Guide flange prosthesis for the management of deviation following hemimandibulectomy: A case report

The mandible is one of the most important facial bones. It helps in performing most of the important functions such as mastication, swallowing, and speech by its various movements brought up by muscles attached to it. Oral cavity cancers and their surgical resections leave the patients in a jeopardized state. After mandibulectomy, patients experience the loss of occlusion and the absence of the muscle attachment to mandible on the surgical side, resulting in inferior rotation of the mandible on closure, with the mandible deviation toward the defect side.[1,2] It also brings facial deformity, difficulty in speech and mastication. Early treatment of the deviated mandible starts with corrective mandibular movement therapy, including physiotherapy.[3,4] Various designs of the prosthesis have been used to guide the mandible into its position.[5-7] Removable guide flange prosthesis can be retained if only a few teeth remain in the oral cavity. It is a simpler technique and economical to the patient. Retention is further compromised by radiation and surgical scarring, which limits mouth opening and functional vestibule depth such that placement and removal of the guide flange prosthesis are impossible for the patient.[8] A fixed prosthesis that would prevent scar contraction by keeping muscles in the stressed condition and at the same time provides corrective and masticatory functions is indicated but in the early treatment, the fixed prosthesis is not given as the muscles are not in a state of bearing much stress.[9,10] Implant-supported prostheses have also been advocated for the correction of mandibular deviation.