Prosthetic management of a Hemi-mandibulectomy patient with Definitive Removable Prosthesis - A case report

Abstract

The loss of continuity of the lower jaw following surgical excision of tumor results in deviation of remaining mandibular segment toward the resected side. Swallowing, speech, mastication, and mandibular movements are adversely affected by mandibular surgery. Prosthetic rehabilitation plays a major role in these patients, by fabricating the whole array of prostheses to meet specific patient needs. This case report describes about the patient diagnosed with squamous cell carcinoma of alveolus on the left side. The patient had undergone hemi mandibulectomy followed by soft tissue reconstruction. As a result, mandible deviated to the affected side with trismus due to scar contraction. Second surgery was planned to remove the scar tissue and to improve mouth opening. Few days following second surgery, guiding flange prosthesis was fabricated to reduce the deviation and to guide the mandible close to occlusion. After three months, a removable cast partial prosthesis was fabricated, for the defect side which was supported by a wing to compensate for lack of underlying structures. It is imperative to provide such patients with guiding flange prosthesis three to four weeks after surgical management to guide mandible to occlusion and minimize the mandibular deviation. Failure to do so will complicate the occlusion. Subsequently patient can be rehabilitated with removable prosthesis to restore the function.