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CASE REPORT
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Prosthetic management of a postsquamous cell carcinoma patient with maxillomandibular resection including lip


 Department of Prosthodontics, King George's Medical University, Lucknow, Uttar Pradesh, India

Date of Submission07-Aug-2020
Date of Decision28-Sep-2020
Date of Acceptance12-Jan-2021
Date of Web Publication22-Jun-2022

Correspondence Address:
Raghuwar Dayal Singh,
Department of Prosthodontics, King George's Medical University, Lucknow - 226 003, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcrt.JCRT_1132_20

 > Abstract 


Maxillofacial defects not only create esthetic and functional problems for the patient but also have psychological and social impact on the patient. The present clinical report describes the management of a patient who had undergone partial maxillectomy, hemimandibulectomy, and partial resection of the lip on the left side. Rehabilitation of this patient was done using silicone lip prosthesis and maxillary obturator. These prostheses improve the esthetics, function, and provide confidence to the patient, hence improving his social life. The lip prosthesis was retained by two magnets that were attached to the denture cum obturator to provide good retention and stability to the lip prosthesis.

Keywords: Denture cum obturator, jaw resection, lip prosthesis, magnet, squamous cell carcinoma



How to cite this URL:
Sohmat P, Jurel SK, Singh RD, Chand P, Solanki N. Prosthetic management of a postsquamous cell carcinoma patient with maxillomandibular resection including lip. J Can Res Ther [Epub ahead of print] [cited 2022 Jul 2]. Available from: https://www.cancerjournal.net/preprintarticle.asp?id=347786




 > Introduction Top


Maxillofacial defects not only create functional and esthetic problems but also have an adverse psychological impact on the patient.[1] In this case report, the patient was rehabilitated with an obturator for the partial maxillectomy defect, in which double row of teeth were given to compensate the deviation of the mandible and also to improve the masticatory efficacy. Lip prosthesis was also given, which was retained to the obturator using magnets.


 > Case Report Top


A 50-year-old male patient presented with a history of squamous cell carcinoma involving the left side of the maxilla, left mandible as well as a portion of the lip.

He underwent surgical resection one year back which included hemimandibulectomy (from the left condyle to the 31 tooth region), maxillectomy of the left maxilla and a part of the left side of the lip was also resected along with the defect [Figure 1]a. The teeth present in the maxilla were 13, 14, 15, and 16 and in the mandible 41, 42, 43, 44, 45, and 46 [Figure 1]b. No surgical reconstruction was done; radiotherapy was given and was completed 6 months back. The patient was given surgical obturator after the surgery and later interim obturator. Treatment was not done for the deviated mandible.
Figure 1: (a) Orthopantomogram of the patient. (b) Intraoral view of the patient. (c) Denture with palatally placed teeth

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On examination, attempt to move the mandible to the unresected side showed stiffness and the patient was unable to move the mandible toward the unresected side. Because the patient was not able to attain a proper mediolateral position as well as an acceptable occlusal contact of the teeth on the remaining segment, guidance prosthesis was deemed of little use to improve the condition. Hence, in this case, the treatment plan was the fabrication of a maxillary denture cum obturator to improve esthetics, function, and speech of the patient, and it was also used for the attachment of lip prosthesis using magnets. Informed patient consent was obtained for the treatment as well as any future documentation.

Procedure

Maxillary and mandibular preliminary impressions were made in irreversible hydrocolloid impression material (Tropicalgin, Zhermack, Badia Polesine, Italy), and the casts were poured with type III dental stone (Kalstone, Kalabhai, Mumbai, India). A custom tray was fabricated on the primary cast and the final impression was made in elastomeric impression material (Elite HD; Zhermack, Badia Polesine, Italy). A 21-gauge round, stainless steel orthodontic wire was used to fabricate circumferential clasps on the 13 and 16 teeth, and a pinhead clasp was given between 14 and 15. Following this, a temporary record base was fabricated with occlusal wax rim, and the functional relationship was recorded. The patient was instructed to move his mandible as far as possible toward the unresected side and then gently close his mandibular jaw into that position to record a maxillomandibular relationship, where the patient can occlude with ease without much difficulty. The casts were mounted on the semiadjustable articulator (Hanau Wide-Vue, Louisville, United States).

Artificial teeth were arranged palatally to the natural teeth on the unresected side and were made to occlude with the mandibular posterior teeth. The double row of teeth were given to compensate for the excessive deviation of mandible, in an attempt to occlude the mandibular posterior teeth with the artificial teeth in the maxillary denture cum obturator to improve the masticatory efficiency. Try-in was done where esthetics and occlusion were evaluated [Figure 1]c.

