21 REHABILITATION OF A TOTAL.cdr

Tongue is one of the most vital organs associated with mastication, swallowing and speech. Oncologic management of advanced carcinoma of the tongue is a tricky medical problem that can generate grave treatment dilemmas1. A total glossectomy with its associated morbidity may sometimes be the treatment of choice. Among all glossectomy patients, though, there seems to be a reluctance to try to speak or take oral fluids after the operation. Tongue prostheses constructed in conjunction with mandibular removable partial dentures, with the tongue portion in an elevated position, give patients the additional help needed to overcome this initial reluctance2. Patient with total glossectomy can be rehabilitated by silicone tongue prosthesis as an aid to improve his speech and swallowing. Palatal augmentation reshapes the hard palate to improve tongue to hard palate contact and thus improves speech and swallowing. This article describes a case report of rehabilitation of a patient with silicone tongue prosthesis and palatal augmentation prosthesis who had undergone total glossectomy for the treatment of carcinoma of tongue. It also discusses some issues involved in the prosthetic management of the total glossectomy patient. 1 2 Pankaj Kharade, Kanchan Dholam 3 4 Gurmit Baccher, Arati Chogule INTRODUCTION : In the management of carcinoma of tongue total glossectomy is the treatment of choice in most of the situations. Tongue is one of the crucial anatomical and physiological union for executing important functions as swallowing, speech and deglutition. Postoperatively, patients with total glossectomy have difficulty or unfeasibility for controlling these functions and it leads to severe functional limitations for the patients. In most of the cases it is associated with resection of floor of the mouth. Contemporary surgical reconstruction of total glossectomy defects usually involves placement of a musculocutaneous, microvascular free flap to close the defect3, 4. So rehabilitation of such patients who have undergone total glossectomy for the treatment of carcinoma of tongue is a very tough procedure. Design of prosthesis changes according to patient's needs and anatomy of the intraoral structures postoperatively. Palatal augmentation prosthesis is used for reshaping the hard palate to improve tongue to hard palate contact and thus improves speech and swallowing ability of the patient. There is scarcity of reports and data associated with prosthetic rehabilitation of tongue and post-operative improvement of the function. This clinical report describes the prosthetic management of an edentulous patient who underwent a total glossectomy followed by surgical reconstruction of the defect with a microvascular free flap. CLINICAL REPORT : A 57-year-old male was referred to Department of Dental & Prosthetic Surgery, Tata Memorial Hospital, Mumbai by head and neck surgeon for evaluation concerning prosthetic treatment. He had a history of squamous cell carcinoma of the base of the tongue that was classified as a T4N2M0 tumor by use of the tumor/lymph node/metastases (TNM) classification system5. The patient had undergone a total glossectomy and bilateral modified neck dissections to remove the residual tumor. The resulting defect was immediately reconstructed with a microvascular REHABILITATION OF A TOTAL GLOSSECTOMY PATIENT WITH TONGUE PROSTHESIS AND PALATAL AUGMENTATION PROSTHESISA CASE REPORT. Journal of Dental Sciences University