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A systematic approach in rehabilitation of hemimandibulectomy: A case report

View Article: PubMed Central - PubMed

ABSTRACT

Loss of mandibular continuity results in deviation of remaining mandibular segment toward the resected side primarily because of the loss of tissue involved in the surgical resection. The success in rehabilitating a patient with hemimandibulectomy depends upon the nature and extent of the surgical defect, treatment plan, type of prosthesis, and patient co-operation. The earlier the mandibular guidance therapy is initiated in the course of treatment; the more successful is the patient's definitive occlusal relationship. Prosthodontic treatment coupled with an exercise program helps in reducing mandibular deviation and improving masticatory efficiency. This case report describes prosthodontic management of a patient who has undergone a hemimandibulectomy and was rehabilitated using provisional guide flange prosthesis followed by a definitive maxillary and mandibular cast partial denture with precision attachments designed to fulfill the patient's needs and requirements.

No MeSH data available.


(a) Pretreatment intraoral view (b) Pretreatment orthopantomogram
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Figure 1: (a) Pretreatment intraoral view (b) Pretreatment orthopantomogram

Mentions: A 44-year-old female patient reported to the Department of Prosthodontics with the chief complaint of difficulty in chewing food due to the deviation of jaw, missing teeth, and wanted replacement of teeth [Figure 1a]. The patient gave a history of supari chewing since 20 years, 8-10 times/day. The patient was diagnosed with early squamous cell carcinoma involving left buccal mucosa and mandibular alveolus and thus left side hemimandibulectomy was performed 6 months ago. Radiation therapy was completed a month before. Extraoral examination revealed facial asymmetry, deviated lower third of face, decreased mouth opening, significant deviation of mandible to left side on mouth opening, left corner of mouth drooping downward, angular cheilitis, and left condyle and ramus absent on palpation. The patient could manually guide herself into occlusion. Intraoral examination revealed left mandibular defect distal to lateral incisor, surgical skin graft seen on resected side, 23–27; 34–37, 32–43, and 45–47 teeth missing. Maxillary and mandibular arches were partially edentulous, representing Kennedy's Class II and Class I condition respectively. Both the ridges were smooth, round with well-keratinized mucosa with sufficient height and width for support. Root pieces were present in the 46, 47 region. Orthopantomogram revealed the absence of the mandible distal the mandibular left canine [Figure 1b]. The case was diagnosed as Cantor and Curtis Class II mandibular defect. Treatment plan decided was mandibular guide flange prosthesis to aid in correction of mandibular deviation, followed by a definitive prosthesis of a maxillary cast partial denture with double row of teeth on nonresected side and a mandibular cast partial denture retained by precision attachments with a buccal guiding flange.


A systematic approach in rehabilitation of hemimandibulectomy: A case report
(a) Pretreatment intraoral view (b) Pretreatment orthopantomogram
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4837783&req=5

Figure 1: (a) Pretreatment intraoral view (b) Pretreatment orthopantomogram
Mentions: A 44-year-old female patient reported to the Department of Prosthodontics with the chief complaint of difficulty in chewing food due to the deviation of jaw, missing teeth, and wanted replacement of teeth [Figure 1a]. The patient gave a history of supari chewing since 20 years, 8-10 times/day. The patient was diagnosed with early squamous cell carcinoma involving left buccal mucosa and mandibular alveolus and thus left side hemimandibulectomy was performed 6 months ago. Radiation therapy was completed a month before. Extraoral examination revealed facial asymmetry, deviated lower third of face, decreased mouth opening, significant deviation of mandible to left side on mouth opening, left corner of mouth drooping downward, angular cheilitis, and left condyle and ramus absent on palpation. The patient could manually guide herself into occlusion. Intraoral examination revealed left mandibular defect distal to lateral incisor, surgical skin graft seen on resected side, 23–27; 34–37, 32–43, and 45–47 teeth missing. Maxillary and mandibular arches were partially edentulous, representing Kennedy's Class II and Class I condition respectively. Both the ridges were smooth, round with well-keratinized mucosa with sufficient height and width for support. Root pieces were present in the 46, 47 region. Orthopantomogram revealed the absence of the mandible distal the mandibular left canine [Figure 1b]. The case was diagnosed as Cantor and Curtis Class II mandibular defect. Treatment plan decided was mandibular guide flange prosthesis to aid in correction of mandibular deviation, followed by a definitive prosthesis of a maxillary cast partial denture with double row of teeth on nonresected side and a mandibular cast partial denture retained by precision attachments with a buccal guiding flange.

View Article: PubMed Central - PubMed

ABSTRACT

Loss of mandibular continuity results in deviation of remaining mandibular segment toward the resected side primarily because of the loss of tissue involved in the surgical resection. The success in rehabilitating a patient with hemimandibulectomy depends upon the nature and extent of the surgical defect, treatment plan, type of prosthesis, and patient co-operation. The earlier the mandibular guidance therapy is initiated in the course of treatment; the more successful is the patient's definitive occlusal relationship. Prosthodontic treatment coupled with an exercise program helps in reducing mandibular deviation and improving masticatory efficiency. This case report describes prosthodontic management of a patient who has undergone a hemimandibulectomy and was rehabilitated using provisional guide flange prosthesis followed by a definitive maxillary and mandibular cast partial denture with precision attachments designed to fulfill the patient's needs and requirements.

No MeSH data available.