Microstomia: Difficult Proposition to Rehabilitate

Introduction: The rehabilitation of microstomia patientspresents difficulties during fabrication of denture as themaximal mouth opening is inadequate. This condition mayresult from the surgical treatment of orofacial cancer, cleft lip,trauma, burns, Plummer–Vinson syndrome or scleroderma.The reduced mouth opening also leads to difficulty in speech,mastication and psychological problems secondary to facialdisfigurement.Case report: It is often difficult to apply conventional clinicalprocedures to fabricate prosthesis for patients who demonstratelimited mouth opening, since it is difficult to follow theprotocol of fabrication of prosthesis and also insertion andremoval of one-piece prosthesis into the oral cavity. Thepresent case report focuses on rehabilitation of microstomiausing sectional prosthesis and intraoral magnets with whichenabled easier and competent removal and insertion by thepatient.Conclusion: The sectional denture attached by the magnetcan be more comfortably removed and inserted by the patientwith reduced mouth opening. It is simple and cost-effectivemethod for rehabilitation of microstomia patient.

Restricted mouth opening and its definitive management: A literature review

This review was intended to discuss the various possible modifications suggested in the literature for prosthetic steps and surgical corrective procedures in nonresponding or complicated cases during rehabilitation of patients with restricted mouth opening. Material and Methods: Medline, PubMed, and Google were searched electronically for articles using keywords: microstomia and treatment options for restricted mouth opening. The various articles on prosthodontic rehabilitation in microstomia were segregated. From these, various modifications in the prosthetic steps were reviewed. Results: Oral hygiene maintenance is difficult for patient either due to limited access or due to associated lack of manual dexterity, so dental decay and periodontal problems are more extensive in such patients; hence, tooth loss is a common finding. All prosthetic procedures require wide mouth opening to carry out various steps, starting from tray placement during impression making to the final prosthesis insertion, especially removable prosthesis. Various prosthetic modifications given by authors are included in this review for each step in prosthodontic management. A total of eight stock tray designs, 12 custom tray designs, and 17 removable prosthesis designs are discussed along with fixed (either tooth-supported or implant-supported) and maxillofacial prosthesis. However, some patients require surgical intervention also for the correction of microstomia either for function or for esthetic purpose before prosthetic rehabilitation and are also enumerated here. Conclusion: Among all prosthetic restorative options, removable prosthesis is most difficult for dentist to fabricate as conventional methods are either very difficult or impossible to apply. To get a more accurate final prosthesis, we need to modify these steps according to the existing case. Several modifications available are discussed here which can help while managing these patients.