This document discusses the prosthetic rehabilitation of patients who have undergone partial or total glossectomy. It outlines the functions of the tongue in swallowing and speech. For total glossectomy patients, the goals of prosthetic rehabilitation are to reduce oral cavity size, direct food boluses, protect fragile mucosa, develop contact with surrounding structures, and improve appearance/psychosocial adjustment. Construction of mandibular tongue prostheses involves impression-taking, framework fabrication, functional tracing to ensure passive contact, and addition of acrylic resin or silicone material. Materials used depend on the degree of resection and available abutment teeth/structures.

1. Prosthetic rehabilitation of patient
with partial and total glossectomy
Ammar Ghanem Salem
4th year KBMS – restorative dentistry

2. Tongue
functions
 Primary function (swallowing)
 Secondary function (speech)

3. Swallowing
 To transport food from the mouth to the stomach.
 Three phases:
 Oral. (The only voluntary neuromuscular control).
 Pharyngeal.
 Esophageal.

4. Oralphase
 Crush food against palate.
 Reposition the bolus against occlusal table.
 Without functioning base posterior 1/3rd of tongue the
contact with soft palate cannot be made  insufficient
negative pressure during pharyngeal phase of
swallowing.
 This takes approximately 1 second (Blonskv et al.
1975)

5. Pressure
generation
mechanism (two-
pumpsystem)
 Oropharyngeal propulsion OPP – tongue anterior 2/3rd
is significant
 Hypopharyngeal suction pump HSP – tongue posterior
1/3rd is significant

6. Speech
 It is major articulator during all phonemes, with
exception of bilabial and labiodental sounds.
(Luciello et al. 1980)
 It restricts air flow to produce consonants such as
k,g,t,d,s and z.

8. Majorproblems
oftotal
glossectomy
 Loss of oral communication.
 Pooling of saliva and liquids.
 Aspiration.

9. Goals of
prosthetic rehab
oftotal
glossectomy
 Reduce size of oral cavity  improve resonance and
minimize pooling of saliva.
 Direct food bolus into oropharynx.
 Protect underlying fragile mucosa.
 Develop surface contact with surrounding structures
during speech and swallowing.
 Improve appearance and psychosocial adjustment.

10. Primaryfactors
forsuccess
 Patient motivation.
 Anatomic factors.
 Associated morbidity of structures.
(mandibulectomy, palatectomy, radiation therapy).
Cases where edentulous resorbed mandible with
irradiation or very mutilated dentition, a palatal
augmentation prosthesis.

11. Marunick M, Tselios N. The efficacy of palatal augmentation prostheses for speech and swallowing in patients
undergoing glossectomy: a review of the literature. J Prosthet Dent. 2004 Jan;91(1):67-74

12. Construction of
mandibular total
tongue prosthesis
 Clinical and radiographic examination.
 Restoring carious teeth, control all dental and
periodontal diseases.
 Primary impression, avoid flow of material to
hypopharynx by:
 High-speed suction by assistant.
 Using maxillary tray.
 Using utility wax posteriorly to seal.
 Adhesive and quick setting irreversible hydrocolloid.
 Primary cast surveyed for mouth preparation.
 Final impression with preferred material by operator.

14. Construction
 Block-out undesirable undercut.
 Relieve floor of mouth by two thicknesses of baseplate
wax.
 Duplicate refractory cast.
 Framework wax pattern  sprue  invested and
casted.
 Framework try-in check of fitting (ensuring passive
seating).

16. Construction–
tracingfloorof
themouth
 Retentive meshwork should not touch the floor of the
mouth at functional movement.
 Layer of sticky wax luted on the framework covered by
layer of mouth temperature softening wax.
 Ask patient to pronounce (eee), opening and closing
and swallowing.
 Every 10 minutes wax tracing is inspected and more
wax added to ensure passive contact with floor of
mouth during functional movements.

18. Construction–
oralsurface
 A mushroom-like projection is waxed to the oral
surface of the framework, complete investment and
process in heat-cured acrylic resin.
Three prosthetic tongues can be made:
- speech.
- Swallowing.
- Both.

21. Speechtype
 It has anterior elevation to facilitate articulation of the
anterior linguoalveolar sounds t and d.
 A posterior elevation to aid in the articulation of the
glottal stops or posterior linguoalveolar sound g and k.

