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 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 4  |  Issue : 3  |  Page : 205-207

Postsurgical prosthetic rehabilitation of unilateral hemimandibulectomy with customized wire guided mandibular prosthesis


Department of Prosthodontics, Post Graduate Institute of Dental Sciences, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana, India

Date of Web Publication9-Dec-2015

Correspondence Address:
Manu Rathee
Department of Prosthodontics, Post Graduate Institute of Dental Sciences, Pt. B. D. Sharma University of Health Sciences, Rohtak, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-0521.171435

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  Abstract 

Segmental resection of the mandible destroys the balance and symmetry of function, leading to altered mandibular movements and deviation of the residual fragment toward the resected side. Prosthodontic management of unilateral hemimandibulectomy is aimed to reduce mandibular deviation and to improve the masticatory effiency. This clinical report describes a simple and efficient method utilizing customized wire-made-guide removable prosthesis to aid in reducing the mandibular deviation and enhances the masticatory efficiency.

Keywords: Hemimandibulectomy, mandibular resection, prosthesis


How to cite this article:
Rathee M, Bhoria M, Boora P. Postsurgical prosthetic rehabilitation of unilateral hemimandibulectomy with customized wire guided mandibular prosthesis. Saudi J Health Sci 2015;4:205-7

How to cite this URL:
Rathee M, Bhoria M, Boora P. Postsurgical prosthetic rehabilitation of unilateral hemimandibulectomy with customized wire guided mandibular prosthesis. Saudi J Health Sci [serial online] 2015 [cited 2019 Jul 20];4:205-7. Available from: http://www.saudijhealthsci.org/text.asp?2015/4/3/205/171435


  Introduction Top


Prosthetic rehabilitation following hemimandibulectomy is one of the most challenging and demanding maxillofacial prosthetic procedures. The site, extent of resection and loss of continuity, markedly influences the masticatory function. Segmental resection of the mandible significantly affects physiological, psychological, and esthetic outcomes. The common finding includes masticatory impairment and deviation of mandible toward the resected side.[1],[2] The mandibular guidance therapy delivered in the early phase of rehabilitation ensures optimal occlusal relationship and masticatory efficiency. Achieving the normal maxillomandibular relations is obstructed by extensive surgical jaw resection, postsurgical complications, and radiation therapy. The buccal-based guidance restorations and palatal-based guidance restorations have been effective in reducing the mandibular deviation.[3],[4] Any uncoordinated masticatory movements may cause trauma and resultant complications. Hence, meticulous periodic monitoring of prosthesis along with resected mandibular site are considered a major part in affecting the success of management.[4] This article presents a simple and efficient method of rehabilitation utilizing customized wire-made-guide removable prosthesis to aid in reducing the mandibular deviation and enhance the masticatory efficiency.


  Case Report Top


A 60-year-old male reported with the chief complaint of deviation of lower jaw and difficulty in chewing food. The previous medical and dental records revealed a diagnosed and surgically treated case of squamous cell carcinoma with postsurgical radiation therapy in the neck region 1 year back. Extraoral examination revealed facial asymmetry with mandibular deviation to the left side. Clinical examination revealed severe deviation of the mandible toward the resected side. On intraoral examination, 31–37 were missing teeth. The mandibular defect was classified as Cantor and Curtis Class III. The radiographic examination showed a unilateral discontinuous mandibular defect on the left side [Figure 1 and [Figure 2]. The patient was clinically evaluated for the guide flange prosthesis (GFP). It was noted that the mandible could be manually placed into the centric occlusion without excessive force. A mandibular acrylic removable prosthesis with a wire-made-guide flange fabrication was planned.
Figure 1: Preoperative intraoral view

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Figure 2: Orthopantomograph showing the extent of surgical resection defect

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Prosthesis design

The design of maxillofacial prosthesis followed the general principles of a removable partial denture. The removable partial denture was planned with maxillary and mandibular buccal supporting acrylic flanges and a 19 gauge stainless steel wire-made-guide flange. The retention to supporting buccal acrylic flanges was provided by the interdental wire design using stainless steel wire engaging the canine, premolars, and the molars. For wire-made-guide flange, 19 gauge stainless steel wire was attached and extended from buccal supporting flange of mandibular prosthesis superiorly to the buccal supporting flange of maxillary arch.

