Severe Microstomia Research Articles

Rehabilitation for a scleroderma patient with severe microstomia using digital and conventional methods

BackgroundMicrostomia is a principal clinical symptom in patients with scleroderma. It is characterized by an abnormally small mouth opening, which makes traditional prosthetic rehabilitation difficult. MethodsFirst, the primary impression and jaw relation record were acquired using an intraoral scanning technique and the primary diagnostic dentures were fabricated using 3-dimensional printing (3DP). The definitive impression and jaw relation were obtained and digitally scanned. The second diagnostic denture was also made to confirm the esthetic and occlusal effects. Next, the adjusted dentition parts were scanned and milled from a cross-linked polymethyl methacrylate disk. In addition, the titanium alloy frameworks were also fabricated using 3DP. With flasking, the milled dentition parts were inserted and the definitive dentures were finally fabricated and delivered to the patient. ResultsThe authors constructed the definitive removable partial dentures successfully using the digital methods of intraoral scanning, computer-aided design, and 3DP. Conclusions and Practical ImplicationsThese digital methods provide an alternative option for prosthetic rehabilitation in scleroderma patients with severe microstomia.

Successful reconstruction of bilateral oral commissure fusion secondary to Stevens Johnson syndrome

Stevens Johnson syndrome (SJS) is a rare and often fatal hypersensitivity reaction commonly triggered by drugs which results in the uncontrolled destruction of keratinocytes with both cutaneous and mucosal involvement. Fusion of the oral commissures, although reported in burn victims, is a very uncommon complication of SJS. The successful reconstruction of oral commissures fusion using a modified commissuroplasty technique in a 19-year-old Hispanic female with severe microstomia secondary to SJS is presented here. Re-establishment of normal speech, oral intake, as well as aesthetic appearance were achieved.

Restoring masticatory function in a patient with severe microstomia using rapid prototyped mesh and a custom-made hinge and swing-lock prosthesis

This clinical report describes the use of rapid prototyped mesh in a complete swing-lock prosthesis to restore masticatory function in an edentulous patient with severe microstomia and perioral scar tissue after an industrial hot tar accident.

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.

Implant-Retained Obturator for an Edentulous Patient with a Hemimaxillectomy Defect Complicated with Microstomia.

Patient. A 68-year-old man was operated on for squamous cell carcinoma (T3N3M0) of the maxilla creating the hemimaxillary surgical defect on right side. The remaining arch was completely edentulous. There was remarkable limitation in the oral opening with reduced perimeter of the oral cavity due to radiation and surgical scar contracture. This article describes prosthetic rehabilitation by modifying the design of the obturator and achieving the retention with dental implant. Discussion. Severe limitation in the oral opening may occur in clinical situations following the postsurgical management of oral and maxillofacial defects. The prosthetic rehabilitation of the surgical defect in such patients becomes a challenging task due to limited access to the oral cavity. This challenge becomes even more difficult if the patient is edentulous and there are no teeth to gain the retention, stability, and support. Conclusion. In severe microstomia prosthesis insertion and removal can be achieved with modification of the maximum width of the prosthesis. Dental implant retention is useful treatment option in edentulous patients with maxillary surgical defect provided that sufficient bone volume and accessibility are there for implant placement.

Management of Severe Microstomia in a Ten-Week-Old Infant

Microstomia is rarely seen in pediatric patients, but usually results from burns, trauma, or caustic ingestions. There have been multiple studies reporting various techniques for oral commissure reconstruction, but few reports in infants. The authors present another modification of previous techniques of microstomia repair performed in a 10-week-old infant using multiple z-plasties and bilateral mucosal rhomboid flaps.

A Simple and Effective Method for Prosthetic Rehabilitation in Scleroderma Patients: A Clinical Report

Treatment of patients with microstomia due to scleroderma is complicated. Limited mouth opening and altered finger shape present difficulties at every step of the prosthetic rehabilitation. This article describes the prosthetic management of an edentulous patient with severe microstomia induced by scleroderma. From among the existing treatment options and according to the patient's ability and financial considerations, the authors provided a simple prosthetic design that effectively facilitated the patient's rehabilitation. To plan treatment for a patient with scleroderma, it is important to have knowledge about existing complications, alternative methods, and the patient's ability and comfort.

A Novel Nonoperative Technique in the Initial Management and Treatment of Congenital Microstomia

Congenital microstomia in the newborn can result in poor functional and aesthetic outcomes. In the past, treatment options have included surgical methods such as commissurotomies and z-plasties as well as nonsurgical treatments using oral splints. In severe microstomia, a surgical release may be required to permit splint placement. Because of the small diameter of the stoma, such surgical releases are not optimal and frequently must be repeated. We devised a nonoperative technique for the initial treatment of congenital microstomia that will slowly enlarge the stomal diameter without the need for surgical release. The patient is a newborn male born with multiple congenital anomalies including severe mandibular hypoplasia and retrusion, microstomia, and microglossia. The size of his oral cavity was less than 1 cm at birth with no clinical signs of a tongue. After initial dilation in the operating room with Hagar dilators, the oral stoma was serially dilated using Boston Scientific esophageal balloons. Once full dilation was achieved, we fabricated oral splints to continue the dilation process while maintaining oral competence with no surgical intervention.

