Management of hemi-mandibulectomy patient with prosthetic devices

Abstract

The success in rehabilitating a patient with hemi-mandibulectomy depends upon the nature and extent of the surgical defect, treatment plan, type of prosthesis, and patient co-operation. The management becomes more challenging when the prosthetic reconstruction has been delayed. The scar tissue forms and the soft tissue becomes stiff, causing severe deviation in the mandible towards the resected side. This case report presents a58year old male patient who underwent a mandibular resection surgery after he was diagnosed with buccal mucosa carcinoma. The patient had mandibular deviation and deranged occlusion making his speech, mastication and esthetics compromised.: The patient was provided with a cast guide flange prosthesis in the beginning as a training device to prevent the scar contracture and increase the mandibular movement towards healthy side to increase the intercuspation. After few months of training, when the deviation was reduced, flexible maxillary and mandibular partial dentures were fabricated with double occlusion in the maxillary denture to increase the masticatory efficiency of the patient.This case report attempts to formulate a treatment plan whereby the patient's discomfort could be minimized. The treatment starts with the fabrication of a removable guide flange as a physical therapy device to reduce the mandibular deviation followed by provision of a maxillary denture with double occlusion to obtain maximum intercuspation.The mandibulectomy patient is difficult to manage because a prosthodontist is limited in his ability to provide a reasonable and practical prosthesis. However, if the patients recognize the limitations of their rehabilitation, they would be more appreciative of the prosthodontic therapy that enhances their rehabilitative progress.