PROSTHETIC MANAGEMENT OF NEUROMUSCOLAR REHABILITATION IN HEMIMANDIBULECTOMY PATIENTS. A CASE REPORT.

ABSTRACT: The radio-surgical treatments for carcinomas involving the oral cavity are often destructive in order to limit as much as possible the high rate of recidivism. The outcome of the combined treatment is represented by lesions on hard and soft healthy tissues besides naturally by a more or less important mandibular deviation depending on greater or lesser quantity of basal bone excised. In some cases it is possible to surgically restore the defective mandible through bone grafting; this means a quite perfect restitutio ad integrum of the mandibular arch; instead, in other cases, because of bone and soft tissue biology, general healthy state and age of the patient prosthetic management would be better as it is less invasive even if less resolutive. For a right tonsillar cavity carcinoma the patient, T. F., female, 73-year old, had undergone radical neck dissection and hemisection of the homolateral mandible. A guide-device was realized for "guiding" the residual mandible into the physiological centric occlusion position, and then a removable partial denture was realized as a definitive prosthesis. After 3 months therapy the patient was easily able to spontaneously reposition the hemimandible itself, also with considerable improvement of the masticatory function. Neuromuscular re-education of hemimandibulectomy patients via the use of a guide flange on a removable prosthesis applied to the residual mandible represents a fundamental condition for permanent prosthetic rehabilitation.