Digitally designed and manufactured sectional custom tray for a patient with microstomia: A case report.

Microstomia presents a challenge for the patient and dental provider. This report describes a partial digital workflow for the fabrication of a mandibular complete denture for a patient with microstomia. Computer-aided design and computer-aided manufacturing technology was utilized to 3D print a sectional custom tray with a unique design. The sectional custom tray was used to make a conventional border molded impression of the edentulous arch to fabricate a flexible complete mandibular denture for a 58-year-old female patient with scleroderma and microstomia. This treatment resulted in a successful prosthetic outcome and high patient satisfaction.

Digital Workflow for a Scleroderma Patient with Microstomia: A Clinical Report.

Making impressions in patients with microstomia is often rather problematic due to their restricted mouth opening. Herein, this report describes a novel digital workflow for making impressions with computer-aided design and computer-aided manufacturing (CAD/CAM) custom sectional trays for a 58-year-old female patient with scleroderma and microstomia. CAD/CAM custom sectional trays were made based on digital dentition models from another case with similar arch scale. After the sectional impressions were obtained, the sectional casts were scanned and digitally aligned to form the final dentition models. The removable partial dentures were designed on the final digital models and printed using a 3D printer. This procedure was executed with a successful prosthetic outcome that included good fit and acceptable esthetics. The patient also reported a high level of satisfaction.

Intraoral midline mandibulotomy to improve access for transoral robotic surgery (TORS) base of tongue resection in a retrognathic and microstomic patient.

A 74-year-old man was referred to a tertiary academic otolaryngology clinic for evaluation of a left-sided neck mass with unknown primary. Nuclear imaging modalities revealed a primary cancer located at the left tongue base. Further investigation revealed the tumour to be a p16 positive squamous cell cancer with metastatic spread to cervical lymph nodes of multiple levels. The patient was found on initial investigation to have microstomia and a retrognathic mandible, which are typically considered unsuitable for robotic surgery due to difficulties obtaining adequate exposure.The patient underwent bilateral neck dissection, followed by transoral robotic-assisted left base of tongue resection. A midline intraoral mandibulotomy was performed to improve robotic access. Following tumour resection, the mandible was repaired using open reduction with internal plate fixation. Postoperative occlusion was maintained, and the patient recovered well from mandibulotomy with none of the morbidity or cosmetic defects associated with a traditional lip-split approach.

Multidisciplinary Rehabilitation in a Case of Congenital Aglossia with Situs Inversus Totalis.

Aglossia is a rare congenital disorder with complete absence of tongue that can also be associated with limb deformities, syndromes and aberrant positioning of the visceral organs. The present case report describes multidisciplinary rehabilitation in a patient with Aglossia Congenita along with dextrocardia, situs inversus, mutilated dentition with a lack of occlusal table and compromised esthetics.

Plurimalformative syndrome associating trisomy 18 and omphalocele. Case report and review of the literature.

Trisomy 18 or Edwards syndrome is a rare chromosomal anomaly, associated with mild to severe intellectual disabilities and multiple congenital anomalies. Trisomies 18 and 13 are lethal, only 5-10% of patients surviving the first year of life. Although prenatal biological and ultrasound investigations are mandatory and free and the detection rate of chromosomal abnormalities is high, the birth of children with no real chance at a normal life being thus avoided by therapeutic abortion, the parents of the here presented child did not benefit from medical examination or prenatal tests, unfortunately the case of many families in Romania. The policy of limiting medical intervention in newborns with Edwards syndrome due to the broad spectrum of severe congenital malformations, severe mental retard and reduced life expectancy is unanimously accepted, but yet difficult to apply from an ethical point of view. That is why very important for both healthcare providers and families to have accurate and detailed knowledge of survival, disease course, and quality of life so that they can make fully informed decisions regarding care of these babies. The particularity of this case is the association of multiple congenital anomalies in a male newborn with trisomy 18, almost all apparata and systems being affected, with the presence of an omphalocele and complete right labiopalatine cleft, which are less frequent at children with trisomy 18.

