Hemimandiblectomy with and without intermaxillary fixation: A Quincy experiment
Abstract
Oral malignancy involving mandible, floor of mouth, tongue, and also palate when treating surgically often requires resection of mandible. Resection of mandible leads to loss of mandibular continuity, deviation of mandible towards resected site, altered mandibular movements, difficulty in swallowing, and impaired speech. Management of this type of mandibular defects without bony reconstruction is complex. Hemimandibulectomy with intermaxillary fixation prevent mandibular deviation and malocclusion.
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Introduction
Surgical treatment for cancerous lesions of the oral cavity frequently requires resection involving the mandible, floor of the mouth, tongue and also the palate.1,2 In patients who have undergone mandibular resection, the remaining mandibular segment will retrude and deviate towards the surgical side. While opening the mouth, this deviation increases, leading to the opening and closing of the angular pathway. Apart from deviation other dysfunction noted are (1) Difficulty in mastication and swallowing which are due to sensory and motor deficits, loss of bone and muscular attachments of floor of mouth; function of tongue is compromised, (2) Difficulty in speech due to compromised tongue control, (3) mandibular movements - the absence of the muscle of mastication on the surgical side results in a significant rotation of the mandible upon forceful closure and (4) respiration is also impaired.3
On contrary mandibular resections resulting in little soft tissue loss have lesser mandibular deviation and mandibular discontinuity. As a result of surgical treatment leads to mandibular deviation and altered muscle function this result in facial asymmetry and malocclusion. Normal occlusion in which the posterior natural teeth interdigitate is lost; and the teeth on the remaining mandibular segment will occlude lingual to the maxillary teeth.4 There is deviation of the residual mandible medially and superiorly. The severity of mandibular deviation is determined by the location and extension of the resection, the amount of soft and hard tissue resection, type of closure and the presence of remaining natural teeth, the degree to which innervations has been involved, the use of adjunctive procedures like radiation therapy. Patients who are closed with a myocutaneous or free flap soon attain an acceptable interocclusal relationship with adjunctive therapy, while some patients who are closed primarily, are never able to achieve an appropriate and a stable interocclusal relationship.1, 2
This present study done at Udaipur, Rajasthan, India, was aimed to compare hemimandiblectomy with and without intermaxilary fixation procedures for mandibular deviation and to reestablish a normal occlusal relationship.
Conclusion
A comfortable mandibular alignment is not always maintainable in the restoration of the patients with partially resected mandible. The use of intermaxillary fixation during immediate postoperative period will reduce the degree of deviation, mandibular function, mastication, facial symmetry.