Now, with the try-in denture cum obturator in place, preliminary impression of the upper lip till the chin was made in irreversible hydrocolloid impression material, and the cast was poured. Wax was used to sculpt the lip prosthesis on the working cast and try-in was done on the face to evaluate the contour and margin adaptation [Figure 2]a. Two marks were made on the trial denture cum obturator for magnet placement, and the markings were transferred to the lip prosthesis. Two pieces of stainless steel metals were trimmed to match the size of the magnet. Exposure of the metal was given only on the surface that will be attached to the magnet embedded in the obturator. The waxed trial of both the lip, and denture cum obturator prosthesis were flasked independently. A hollow closed bulb was given to the obturator by the use of a lost salt technique to reduce the weight of the prosthesis.
Figure 2: (a) Try-in of the lip prosthesis. (b) Magnets within the denture. (c) Extraoral view before the prosthesis. (d) Extraoral view after the prosthesis

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Facial shade was matched using a spectrophotometer (eSkin), the code was transferred to the eSkin website, and silicone mixing was done accordingly. While silicon (Technovent M511; Technovent Ltd.,) mixing, intrinsic colorants were incorporated accordingly. Packing was done and then vulcanized according to the manufacturer's directions. After processing, the silicone prosthesis was removed from the mold and the excess were trimmed with fiber trimming wheels and burs. Extrinsic staining was done, so that the color of the prosthesis blends with the skin of the patient. After both the prostheses were retrieved, the magnets were positioned on the obturator using pickup technique using self-cure acrylic, so that the patient could easily insert and remove the obturator prosthesis and correctly position and place the lip prosthesis. Two electrochemical frequency modulation alloy dynamagnets (Dyna Dental Engineering BV Vang 9, Halsteren, Netherlands) were incorporated within the maxillary denture cum obturator [Figure 2]b, to provide retention for the lip prosthesis. Based on subjective assessment, the described treatment markedly improved the patient's quality of life [Figure 2]c and [Figure 2]d.


 > Discussion Top


Maxillofacial prosthesis provides a valuable treatment in the restoration of lost facial parts as surgical reconstruction may not be able to restore the full esthetic requirement.[2],[3],[4],[5],[6] Loss of part of lip can hamper the social appearance of the patient along with the speech.[2] Various modes of retention of these prostheses have been used such as anatomic undercuts, adhesives, and osseointegrated implants. Postsurgical resection, modification of the residual soft tissues might provide retention to prosthesis.[7] However, as any secondary surgical exposure was not acceptable to the patient in this case, magnets embedded in intraoral denture were used for retaining the extraoral lip prosthesis. Successful use of magnets for improving extraoral prosthesis retention has been reported in the literature.[8] The patient was satisfied with the appearance and reported improvement in speech and chewing efficiency by the use of double rows of teeth on the obturator.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Beumer J, Curtis T, Marunick M. Maxillofacial Rehabilitation: Prosthodontic and Surgical Considerations. Tokyo: Ishiyaku EuroAmerica Inc.; 1996. p. 377-454.  Back to cited text no. 1
    
2.
Cheng AC, Morrison D, Maxymiw WG, Archibald D. 1997 Judson C. Hickey Scientific Writing Awards. Lip prosthesis retained with resin-bonded retentive elements as an option for the restoration of labial defects: A clinical report. J Prosthet Dent 1998;80:143-7.  Back to cited text no. 2
    
3.
McKinstry RE. Fundamentals of facial prosthetics. Clearwater (FL): ABI Professional Publications; 1995. p. 19-30.  Back to cited text no. 3
    
4.
Parel SM, Branemark PI, Tjellstrom A, Gion G. Osseointegration in maxillofacial prosthetics. Part II: Extraoral applications. J Prosthet Dent 1986;55:600-6.  Back to cited text no. 4
    
5.
La Velle W, Arcuri M, Panje W, Jons R. Transmolar pin and magnetic carrier for midfacial reconstruction: A clinical report. J Prosthet Dent 1993;70:204-6.  Back to cited text no. 5
    
6.
Pillet J. Esthetic hand prostheses. J Hand Surg Am 1983;8:778-81.  Back to cited text no. 6
    
7.
Birnbach S, Herman GL. Coordinated intraoral and extraoral prostheses in the rehabilitation of the orofacial cancer patient. J Prosthet Dent 1987;58:343-8.  Back to cited text no. 7
    
8.
Rao SB, Gurram SK, Mishra SK, Chowdhary R. Magnet retained lip prosthesis in a geriatric patient. J Indian Prosthodont Soc 2015;15:187-90.  Back to cited text no. 8
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