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 Table of Contents  
CASE REPORT
Year : 2021  |  Volume : 10  |  Issue : 2  |  Page : 169-172

Postoperative custom-made submandibular two-part silicone prosthesis


1 Department of Prosthetics and Orthotics, Pandit Deen Dayal Upadhaya National Institute for Persons with Physical Disabilities (Divyangjan), Under Ministry of Social Justice and Empowerment, Governement of India, New Delhi, India
2 Department of Prosthetics and Orthotics, National Institute for Locomotor Disabilities, Under Ministry of Social Justice and Empowerment, Government of India, Kolkata, West Bengal, India
3 Rekon Prosthetic and Orthotics Center, Kolkata, West Bengal, India
4 Department of Prosthetics and Orthotics Artificial Limb Manufacturing Corporation of India, Kanpur, Uttar Pradesh, India

Date of Submission13-Mar-2020
Date of Decision28-Sep-2020
Date of Acceptance11-Oct-2020
Date of Web Publication18-May-2021

Correspondence Address:
Dr. Smita Nayak
Department of Prosthetics and Orthotics, Pandit Deen Dayal Upadhaya National Institute for Persons with Physical Disabilities (Divyangjan), 4, Vishnu Digamber Marg, New Delhi - 110 002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_36_20

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  Abstract 


Any defect or loss of cosmesis to the face and neck area leads to greater impact on self esteem and psychology. Post operative Squamous cell carcinomas at sub mandibular area comprise a thrashing in cosmesis, difficulty in verbal communication and swallowing. A 45-years woman undergone surgical intervention rehabilitated with sub mandibular magnetic retained prosthesis. Notable improvement observed in score of appearance, pain, mood and swallowing through University of Washington Quality of life (UW-QOL) questionnaire post fitment of prosthesis.

Keywords: Sub mandibular silicone Prosthesis, Quality of life, Magnetic suspension, Psychological Tool


How to cite this article:
Nayak S, Lenka PK, Bhattacharya I, Das RK. Postoperative custom-made submandibular two-part silicone prosthesis. Int J Health Allied Sci 2021;10:169-72

How to cite this URL:
Nayak S, Lenka PK, Bhattacharya I, Das RK. Postoperative custom-made submandibular two-part silicone prosthesis. Int J Health Allied Sci [serial online] 2021 [cited 2021 Jun 17];10:169-72. Available from: https://www.ijhas.in/text.asp?2021/10/2/169/316294




  Introduction Top


Maxillofacial prosthesis is a treatment to rehabilitate the patients suffering from facial deformity due to congenital, traumatic, or ablative surgery. Cancer is the major factor for these defects. There are an estimated 405,000 new cases of oral cancer diagnosed each year worldwide and out of these more than 50% are related to cancer of the oral tongue. Squamous cell carcinoma (SCC) is the most common malignant neoplasm of the oral cavity and represents about 90% of all oral malignancies.[1] The incidence of oral tongue SCC in the United States has increased over the past three decades, and currently is estimated at 3/100,000 populations.[2] In India, 20/100,000 populations are affected by oral cancer which accounts for about 30% of all types of cancer.[3] Over five people in India die every hour because of oral cancer and the same number of people die from cancer in the oropharynx and hypopharynx.[4] In India, oral cancer represents a major health problem constituting up to 40% of all cancers and is the most prevalent cancer in males and the third most prevalent in females.

In Western countries, oral SCC affects the tongue in 20%–40% of cases and the floor of the mouth in 15%–20% of the cases, and together these sites account for about 50% of all cases of oral SCC.[5] Surgery is the preferred first-line treatment of small, accessible oral SCCs. However, advanced-stage oral SCC is usually treated by a combined treatment program of surgery, chemotherapy, and radiotherapy.[6] In cases of recurrent oral SCC, epidermal growth factor receptor inhibitor coupled with chemoradiotherapy is the first line of treatment.[7] Extensive surgical resection of maxillofacial malignancies leads to severe disfigurement of the face in addition to psychological trauma owing to negative self-perception and difficulties in social integration.[8] Large facial defects compromise vital functions such as respiration, mastication, speech, swallowing, and esthetics. A prosthetic reconstruction of the facial defects helps in restoring functional disabilities and aids in morale recovery of patients and their family members.[9] Prosthetic palliative rehabilitation of a postsurgical defect will help the patient live a better life, it is considered an essential part of end-of-life care in advanced oral malignancy patients.[10] This prosthesis is retained with adhesives, tissue undercuts, magnets, or in some cases osseointegrated implants.[11] The use of magnets is one of the most efficient means of providing sectional prosthesis with adequate retention and stability in patients with deformities requiring complex rehabilitations.[12],[13]