Use of Pindex system in fabrication of the sectional custom tray.

This article describes a new, precise, and simple method for making an impression with an individual tray for a patient with microstomia. In this method, a Pindex system on the handle of the tray was used for attaching two parts of the sectional tray.

Prosthetic Management and Analysis of Combined Extraoral-Intraoral Maxillofacial Defects Complicated with Microstomia. A Report of Three Cases.

Different prosthetic treatment plans for three patients with variable degrees of acquired maxillofacial defects were reported and analyzed. Combined extraoral-intraoral prostheses were selected to restore the three cases. Two patients were rehabilitated using two separated prostheses, while the third one was restored with a coupled two-unit prosthesis. The design of extraoral-intraoral prosthesis either separated or connected, is influenced by the condition and nature of the residual tissues, defect configuration, patient needs, degree of tissue damage and the anticipated success rate or complications with the treatment. It was observed that separating the intraoral part from that of the extraoral resulted in better retention, stability, and more comfort to the patient with combined defects. Furthermore, fabrication and repair of each part is technically easier as perceived it can be carried out independently and the patient can continue to use one-part and send the other for repair. Another advantage is the reduction of size and weight of the prosthesis.

A technique for fabricating a hinged mandibular complete dental prosthesis with swing lock for a patient with microstomia.

Microstomia is defined as an acquired or congenital condition involving a reduction of the oral aperture severe enough to compromise esthetics, nutrition, and quality of life. This clinical report describes a technique for fabricating a mandibular swing-lock complete denture with a hinge for a patient with muscular dystrophy. A hinge in the midline allowed the denture to collapse. The collapsed denture could then be inserted into the mouth and locked into position. A sectional impression technique was used and the custom hinge was designed on the cobalt-chromium metal framework of the complete denture. The protocol presented can provide a viable treatment option for edentulous patients with microstomia.

Bilateral craniofacial microsomia: orthognathic treatment for an advanced dentofacial deformity.

In this article, we report the combined surgical and orthodontic treatment for a patient with bilateral craniofacial microsomia and facial asymmetry.

A simplified technique for solving the transfer problem of implant-supported fixed partial dentures for patients with microstomia.

Techniques for treating a fully or partially edentulous patient with microstomia have been developed to overcome the challenge of accessing the oral cavity. Management of the problems associated with providing implant-supported fixed partial dentures for patients with microstomia has not been well reported. This article describes a solution for the transfer problem that occurs when making an impression of an implant-supported fixed partial dentures for patients with microstomia.

Prosthetic rehabilitation of an edentulous maxilla with microstomia, limited interarch space, and malaligned implants: a clinical report.

BACKGROUND: Although dental implant treatment is a very successful option today, a meticulous treatment planning and close collaboration between the oral surgeon and restorative doctor is crucial to eliminate undesired outcomes. PURPOSE: To present a challenging case restored with a maxillary screw-retained fixed prosthesis using malpositioned/malaligned implants. MATERIALS AND METHODS: A 47-year-old female had a Lefort I fracture and lost all maxillary teeth due to traumatic injury in a traffic accident. Seven maxillary implants were placed using a 1-stage surgical approach, 6 months after open reduction surgery in a private practice. Radiographic and clinical evaluation indicated marginal bone loss around 3 anterior implants. The malposition and malalignment of implants made impression and casting procedures very complicated. The other challenging factors with this patient were microstomia, limited mouth opening due to scar tissue from previous plastic surgery, and a very small maxilla. The 1-piece metal framework did not fit accurately so it was sectioned into 3 segments. The 3 separate segments were screwed on the abutments individually, then connected to each other using an acrylic resin. The 3 framework segments were laser welded. After the laser welding, a passive fit of the framework was achieved. CONCLUSION: It has been suggested that providing an implant treatment to a patient with implants placed in wrong positions with undesired angulations can be very difficult. Also, laser welding may be a viable option to eliminate misfit of full-arch metal frameworks.

