Prosthodontic Management of Segmental Mandibulectomy Patient with Guidance Appliance and Overlay Denture

Abstract

Patients who undergo segmental or hemi-mandibulectomy suffer from various postoperative problems in esthetics and function. The solution to such problem is providing a mandibular guidance appliance to correct mandibular deviation to resected side due to loss of muscle action on the affected side. This article describes the treatment of a female patient who underwent segmental mandibulectomy on right side secondary to adenoid cystic carcinoma of the base of tongue. An acrylic guidance appliance was constructed to help control the mandibular deviation and co-ordinate masticatory movements. The prosthesis was worn continuously by the patient for 1 month which corrected the occlusion on the left side. To compensate for the open-bite caused due to rotation of mandible following partial mandibulectomy, an overlay removable partial denture was given. The patient was satisfied with the improvement in esthetics and mastication.

Guidance Prostheses for Partial Mandibulectomy Patients: A Case Series

“…The loss of mandibular continuity disrupts the mandible's balance and symmetry, resulting in altered movements and deviation of the remaining section toward the surgical site [6,7]. Various complex and interrelated factors such as scar contracture, tight wound closure, and muscle imbalance affect the postsurgical envelope of motion and the deviation severity.…”

Prosthetic management of hemimandibulectomy patient with guiding plane and twin occlusion prosthesis

“…When surgical reconstruction following mandibulectomy is not feasible, various prosthesis are used to reduce or eliminate mandibular deviation. [ 4 6 9 10 11 12 13 14 ] In the present case, a maxillary acrylic inclined guiding plane prosthesis was fabricated to assist muscle retraining as acrylic allows for some adjustments when the relationship improves in positioning the mandible. This inclined plane prosthesis is generally indicated for those patients who are edentulous in the maxillary arch only and who have anatomic contours that permit good border seal and a stable maxillary prosthesis similar to the case presented.…”

Radiotherapy and Management in Maxillofacial Prosthodontic: Part 1- Before Radiotherapy

“…Pour les cas de déviation mandibulaires très sévères, l'appareil avec plan de guidage palatin est préférée par rapport à celle mandibulaire [51] le plan guide incliné permet de guider la mandibule au moment de la fermeture en la dirigeant vers une position inter occlusale correcte. La présence des dents au niveau des deux arcades est importante pour une guidance efficace et aide pour la reprogrammation de la mandibule [52] Confection des appareils porte rayonnement, des gouttières de protection plombée, des gouttières de repositionnement : [40] Le spécialiste en PMF confectionne des dispositifs pour réduire les effets iatrogènes tissulaires induits par la radiothérapie, parmi ces dispositifs on note : Les Stents de Positionnement : Il s'agit en effet d'un artifice permettant d'isoler le volume à irradier, il est utilisé souvent dans les cas de cancer de la langue et de la lèvre traité par RTH conventionnelle ; en effet une position inférieure de la langue et de la mandibule permet au radiothérapeute de déplacer les champs d'irradiation et donc d'épargner une portion importante des glandes salivaires des irradiations. Ces dispositifs doivent permettre un repositionnement répétitif des structures à irradier durant la période du traitement (6 à 8 semaines).…”