  Case Report Top


A 45-year-old female was presented with postoperated SCC in the mouth. Clinical examination revealed with the removal of tongue commando and radial forearm flap reconstruction [Figure 1]. A nasal gastrotomy tube fitted for food intake. She was severely impaired with issues in speech and swallowing. Removal of the submandibular was a challenge that led to the suspension of the prosthesis and maintenance of cosmesis. The surgeons along with prosthetist and orthotist decided to fabricate such a prosthesis which will protect the lady from infection and could also continue with chemotherapy. The magnetic retained two part silicone flap prosthesis was fabricated which maintained the cosmesis as well as required function. Proper consent of the patient was obtained before fabrication and during every stage of the procedure.
Figure 1: Tongue commando and radial forearm flap reconstruction

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The two ways cast was taken by alginate impression material, one for lower palate and another for the submandibular area [Figure 2]. The cast was hardened by pouring orthokal stone plaster to get better wax model. The wax was poured through 4 mm hole. The die was prepared in three phases for the easy removal of the prosthesis. In the first phase, the base along with the wax model was placed inside the lower part of the die followed by covering of prepared half of the die in second phase, and at the third phase, the upper part of the die was poured [Figure 3]. The alignment of magnet was decided by marking a horizontal crosssection in the die and checking it by steel pin before pouring of silicone [Figure 4].
Figure 2: Two way cast by alginate impression material

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Figure 3: Three phase die preparation

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Figure 4: Color matching and alignment of the magnet

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During the placement of magnet, it was taken care that the prosthesis was cut into two parts in the horizontal cross section as female and male [Figure 5]. The tongue shape was prepared in the inner part of the prosthesis to fill the gap of the tongue and enhance the cosmesis [Figure 6]. The final silicone prosthesis was removed from die, and auxiliary suspension thread was used, and second prosthesis was provided after 3 months [Figure 7].
Figure 5: Inner and outer part of the mandibular prosthesis

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Figure 6: Mandibular prosthesis with artificial tongue

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Figure 7: Patient with final silicone mandibular prosthesis

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  Results Top


The patient was assessed using University of Washington quality of life (UW-QOL) questionnaire[14] on a three point time scale just after surgery, after 3 months and after 9 months, as shown in [Table 1]. The marked improvement in appearance, speech, swallowing, and mood shows the effectiveness of prosthesis.
Table 1: University of Washington Quality of life (UW-QOL) questionnaire, postoperative score of patient with submandibular silicone prosthesis

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  Discussion Top


Facial prostheses are important not only for rehabilitation and esthetics but also for patient re-socialization. The level of reintegration is directly related to the degree of satisfaction with rehabilitation. Hence, the maxillofacial prosthetics must provide patient satisfaction during treatment. The problems experienced by these patients may decrease when specialists keep the patient on regular inspection. Rehabilitation through alloplasty or prosthetic restoration provides satisfactory conditions in esthetics and well-being and reinstates individuals in the familial and social environment.[15]

The patient was fitted with the silicone submandibular prosthesis just after the surgery to continue chemotherapy. It had dual advantage for the patient as she was surprised to see that the prosthesis made little difference in her appearance, and she could also go ahead with her chemotherapy without any complications. She was assessed with the UW-QOL version 4 on a three point scale just after surgery, after 3 months and 9 months, respectively. She was satisfied with her appearance just after surgery due to cosmesis, proper retention by magnets, and stability factor of the prosthesis. The prosthesis also acts as a protector from outside agents and prevents from infection. The appearance was near to normal after 3 months due to the use of sub mandibular magnetic silicone prosthesis, and the percentage increase in score was near about 40% during the period from 3 months to 9 months. The mood, swallowing, and speech showed a significant improvement with the use of prosthesis. These types of cases are patient specific and different for every individual. Hence, the effectiveness studies of silicone mandibular prosthesis are also specific to different individual. The satisfaction on the face of the patient is the greatest measure of the effectiveness of the prosthesis.