Principes généraux de la chirurgie reconstructrice des séquelles de brûlures

The aims of burn reconstruction should be to preserve, restore, and maintain function and appearance so the patient can recover a social life. Reconstruction surgery is delayed until the scar tissue has fully matured; it occurs generally by 9 to 12 months or more (merits of vitro-pressure test). Exception in presence of severe contracture (growth disturbance, unstable scars, corneal exposure with ectropion, severe microstomia) Occupational and physical therapy, scar management, compressive techniques, psychotherapy are all integral components of burn rehabilitation, but the place of plastic surgeon is fundamental all along the process.

Sectional impressions and simplified folding complete denture for severe microstomia

Sectional impressions and simplified folding complete denture for severe microstomia

Sectional Impressions and Simplified Folding Complete Denture for Severe Microstomia

A patient presenting with severe microstomia (PDI Class IV) was unable to insert a maxillary complete denture. Sectional final impressions were made using two impression materials and an interlocking custom tray. A folding record base was used for maxillomandibular relationship records. A novel folding maxillary denture with a custom hinge and plunger attachment to lock the denture in the open position was fabricated. The patient was able to insert the collapsed denture, open it intraorally, and enjoy successful masticatory function.

Single-stage functional reconstruction of the post-burn lower lip

Burn scar contracture of the lower face and neck is one of the most difficult subjects to solve because it produces problems with function and appearance. The lip is a part of the face that is frequently affected by burn injury. Lower lip deformity can be due to an extrinsic or intrinsic cause. Post-burn sequelae in this area results in cosmetic disfigurement and psychological trauma to patients as it is often associated with ectropion of the lower lip, severe microstomia leading to poor oral access for intubation, drooling, difficulty in eating, speaking and oral hygiene. The aim is to describe a single-stage correction to address all of these problems for a successful outcome. The technique was applied to 30 post-burn scar contractures of the lower lip. We classified the deformities of the lower lip and based on this classification the surgical procedure was executed to obtain functional improvement. At 2 months post-surgery the patient is able to demonstrate speech clarity with full functional oral range of movement. Neck release combined with vermillionectomy and comissuroplasty of the lip is a rational approach for preserving the function. A good planning of reconstructive procedures, facilitate patient recovery and optimize functional and aesthetic outcomes.

Surgical treatment of a severe microstomia developed following leucocytoclastic vasculitis

Narrowing of the oral opening, also known as microstomia, is a rarely seen condition. It can develop iatrogenically after wide excision of perioral tumors with subsequent reconstruction or can be a component of severe scleroderma. In the pediatric population, exposure to caustic agents and subsequent scarring is another cause. This situation can cause problems in feeding, articulation, and oral hygiene. Most of the cases reported have been moderately affected; these require non-surgical treatment or a small procedure, such as a comissuroplasty, to provide an adequate oral opening. A case of severe microstomia developed as a result of a rare condition known as leucocytoclastic vasculitis is presented. A boy aged 2 1/2 years was admitted complaining of severely restricted mouth opening. This resulted from a complicated vasculitic illness, the etiology of which was unknown. The condition subsequently caused necrosis and gangrene with autoamputation of the toes of the right foot, the distal two phalanges of the right index finger, and the distal phalanx of the left ring finger. In addition to the limb problems, he also developed a similar situation around the left side of his mouth. For 21 days, he was treated with antibiotics and antifungal medication. He also had serial skin biopsies, which showed only a leucocytoclastic vasculitis. The initial examination revealed significant scarring around the mouth with a severe microstomia. His mouth opening area was restricted to 1 cm. The surgical correction consisted of opening the mouth using full-thickness incisions on both oral commissures to slightly overcorrect the situation. A moderately extensive dissection was carried out to identify the orbicularis muscles and to allow reconstruction of the muscular element of the commissures. Once the functional area of the commissures had been reconstructed, mucosal flaps were developed and advanced to form the red margin. After 7 years of follow-up, his mouth opening remains satisfactory, and he had been able to have extensive orthodontic treatment.

Freeman–Sheldon syndrome: a case report

Freeman-Sheldon Syndrome is a rare craniofacial syndrome that has not been described in the dental literature to date. The main feature of relevance is severe microstomia, which limits access for routine dental care. Dental treatment was carried out successfully under local anaesthetic for a young child with Freeman-Sheldon syndrome. A novel coloured compomer material was helpful in the management of the case. The importance of early referral of children with rare craniofacial anomalies to Specialist Paediatric Dental services is highlighted.

