Case Report DOI: 10.18231/2395-499X.2017.0041 International Journal of Oral Health Dentistry; July-September 2017;3(3):195-198 195 Prosthetic management of hemimandibulectomy patient Lara Jain 1 , Himanshu Aeran 2,* , Neeraj Sharma 3 1 PG Student, 2 Director Principal, Professor & HOD, 3 Reader, Dept. of Prosthodontics, Seema Dental College & Hospital, Rishikesh, Uttrakhand *Corresponding Author: Email: drhimanu@yahoo.com Abstract Segmental resection of the mandible commonly results in the Mandibular deviation is multifactorial defect and its severity is based on the extent of osseous and soft tissue involvement, degree of tongue impaired, the loss of sensory and motor innervations, the type of wound closure, the presence of remaining natural teeth and finally the first initiation of prosthetic treatment. Prosthodontic treatment along with physical therapy may be useful in reducing mandibular deviation and improving masticatory efficiency. This clinical report describes the use of a cue-sill prosthesis to rehabilitate a hemimandibulectomy case for improved masticatory efficiency and esthetics. Introduction Odontogenic tumors of epithelial origin commonly seen in posterior mandible are often treated with surgical excision. Neoplastic lesions of the oral cavity requires resection involving mandible, floor of the mouth, tongue and also palate as per oral surgical assessment. If mandibular continuity is not restored during surgical closure of wound, the remaining mandibular segment will retrude and deviate toward the surgical side at the vertical dimension of rest. This mandibular deviation is mainly due to uncompensated influence of contralateral musculature particularly the internal pterygoid muscle and pull from the contraction of cicatricial tissue on resected side. A mandibular guidance prosthesis can be defined as a maxillofacial prosthesis used to maintain a functional position for the jaws (maxillae and mandible), improve speech and deglutition following trauma or/and surgery to the mandible or/and adjacent structures. The main objective of using a guidance prosthesis is to re-educate the mandibular muscles to re-establish an acceptable occlusal relationship (physiotherapeutic function) for residual hemimandible. Several modalities to return the mandible to optimum maxilla-mandibular relationship have been described. These include intermaxillary fixation, vacuum formed PVC splints, mandibular guidance prostheses and a widened maxillary occlusal table using a double row of teeth. The prosthodontic rehabilitation of patients with mandibular defects is challenging. The unilateral loss of mandibular continuity due to surgery or trauma results in mandibular deviation toward the defect side with lack of occlusion. Unlike the dentulous patients, edentulous patients are difficult to retrain mandibular movement and many times may never achieve proper maxillomandibular relationships for optimum mastication and appearance. There are several unfavourable, physical limitations when rehabilitating completely edentulous patients with resected mandibles. This includes resected skin grafts, scar tissue and deviation of the resected mandibles, limited coordinative ability, and resorbed ridges. One of the basic objectives in rehabilitation is to retrain the muscles for mandibular denture control and repeated occlusal approximation. A case of a partially edentulous hemimandibulectomy patient for replacement of missing teeth after 2years of cancer therapy reported. Initial evaluation of considering prosthetic management indicated poor prognosis. However, the patient's positive mental attitude toward treatment along with the application of basic fundamental principles by the prosthodontist during treatment procedure led to fabricate a simple, effective functioning prosthesis that showed positive satisfactory prosthetic results. Classification Cantor & Curtis provided a hemimandibulectomy classification for edentulous patient that can also be applied in partially edentulous arches. Class I: Mandibular resection involving alveolar defect with preservation of mandibular continuity. Class II: Resection defects involve loss of mandibular continuity distal to the canine area. Class III: Resection defect involves loss up to the mandibular midline region. Class IV: Resection defect involves the lateral aspect of the mandible, but are augmented to maintain pseudoarticulation of bone and soft tissues in the region of the ascending ramus. Class V: Resection defect involves the symphysis and parasymphysis region only, augmented to preserve bilateral temporomandibular articulations. Class VI: Similar to class V, except that the mandibular continuity is not restored. This article describes the use of a cue-sill prosthesis in a patient who had undergone partial mandibulectomy. Case Report A 53 year old male patient reported to the Department of Prosthodontics in Seema Dental College and Hospital, Rishikesh, with a chief complaint of asymmetry of the mandible, drooling of saliva and difficulty in chewing and speaking since 10 months. The