Microstomia Research Articles

Sectional Complete Denture in a Patient with Sub Mucous Fibrosis- A Clinical Report

Microstomia is the term used to describe a condition of reduction in the size of the oral aperture which can be either acquired or congenital. Patients with microstomia have restricted mouth opening which causes difficulty in inserting and removing the prosthesis as a whole. Prosthetic rehabilitation of such patients is a challenge. Steps in the fabrication of complete denture like impression making and denture processing are modified in sectional complete denture. This enables the patient to use them in sections without much difficulty. This clinical report describes prosthodontic management of a completely edentulous patient with microstomia developed due to oral sub mucous fibrosis. Sectional maxillary denture was fabricated using a sectional impression tray technique. With the use of post and tubes in the palatal region, the denture could be easily inserted and removed in two parts. Mandibular denture was fabricated by the conventional method.

Experience of surgical treatment of post-burn oral commissural contracture (Microstomia)

Introduction: One of the significant problems of facial burns is post burn oral commissural contracture (Microstomia) occurring as a result of circumferential scarring at the junction between the lips and cheek. It results in aesthetic disfigurement of face and functional impairments like feeding, speech and oral hygiene and difficulty of intubation. Objective: This study aims to share the experience of treatment of microstomia with various methods. Methods: This study comprised of 7 cases of microstomia of variable severity over a period of 10 years. Case number 1, 2 and 3, having severe microstomia, were treated with Converse method of commissuroplasty without waiting for scar maturation. Case number 4 and 5 had moderate severity microstomia, in these patients the correction of the neck contracture was considered as priority and were treated with release of neck contracture and split skin grafting. Case number 6 and 7 had pressing priority of treatment of ectropion which was treated first but unfortunately further the treatment of microstomia was given back seat by the patients. Results: Case number 1 to 5 treated operatively showed significant improvement in mouth opening while case number 6 and 7 who rejected treatment, showed no improvement.Conclusion: Post burn microstomia is infrequent yet important functional condition causing difficulty for feeding and for intubation during anesthesia and hence its correction falls under essential procedure to be done earliest without waiting for scar maturation. Cases which were treated operatively showed significant improvement in mouth opening. In cases that rejected treatment, hence considered as conservatively treated, the results were inferior.

Two cases of commissurotomy of microstomia

Two cases of commissurotomy of microstomia

Reconstruction of lip defects with the Karapandzic technique.

To study the use and effects of Karapandzic technique of lip reconstruction by long-term assessment. A descriptive study. CMH Rawalpindi from January 1994 to January 2002. Thirty seven consecutive patients who underwent Karapandzic technique of lip reconstruction with a minimum follow-up period of two years have been included. The variables assessed were hemorrhage, wound infection, flap necrosis, microstomia, reconstruction time, hospital stay and dynamic lip functions. Results drawn were analyzed. A total of 37 patients were included in the study. Thirteen (35%) patients were outdoor cases while 24 (65%) were in-patients. Average time of reconstruction was 40 minutes, which was done under general anesthesia in 21(57%) patients and under local anesthesia in 16 (43%) cases. Mean hospital stay of the indoor cases was 26 hours. There was no flap loss except for marginal necrosis in 04 (11%) patients. Wound infection and wound dehiscence was observed in 03 (08%) patients. Sensations were completely intact in 29 (78%) patients and aesthetically 28 (76%) patients gave normal look at the end of two years (2Y). Twenty-seven (74%) patients had no change in speech and only one (3%) patient had unsatisfactory speech after 2 years. Varying degree of microstomia was observed in all the cases at immediate postoperative stage of one month but 35 (95%) patients showed gradual improvement with active mouth opening and stretching by prosthetic splints over 2 years. The Karapandzic technique of lip reconstruction is strongly recommended over the other techniques as it is a single stage, quick and safe procedure which gives cosmetically and functionally excellent results. Microstomia, occurring in early postoperative stage, shows gradual improvement on long-term follow-up.

Modified Stepladder Lip Flap in Secondary Oral Commissure Reconstruction

In this paper we describe our experience using a two-stage reconstruction procedure in 24 patients who underwent ablative buccal cancer resection. In the first stage, cheek defects were reconstructed using free radial forearm flap in 10 of the patients, and free anterolateral thigh flap in 14 of the patients. Modified stepladder lip flap for oral commissure reconstruction followed in the second stage. The modified stepladder lip flap is different from the traditional stair step flap in that each step of the flap consists of different components of tissue. The first step is a full-thickness layer comprising skin, orbicularis oris muscle and mucosa. The second step is a partial-thickness layer comprising skin, subcutaneous fat and partially split orbicularis oris muscle. The third step is a dermis layer. The 24 patients in the study (all male, with a mean age of 51 years old) were followed up for at least 6 months after the second stage commissure reconstruction. Prior to commissure reconstruction, all had symptoms of oral incompetence (saliva drooling and food/liquid expulsion), and all obtained adequate oral competence after surgery. Nine patients resumed a regular diet, 8 patients had a semi-solid diet and 7 patients had a soft diet after surgery. Six of the patients developed mild microstomia postoperatively though did not have difficulty with dietary intake. All the patients were satisfied with their postoperative appearance. Postoperative scar contracture did not occur in any of the patients. Using this technique, continuity and function of the orbicularis oris muscle can be restored, and satisfactory cosmetic and functional results can be achieved.

A prosthesis to control microstomia

A prosthesis to control microstomia

Custom made microstomia mouth splint for a baby

Custom made microstomia mouth splint for a baby

An appliance to prevent and treat microstomia from burns

An appliance to prevent and treat microstomia from burns