Prenatal diagnosis of Freeman–Sheldon syndrome and usefulness of an ultrasound fetal lip width normogram

Freeman-Sheldon syndrome (FSS) is a rare genetic condition with facial and joint abnormalities. Here we report the first case of prenatal diagnosis in a fetus with negative familial history for this syndrome. A chart of the fetal mouth length was generated and its usefulness verified. A cross-sectional study was carried out to derive standard charts for fetal lip lengths. The study population was made up of 371 fetuses between 15 and 38 weeks of gestation examined only once for this purpose. A statistical analysis previously recommended to derive normal ranges in fetal growth charts was employed. A 34-year-old woman was referred at 28 weeks of gestation for polyhydramnios and clubfeet. A detailed scan confirmed those findings and showed joint contractures of hands, a severe microstomia with a 'whistling' mouth, and an H-shaped mark over the chin. FSS was suspected, though there was no family history for this genetic syndrome. After emergency delivery at 32 weeks, the syndrome was confirmed. The infant died two months later from pneumonia. Upon construction of a standard mouth length chart, it was found that the fetal lip width in this case of FSS was well below the 5th centile. Here we present a standard chart for fetal lip width. We demonstrated its usefulness in cases with fetal face anomalies. Specific charts are fundamental for an objective assessment of the fetal parameters.

Fabrication of silicone oral splints for severe burn microstomia in children

This paper describes a simple technique of fabrication of oral splints (from silicone blocks), which can be utilized in the postoperative period following the release and graft of anterior oral contractures in children. Advantages of the silicone splint when compared to standard acrylic splints are discussed.

Oral lesions in recessive dystrophic epidermolysis bullosa

To study the prevalence of oral lesions in 35 patients diagnosed with generalized recessive dystrophic epidermolysis bullosa (RDEBg), with a quantification of their microstomia in comparison with a control group. The presence of oral mucosal lesions and interincisal maximum oral aperture (MOA) was determined, classifying microstomia according to the method of Naylor, Douglass and Mix (1984). Blister lesions were identified in 92% of the patients at the time of exploration--the tongue being the most affected location. Microstomia and palatal atrophy were the most prevalent sequelae (100%), while ankyloglossia, vestibular obliteration and lingual depapillation were recorded in over 90%. In 80% of the patients interincisal MOA was <30 mm (severe microstomia), while in the remaining cases maximum aperture was in the range of 31-40 mm (moderate microstomia). Blister lesions were found throughout the oral mucosa in our series of patients with RDEBg, the most frequently affected location being the tongue. These lesions in turn led to invalidating sequelae such as microstomia and ankyloglossia.

Effects of a nonsurgical exercise program on the decreased mouth opening in patients with systemic scleroderma.

The decreased mouth opening (microstomia) represents a frequent finding in patients with systemic scleroderma (SSD), but little information is available about the efficacy of nonsurgical management of this condition. The aim of this study is to assess the effects of a nonsurgical exercise program on the decreased mouth opening in a group of 10 SSD patients with severe microstomia (maximal mouth opening < or =30 mm). The subjects were instructed to perform an exercise program including both mouth-stretching and oral augmentation exercises. The effects of such exercises were assessed after an 18-week period by measuring the maximal mouth opening of each subject. All patients completed the study and no adverse effects occurred, with the exception of transient muscular fatigue. The exercise program improved the mouth opening of all subjects (mean increase: 10.7+/-2.06 mm, P<0.005), without significant differences between dentate and edentulous ones (P>0.1). At the end of the 18-week period, all patients commented that eating, speaking and oral hygiene measures were easier. The edentulous subjects also experienced less difficulty inserting their own dentures. These findings suggest that regular application of the proposed exercise program may be useful in the management of microstomia in SSD patients.

Severe microstomia due to burn by caustic soda

The lesions that compromise the labial commissures can cause microstomias (reduction of the size of the mouth), with important aesthetic and functional impairments (feeding, speech and oral hygiene). They are more frequent among children in the preschool and school age [1]. The congenital causes are rare, detachment in epidermolysis bullosa [2] and Freeman–Sheldon Syndrome [3]. Most of the cases are acquired, having as main etiology electric, thermal and chemical burns [4] (the Estlander’s technique for lip reconstruction is another acquired cause of microstomia) [5]. These deformities generally need surgical treatment, with a careful postoperative accompaniment.

Treatment of an edentulous patient with surgically induced microstomia: A clinical report

This clinical report describes the fabrication of a sectioned mandibular complete denture for a patient with severe microstomia. Dovetails were created in the denture base to orient and secure the prosthesis. (J Prosthet Dent 2002;87:423-6.)