Clinical procedure

The preliminary impressions of maxillary and mandibular arches were made with irreversible hydrocolloid (Algitex, DPI, Mumbai). The diagnostic cast was surveyed and planned for the framework. The maxillomandibular relationship was recorded using facebow followed by manually assisted static technique and mounting procedure accomplished on a Hanau Wide-Vue articulator. Try-in of the mandibular denture was done [Figure 3]. Here, the posterior occlusion was established on the defect side as the surgical wound was well healed and organized. The occlusion was planned to provide a contact in centric occlusion with no contact in an eccentric position on the defect side. The supporting acrylic flange on the buccal side of the maxillary and mandibular arch was made after block out to least traumatized the gingiva when the patient closes the mouth. The wire-made-guide flange using 19 gauge stainless steel wire was prepared and attached on the mandibular buccal acrylic supporting flange with sufficient extension on maxillary buccal acrylic supporting flange [Figure 4]. The prosthesis was finished, inserted, and evaluated intraorally. Optimal function was achieved with the prosthesis. The patient was instructed about the use, hygiene maintenance, and regular follow-up.
Figure 3: Wire-made-guide mandibular prosthesis on articulator

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Figure 4: Postoperative intraoral view showing prosthesis in situ

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  Discussion Top


Oral cancer is the eighth most common carcinoma worldwide, which often requires resection involving both the jaw bones, the floor of the mouth, and tongue that may result in adversely affecting an individual's mental well-being. The mandibular resection results in the loss of proprioceptive sense of occlusion. The absence of the muscles of mastication on the resected side causes significant rotation of the mandible on closure and the mandibular deviating toward the affected side.[3],[4] The success of the mandibular resection prosthesis is related directly to the amount of the remaining bone and soft tissue. Segmental mandibulectomy results in special physiological and esthetic problems. Frequently, the edentulous mandible requires reconstructive plastic surgery to create a buccal or lingual sulcus depth to provide a favorably attached tissue foundation for an acceptable mandibular denture. Cantor and Curtis provided a hemimandibulectomy classification for an edentulous patient that can also be applied in partially edentulous arches.[5] Cantor and Curtis Classes II–V guide fiange prosthesis is an accepted treatment modality. The presence of a sufficient number of periodontally sound teeth is required for effective guide fiange prosthesis. GFP is a mandibular, conventional prosthesis designed for the patient who is able to achieve an appropriate mediolateral position of the mandible but is unable to repeat this position consistently for adequate mastication. Hence, in such cases, the maxillofacial prosthetic care delivered through static prosthetic requirements is useful for restoring large maxillofacial defects. The objective of maxillofacial prosthesis is to reconstruct disfigurement caused by maxillofacial defects by providing a GFP to relocate the deviated jaw positioning. The surgical loss of jaw bone restored by prosthetic care imparts the great improvement in speech and swallowing that can significantly help the rehabilitation.[6],[7]

The presented design is a simple, efficient, and convenient method for fabrication of customized wire-made-guide flange removable prosthesis to aid in the reducing the mandibular deviation and enhances the masticatory efficiency. The patient accepted the final prosthesis as oral functions were restored successfully. Low weight prosthesis with low-cost is conservative rehabilitation prosthesis for hemimandibulectomy patients.


  Conclusion Top


The prosthetic management with mandibular guiding flange prosthesis provides a biomechanical system to restore and reconstruct the defect and deviation that allows ease of placement, maintenance, and in addition, low-cost, low-weight that enhances the acceptance of prosthetic phase. This conservative treatment provides a more conducive psychological and physiological balance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Mou SH, Chai T, Shiau YY, Wang JS. Fabrication of conventional complete dentures for a left segmental mandibulectomy patient: A clinical report. J Prosthet Dent 2001;86:582-5.  Back to cited text no. 1
    
2.
Banerjee R, Banerjee S. Guiding flange prosthesis for a patient with a hemi-mandibulectomy defect: A clinical report. J Clin Diagn Res 2010;4:2347-53.  Back to cited text no. 2
    
3.
Nelogi S, Chowdhary R, Ambi M, Kothari P. A fixed guide flange appliance for patients after a hemimandibulectomy. J Prosthet Dent 2013;110:429-32.  Back to cited text no. 3
    
4.
Sahu SK. Mandibular guide flange prosthesis following mandibular resection: A clinical report. J Clin Diagn Res 2010;4:3266-70.  Back to cited text no. 4
    
5.
Cantor R, Curtis TA. Prosthetic management of edentulous mandibulectomy patients. I. Anatomic, physiologic, and psychologic considerations. J Prosthet Dent 1971;25:446-57.  Back to cited text no. 5
    
6.
Agarwal S, Praveen G, Agarwal SK, Sharma S. Twin occlusion: A solution to rehabilitate hemimandibulectomy patient – A case report. J Indian Prosthodont Soc 2011;11:254-7.  Back to cited text no. 6
    
7.
Patil PG, Patil SP. Guide flange prosthesis for early management of reconstructed hemimandibulectomy: A case report. J Adv Prosthodont 2011;3:172-6.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
References
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