Sectional impressions and simplified folding complete denture for severe microstomia.

A patient presenting with severe microstomia (PDI Class IV) was unable to insert a maxillary complete denture. Sectional final impressions were made using two impression materials and an interlocking custom tray. A folding record base was used for maxillomandibular relationship records. A novel folding maxillary denture with a custom hinge and plunger attachment to lock the denture in the open position was fabricated. The patient was able to insert the collapsed denture, open it intraorally, and enjoy successful masticatory function.

Anterolateral thigh adipofascial flap for the restoration of facial contour deformities.

From January 2000 to May 2008, 50 patients with facial contour deformities underwent soft tissue augmentation with 51 anterolateral thigh (ALT) adipofascial flaps. Fifty flaps survived with no complications; partial fat necrosis occurred in one flap. Mean follow-up was 16 months. Flaps ranged from 10 x 6 cm to 20 x 12 cm. Perforators were found in 50 flaps, 43 musculocutaneous perforators (84.3%) and 7 septocutaneous perforators (13.7%), with a mean of 2.5 perforators per flap. In one flap (2.0%), no perforator was found. In this case, we used an anteromedial thigh adipofascial flap using the medial branch of the descending branch of lateral circumflex femoral artery as the vascular pedicle. Relatively symmetric facial contour was achieved in 20 cases. In 30 cases, adjunctive procedures including flap debulking, fat injection, and resuspension were necessary, and 23 patients achieved satisfactory outcomes. We conclude that the ALT adipofascial flap can be successfully elevated and transplanted for the correction of soft tissue facial defects. This flap can provide tissue to fill large defects, and posses the qualities of pliability, an excellent blood supply, ease of suspension and fixation, and minimal morbidity at the donor site.

Management of microstomia in adult burn patients revisited.

OBJECTIVE: This study aims to review our experience in the surgical management of microstomia following facial burns. PATIENTS AND METHODS: For this retrospective study, we searched our burn patients' database for oral commissuroplasties with local mucosal flaps and reviewed the 18 patients suffering from microstomia after facial burns who had been operatively treated between 1995 and March 2007. Fifteen of the patients were primarily treated for severe facial burns in our burns unit, three were referred to our outpatients clinic for secondary reconstruction. Reconstruction of the oral commissures was performed according to one of the following methods: (1) triangular scar excision and mucosal Y-V advancement (n=10), (2) scar excision and wound closure with full-thickness or split-skin graft (n=4) and (3) division of the contracture and closure of the resulting defect with two rhomboid mucosal flaps per side (n=4). RESULTS: All patients showed acceptable aesthetic results and a good functional outcome. Apart from minor wound-healing disturbances, which neither required surgery nor worsened the result, no complications were observed. Patient satisfaction was high. CONCLUSION: Commissuroplasty is an early functional post-burn corrective procedure that often must be performed prior to completion of scar maturation. Mucosal advancement flaps are a viable procedure for the treatment of microstomia after facial burns, resulting in good aesthetic and functional outcome. Direct scar excision and skin grafting, although unavoidable in cases of extensive perioral scarring, frequently produces inferior results.

Case report: Dystrophic Epidermolysis Bullosa: dental management and oral health promotion.