  Conclusion Top


Rehabilitation of postoperative sarcoma is totally a team approach. Maintenance of psychology due to appearance in any extensive surgery is the main issue. This prosthesis was helping the patient in swallowing, speech, protection as well as in cosmesis. The prosthesis is considered as a psychological tool in the postoperative SCC of the submandibular region.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lawoyin JO, Lawoyin DO, Aderinokun G. Intra oral squamous cell carcinoma in Ibadan: A review of 90 cases. Afr J Med Med Sci 1997;26:187-8.  Back to cited text no. 1
    
2.
Ganly I, Patel S, Shah J. Early stage squamous cell cancer of the oral tongue—Clinicopathologic features affecting outcome. Cancer 2012;118:101-1.  Back to cited text no. 2
    
3.
Sankaranarayanan R, Ramadas K, Thomas G, Muwonge R, Thara S, Mathew B, et al. Effect of screening on oral cancer mortality in Kerala, India: A cluster randomised controlled trial. Lancet 2005;365:1927-33.  Back to cited text no. 3
    
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Gupta B, Ariyawardana A, Johnson WN. Oral cancer in India continues in epidemic proportions: Evidence base and policy initiatives. Int Dent J 2013;63:12-25.  Back to cited text no. 4
    
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Bello OI, Soini Y and Salo T. Prognostic evaluation of oral tongue cancer: Means, markers and perspectives (I). Oral Oncol 2010;46:630-5.  Back to cited text no. 5
    
6.
Braakhuis BJ, Bloemena E, Leemans CR, Brakenhoff RH. Molecular analysis of surgical margins in head and neck cancer: More than a marginal issue. Oral Oncol 2010;46:485-91.  Back to cited text no. 6
    
7.
Lorch JH, Posner MR, Wirth LJ, Haddad RI. Seeking alternative biological therapies: The future of targeted molecular treatment. Oral Oncol 2009;45:447-53.  Back to cited text no. 7
    
8.
Barocas R, Karoly P. Effects of physical appearance on social responsiveness. Psychol Rep 1972;31:495-500.  Back to cited text no. 8
    
9.
Vickery LE, Latchford G, Hewison J. The impact of head and neck cancer and facial disfigurement on the quality of life of patients and their partners. Head Neck 2003;25:289-96.  Back to cited text no. 9
    
10.
Carl W. Preoperative and immediate postoperative obtura-tores. J Prosthet Dent 1976;36:298-305.  Back to cited text no. 10
    
11.
Mantri SS, Mantri SP, Rathod CJ, Bhasin A. Rehabilitation of a mandibular segmental defect with magnet retained maxillofacial prosthesis. Indian J Can 2013;50:21-4.  Back to cited text no. 11
    
12.
Barron JB, Rubinstein JE, Archibald D, Manor RE. Two piece orbital prosthesis. J Prosthet Dent 1983;49:386-8.  Back to cited text no. 12
    
13.
Sasaki H, Kinouchi Y, Tsutsui H, Yoshida Y, Karv M, Ushita T. Sectional prostheses connected by samarium-cobalt magnets. J Prosthet Dent 1984;52:556-8.  Back to cited text no. 13
    
14.
Rogers SN, Gwane S, Lowe D, Humphris G, Yueh B, Weymuller EA. The addition of mood and anxiety domains to the University of Washington Quality of Life Scale. Head Neck 2002;24:521-9.  Back to cited text no. 14
    
15.
Goiato MC, Pesqueira AA, Ramos da Silva C, Gennari Filho H, Micheline Dos Santos D. Patient satisfaction with maxillofacial prosthesis: Literature review. J Plast Reconstr Aesthet Surg 2009;62:175-80.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1]



 

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