partial glossectomy/ online orthodontic courses

REHABILITATION OF
A PATIENT WITH
PARTIAL
GLOSSECTOMY
INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

 GLOSSECTOMY : partial or total
resection of the tongue – GPT-8

Introduction
 One of the most challenging complications in
maxillofacial prosthetics is the rehabilitation
of the patient who has lost all or a part of the
tongue. Such patients have difficulties with
 deglutition,
 mastication,
 speech
 and saliva control.
 Dysfunction in swallowing is also a problem,
and it often contributes to nutritional
deficiency.

FUNCTIONS OF TONGUE
MASTICATION:-
• Defined as the act of chewing foods.
• It represents the initial stage of digestion, when the food is
broken down into particle sizes for ease of swallowing.
• The tongue has a complex role in mastication.
• It directly crushes the food against the rugae of the hard
palate & it aids repositioning of food bolus onto the
occlusal surfaces after each chewing stroke.

SWALLOWING:-
• Swallowing is a series of coordinated muscular
contractions that moves a bolus of food from the
oral cavity through the oesophagus to the
stomach.
• It occurs in three stages:-
– Stage I : Oral stage – Voluntary stage.
– Stage II : Pharyngeal stage – Involuntary (reflex) stage.
– Stage III : Oesophageal stage – Involuntary (reflex)
stage.

 McConnel et al (1988) described swallowing as a
pressure-generation mechanism powered by a
two-pump system.
 These two pumps are the
I. oropharyngeal propulsion pump (OPP) and
II. the hypo pharyngeal suction pump (HSP).
 The significance of normal tongue mobility for
normal deglutition to take place is that any
condition that affects the anterior two thirds of
the tongue will necessarily affect the OPP and
that any problems affecting the base of the tongue
will alter HSP.

SPEECH:-
• Speech occurs when a volume of air is forced from the
lungs by the diaphragm through the larynx & oral cavity.
• Controlled contraction & relaxation of vocal cords create a
sound with the desired pitch.
• Once the pitch is produced, the precise form assumed by
the mouth determines the exact articulation of the sound.

 The tongue is the primary articulator
of speech sounds.
 It shapes the oral and pharyngeal
cavities for vowel sounds
 and restricts airflow through the oral
cavity for consonant sounds.

Types
 Bilabial
 Linguodental
 Linguoalveolar
 Linguopalatal
 Linguovelar.

ARTICULATION OF SOUND:-
• Important sound formed by the lips are
letters “m, b & p”.-
• Teeth are important in saying “s ”
sound.-
• The tongue & the palate are especially
important in forming “d ” sound. The
tip of the tongue reaches up to touch
the palate directly behind the incisors.

• A combination of anatomic structures can also be used to
form many sounds.
• The tongue touches the maxillary incisors to form
“th ” sound.-
• The lower lip touches the incisal edges of maxillary teeth
to form “f & v ” sounds.
• The posterior of the tongue rises to touch the soft palate
to produce “k or g ” sound.

• Major goals in prosthodontic rehabilitation
1) Reduce the size of oral cavity, which improves resonance
& minimizes the degree of pooling saliva.
2) Direct the food bolous into the oropharynx with the aid
of a trough carved into the dorsum of the tongue
prosthesis.
3) Protect the underlying fragile mucosa if the skin flaps
were not used.
4) Develop surface contact with the surrounding
structures during speech & swallowing.
5) Improve appearance & psychosocial adjustment.

• Success of rehabilitation depends on:-
- Patient motivation
- Anatomic factors(such as presence or absence of
teeth)
- Associated morbidity of surrounding structures,
including mandibulectomy, palatectomy, &
radiation therapy.

Case report
 A 51yr old man name, Mr. Pardesi
working as a policeman reported to the
clinic with a history of carcinoma of the
tongue
 treatment with partial glossectomy and
radiotherapy was planned.

On clinical examination:
 it was observed that the surgery
consisted of the resection of the
anterior two-thirds of the tongue.
 The posterior portion was intact
 The maxillary and the mandibular
alveolar ridges with the entire
dentition were intact.
 Mouth opening was slightly restricted
due to postoperative radiotherapy.

Chief complaint
1. pooling of saliva in the anterior part
of the mouth
2. and speech impairment

 The patient's tongue could contact the
posterior part of the palate but not
the anterior and middle portions of
the palate.
 It was then decided to treat the
patient using palatal augmentation
prosthesis.

Palatal augmentation
prosthesis
 Maxillary partial denture framework
was fabricated, with wrought wire
clasps on I 8 and 28 to avoid
interference with the occlusion.

conclusion
 Surgery for carcinoma of the tongue and
floor of the mouth results in the alteration of
the muscles of the tongue and floor of the
mouth.
 Both primary and secondary surgical
procedures often result in scar formation
with reduced mobility of the tongue during
speech and deglutition.
 The prosthodontic management of patients
with partial tongue resection often includes
lowering the palatal vault, while the
management of total glossectomy usually
requires a mandibular tongue prosthesis

 Speech therapy can be used to help
determine the proper placement of
the portion of the prosthesis involved
in speech.
 The prosthetic rehabilitation
approach described in this study
lowers the palatal vault with a false
palate to enable the tongue to
function against it during speech and
swallowing.

REFERENCES
 1. McKinstry RE, Aramany MA, Berry
QC, Sansone I. Speech considerations
in prosthodontic rehabilitation of the
glossectomy patients. J Prosthet Dent
1985;53: 384-7.
 2. Knowles Je. Chali3.n V A, Shanks
Je. A functional speech impression
used to fabricate a maxillary speech
prosthesis of a partial glossectomy
patients. J Prosthet Dent
1984;51:232-7.

 Cotert HS, Aras E. Mastication,
deglution and speech considerations
in prosthodontic rehabilitation of a
total glossectomy patients. J Oral
Rehabili 1999;26:75-9.

For more details please visit

partial glossectomy/ online orthodontic courses

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to partial glossectomy/ online orthodontic courses

Similar to partial glossectomy/ online orthodontic courses (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

partial glossectomy/ online orthodontic courses