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References

Karapandzic M Reconstruction of lip defects by local arterial flaps. Br J Plast Surg. 1974; 27:(1)93-97
Cura C, Cotert HS, User A Fabrication of a sectional impression tray and sectional complete denture for a patient with microstomia and trismus: a clinical report. J Prosthet Dent. 2003; 89:(6)540-543

Flexible and sectional complete dentures with magnetic retention for a patient with microstomia – a case report

From Volume 43, Issue 3, April 2016 | Pages 212-213

Authors

Elizabeth King

BDS(Hons), MFDS, MSc

Senior Associate Teacher/Consultant in Restorative Dentistry, Bristol University/Bristol Dental Hospital, Lower Maudlin Street, Bristol BS1 2LY, UK.

Articles by Elizabeth King

James Owens

BDS(Wal), FDS RCS(Edin), MSc(Brist), FDS(Rest Dent), MRD RCS(Edin) FHEA

Consultant, Department of Restorative Dentistry, Morriston Hospital, Swansea SA6 6NL, UK

Articles by James Owens

Abstract

This case report describes treatment for a patient with microstomia and the development of the index of oral access for restorative dental treatment (IOA).

CPD/Clinical Relevance: An understanding of the causes of microstomia and challenges encountered when treating microstomia patients with an index to aid diagnosis and treatment planning.

Article

Microstomia is the congenital, developmental or acquired reduction in size of the oral aperture to a degree where function and aesthetics are compromised. Causes include:

  • Congenital craniofacial abnormalities;
  • Systemic or autoimmune diseases affecting the connective tissues;
  • Fibrosis following head and neck irradiation;
  • Submucous fibrosis; and
  • Scarring following peri-oral surgery or trauma.

    • Treatment often involves oral opening devices and, less commonly, surgery, however, the majority of microstomia-related diseases are irreversible and/or progressive and therefore patients are often left with functional and aesthetic impairments.

    Provision of removable prostheses for such patients is challenging due to the reduced elasticity and altered anatomy of the oral tissues. Furthermore, restricted oral opening can make it considerably difficult, if not impossible, for patients to insert and remove conventional dentures. The utilization of modern flexible materials and use of sectional denture design can help overcome these problems.

    Case report

    The patient presented with surgically induced microstomia following treatment for squamous cell carcinoma (SCC) of the lower lip using a bilateral Karapandzic flap resection and reconstruction (Figures 1–3). Successful dental rehabilitation was achieved using maxillary and mandibular complete sectional dentures with flexible substructures and rigid superstructures retained by magnets (Figures 4–7).

    Figure 1. SCC lower lip pre-operatively – patient to undergo bilateral Karapandzic flap procedure.1
    Figure 2. Diagram of Karapandzic flap.2
    Figure 3. Microstomia post-operatively.
    Figure 4. Flexible and sectional dentures with magnetic retention between bases – mandibular flexible base and rigid superstructure.
    Figure 5. Flexible and sectional dentures with magnetic retention between bases – maxillary flexible base and rigid superstructure.
    Figure 6. (a, b) Patient successfully inserting maxillary flexible base and rigid superstructure.
    Figure 7. Dentures in situ.

    Management of microstomia involves multiple specialties within Medicine and Dentistry, however, there is currently no recognized method of communicating the severity of microstomia amongst clinicians. Included in this report is a microstomia severity index developed to aid clinicians in diagnosing, recording and monitoring the severity of microstomia, and to encourage more objective treatment planning for this patient group (Table 1).


    IOA 0 - Normal
  • Access to all areas of the mouth for all restorative treatment possible
  • Modification of impression technique or prosthetic design not required
    • IOA 1 - Mild
  • Access to molar teeth restricted - complex treatment (endodontic treatment/indirect restorations) may be compromised or not possible
  • Minor modification of impression technique required to enable impression-taking
  • Minor modification to prosthetic design required to enable insertion and removal
    • IOA 2 - Moderate
  • Access to molar teeth for restorative treatment not possible
  • Access to premolar teeth restricted - complex treatment (endodontic treatment/indirect restorations) may be compromised or not possible
  • Access to incisors and canines for all treatment possible
  • Modification of impression trays required to enable impression-taking
  • Modification to prosthesis design required to enable insertion and removal
    • IOA 3 - Severe
  • Access to incisor and premolar teeth restricted - complex treatment (endodontic treatment/indirect restorations) may be compromised or not possible
  • Impression-taking severely compromised and significant modification to trays and technique required to enable impression-taking
  • Significant and complex adjustments to prosthetic design required
    • IOA 4 - Extreme
  • Access to all restorative treatment not possible
  • Impression-taking not possible
  • Prosthetic rehabilitation modification not possible