Abstract
Hemimandibulectomy can have several consequences such as disoriented masticatory cycle, eccentric occlusion, distorted speech and facial disfigurement depending on the severity of the defect. It is challenging for the prosthodontist to rehabilitate the patients in whom osseous reconstruction has not been carried out. This clinical report describes the Prosthetic management of a patient who had undergone hemimandibulectomy due to moderately differentiated squamous cell carcinoma involving left buccal mucosa, gingivobuccal sulcus and retromolar trigone. A non- surgical approach was carried out to rehabilitate this patient, which included the fabrication of a maxillary guide flange prosthesis for correction of the frontal plane rotation and a twin occlusion prosthesis for ease of mastication. The appearance of the patient was improved drastically by the fabrication of an extraoral prosthesis.
Highlights
Malignant tumours of the oral cavity are more destructive than other tumours [1]
Resection of hard and soft tissues causes loss of proprioception leading to frontal plane rotation
Beumer et al advocates correction of deviation and frontal plane rotation of the mandible by fabricating a maxillary or mandibular guidance prosthesis followed by establishing functional occlusion
Summary
Malignant tumours of the oral cavity are more destructive than other tumours [1]. Tumours of oral cavity often requires resection of some parts or whole of maxilla or mandible. In patients who have undergone hemimandibulectomy, loss of mandibular continuity leads to deviation of the mandible due to secondary scar contracture and muscle imbalances [2]. There is a well-known quote by a German surgeon named Dieffenbach about the patient with facial disfigurement. He says “At the sight of whom all men turn in disgust and abhorrence and at whose presence children cry and dogs bark” [4]. Advancements in the field of maxillofacial prosthetics such as bone grafts followed by implant placement provide good anchorage for dental prosthesis. Another major advancement in mandibular reconstruction is the improvement in the microvascular surgical techniques. Its effectiveness in correcting mandibular deviation depends on the time elapsed after surgery [4,7]
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