BACKGROUND: Epidermolysis Bullosa (EB) is a group of rare genetically determined disorders characterised by the development of blisters following minor or insignificant trauma or traction to the skin or mucosal surfaces. It appears that the cause of EB is related to abnormal enzyme activity and collagen degradation, but the exact pathogenesis and aetiology remain obscure. There are three major forms -- simple, junctional, and dystrophic. Oral manifestations and dental involvement of EB vary in frequency, and severity according to the form. CASE REPORT: A 13-year old boy with a known diagnosis of Dystrophic Epidermolysis Bullosa (DEB) since birth was seen in our dental practice in 2004. Upon examination, the patient had multiple scars and blisters involving his neck, head, elbows and knees. Pseudosyndactyly was present on both hands. Intraoral examination revealed multiple carious lesions affecting almost the entire dentition, with severe gingival inflammation, mycrostomia, ankyloglossia and elimination of buccal and vestibular sulci. TREATMENT: This was divided into four phases- (1) oral hygiene and dietary instructions, elimination of gingival inflammation, (2) restorative procedures, (3) extractions of the carious destroyed teeth, and (4) recall system. FOLLOW-UP: The patient was recalled on a schedule every three months with continued evaluation of oral status (Pl and GI indices). The preventive regimen included twice yearly topical fluoride application (Duraphat 2.26%). The final recommendations for our patient (except brushing twice a day), were to use daily fluoride mouthrinse (NaF 0.05%), to avoid cariogenic food products, and to visit a dietician to correct his diet. CONCLUSION: By applying present knowledge of DEB the oral health of these patients can be improved and eliminate complications arising from the oral condition. After three routine check-ups and due to the cooperation of this patient, his oral health status remains very satisfactory.

Craniodentofacial manifestations in Hallermann-Streiff syndrome.

Hallermann-Streiff syndrome (HSS) is a rare congenital disorder characterized by significant craniofacial findings. Dyscephaly, microphthalmia, cataracts, hypotrichosis, cutaneous atrophy, thin pinched nose, and a typical bird-like face are the main features of the syndrome. Additional features of the syndrome include dental anomalies, micrognathia, skeletal defects, and short stature. What follows is a case report of a 10-year-old girl with HSS with special consideration on orodental findings. Clinical, radiographic, and cephalometric analysis revealed hypoplasia of the mandible, high arched palate, Class II malocclusion due to mandibular retrognathia, open bite, posterior crossbite, crowding, malformed teeth, and oligodontia. Magnetic resonance images (MRI) of the temporomandibular joints showed abnormal disks flattened with uniform thickness and deformed condyles bilaterally. Also discussed are the features of HSS with the differential diagnosis, and the dental management of the case is described.

Prosthetic rehabilitation of patients with microstomia.

Microstomia is defined as an abnormally small oral orifice which can be due to various factors. Microstomia is a definite prosthodontic hindrance to carry out the different treatment successfully. To rehabilitate a patient with microstomia, successfully, the methods and designs incorporated in the prosthesis have to be modified. In the past, various techniques have been tried, incorporating certain biological and scientific methods to rehabilitate patients with microstomia. This article reviews the previously described treatment modalities in case of patients with microstomia.

Dental rehabilitation using an implant-carrying plate system in a severely resorbed edentulous maxilla: a case report.

This clinical article describes a case of dental rehabilitation using an implant-carrying plate system (EPITEC) for a patient with severely resorbed edentulous maxilla and microstomia. In this case, the presence of microstomia prevented bone augmentation procedures through an intraoral approach. Treatment using 2 endosseous implants inserted in the canine regions and an implant-supported overdenture was planned. However, endosseous implants were not feasible on the right side because of insufficient available bone volume. An implant-carrying plate system was then utilized on the right side. Four months later, an implant-supported ball-attachment overdenture was fabricated. At the 2-year follow-up, the clinical course remained uneventful, and the patient remained satisfied with the treatment.

Fabricating sectional-collapsible complete dentures for an edentulous patient with microstomia induced by scleroderma.

Patients with microstomia who have to wear removable dental prostheses often face the difficulty of being unable to insert or remove the prosthesis because of the constricted opening of the oral cavity. This clinical report describes in detail the prosthodontic management of an edentulous patient with microstomia induced by scleroderma. Sectional-collapsible maxillary and sectional mandibular complete dentures were fabricated by means of sectional trays. With the use of palatal midline hinge and stud attachments, the sectional dentures were successfully and easily inserted and removed.