Evidence-Based Dentistry Protocol used in the Formulation and Application of Mandibular Muscle Physiotherapeutic Exercises in the Non-Surgical Correction of Mandibular Deviation Associated with Hemi-Mandibulectomy

Abstract

Dental literature demonstrates limited research on non-surgical management of hemi-mandibulectomy patients with completely edentulous arches and severe deviation. In this evidence-based case report, a 65 year old, Cantor Curtis Class III hemi-mandibulectomy patient presented to the Department of Prosthodontics with completely edentulous mandibular arch and chief complaint of difficulty in mastication and speech. Surgical correction was not possible due to patient's incompliance and history of radiation. Meanwhile, Prosthodontic prognosis was considered poor, due to severe deviation of the mandible and hence the patient was deemed unrehabilitable.Objective: 1) To understand the unusual activity of mandibular muscles in a hemi-mandibulectomy patient and find the muscles involved in causing deviation. 2) To devise Mandibular muscle physiotherapeutic exercises based on the "5 Step Evidence-Based Dentistry Protocol," in order to train the muscles in obtaining a harmonic maxillo-mandibular relationship. 3) Demonstrate the use of an Orthopedic Chin cup appliance as an adjunct to physiotherapy. Methodology:The "5 Steps of Evidence-Based Dentistry Protocol" were used to understand the unusual muscle activity in a hemi-mandibulectomy patient and formulate Mandibular Muscle physiotherapeutic exercises to limit deviation. The entire clinical scenario was translated into three answerable questions. Namely: 1) Which muscles cause the deviation of the mandible in hemi-mandibulectomy patients? 2) What are the recommended physiotherapeutic exercises to reduce deviation of the mandible in hemi-mandibulectomy patients along with the frequency and intensity of such exercises? 3) Would an extraoral appliance reduce mandibular deviation in edentulous patients? Results:Stepwise Evidence based Practice led to a reduction in the mandibular deviation by guiding muscles to a harmonic position. Following which, fabrication of maxillary removable partial denture with palatal ramp and mandibular complete denture was possible in a hemi-mandibulectomy patient restoring mastication, speech and overall (QOL) Quality of life, whose initial prosthetic prognosis was poor and deemed unrestorable. Conclusion:This evidence-based case report creates awareness among Dentists about the importance of knowledge of "Unusual muscle activity after hemi-mandibulectomy". In order to successfully rehabilitate such patients it is imperative for dentists to broaden their knowledge of the Stomatognathic system.