator can substantially restore oral function and social confidence, that marital status, education, defect size, dentition, radiotherapy exposure and obturator retention are consistently associated with reported quality of life, and that the choice between obturator rehabilitation and flap reconstruction should be individualised rather than treated as a uniformly hierarchical decision. Persisting gaps include a scarcity of large prospective cohorts, heterogeneous outcome measures, and limited long-term data on newer digital and implant-retained obturator systems. Future research directions and the limitations of the present narrative synthesis are outlined.