22. Speechtype-
construction
 Using gray stick compound to create those elevations.
 Both elevations reduced 2-3mm and a layer of Iowa
wax added and patient is asked to repeat f, d, k, and g
and attempt swallowing.
 It is processed using heat cured acrylic resin.

23. Swallowingtype
 It is waxed in the form of a sloping trough-like base in
the posterior aspect to help guide the food bolus into
oropharynx.
 A mushroom-like projection of the framework is used
with heavy mix of tissue-conditioning material added
to base and ask patient to make mandibular movement
while pronouncing t , d, k, g.
 Tracing is done until satisfactory speech and
swallowing attained.
 Remove tracing and duplicated silicone with intrinsic
coloration and attached mechanically to mushroom-like
projection.

25. Prosthetic
treatment of
partial
glossectomy
 Removal of <50% of tongue doesn’t require prosthetic
intervention. (Aramany et al. 1982).
 It is needed in cases where it is associated with partial
mandibulectomy in which you can fabricate with
palatal augmentation (artificial lowering of palatal
vault) or mandibular augmentation prostheses.
 The choice depends on the: availability of abutment
teeth, extent and site of tongue deficiency, and patient
acceptance.

26. Mandibular
augmentation
procedure
 Interim/conventional mandibular RCD or RPD.
 Thick mix of tissue conditioning added to lingual flange
in tongue deficiency area.
 Prosthesis inserted with conditioning into the mouth
and instruct to swallow, open and close and pronounce
certain phonemes.
 Anterior resection requires consonant sound t, d.
 Posterior resection requires glottal stop execution k, g.

28. Mandibular
augmentation
procedure
 After setting, plaster matrix made of tissue
conditioning impression and soft-liner material
eliminated and augmented part fabricated with
autopolymerizing resin and utilized in neutral zone.

29. Palatal
augmentation
prosthesis
 Fabricate framework with added midpalatal meshwork
to retain the augmentation portion.
 Functional molding same as mandibular, emphasizing
anterior tongue consonants.
 Thick mix of conditioning material added to palatal
portion of maxillary denture.
 After setting, a plaster matrix is fabricated and tissue
conditioning replaced with autopolymerizing resin.
 If palatal augmentation is large consider reducing
weight by making hollow.

31. Defect
classification with
treatment option
 Complete edentulous with total glossectomy:
mandibular denture lingual flange extending over floor
of mouth.
 Complete edentulous with total glossectomy and hemi-
mandibulectomy: mandibular complete denture with
guiding flange to close the defect.

32. Defect
classification with
treatment option
 Partially edentulous with partial glossectomy involving
anterior part of tongue: maxillary PD with palatal
augmentation.
 Dentulous patient with segmental resection of
mandible and resection of lateral part of the tongue:
maxillary PD with palatal augmentation and
mandibular cast PD obturating the defect with guiding
flange.

34. Materialsused
fortongue
prosthesis
 Acrylic resin (PMMA)
Easy to work
Hygienic
Durable
Higher strength than silicone.
But: cannot be used in movable tissue beds and high
thermal conductivity

35. SiliconeMDX4-
4210
 Most common used in maxillofacial prosthesis
 Require heat for vulcanization.
 High viscous, white, opaque.
 Excellent thermal stability.
 Color stability with UV.
 Biologically inert.
 Polychromatic.
 Good tear strength.

36. SiliconeMDX4-
4210
 But:
 Low edge strength.
 Poor wettability.
 Low elasticity.
 Difficult extrinsic coloring.

44. Conclusion
 To rehabilitate a patient with partial or total
glossectomy, an understanding of basic anatomy and
neurophysiology is needed.
 Digital workflow application and speech software
analysis are further needed to be implemented into the
fabrication of tongue prosthesis.
 Silicone is the material of choice for fabrication of
tongue prosthesis.
 Patient acceptance and tolerance is a major factor in
success of tongue prosthesis.

45. References
 Marunick M, Tselios N. The efficacy of palatal augmentation
prostheses for speech and swallowing in patients undergoing
glossectomy: a review of the literature. J Prosthet Dent. 2004
Jan;91(1):67-74.
 Balasubramaniam MK, Chidambaranathan AS, Shanmugam G,
Tah R. Rehabilitation of Glossectomy Cases with Tongue
Prosthesis: A Literature Review. J Clin Diagn Res. 2016
Feb;10(2):ZE01-4.
 Aponte-Wesson R, Knott J, Montgomery P, Chambers MS. Floor
of mouth prosthesis with removable depressible tongue: A
clinical report. J Prosthet Dent. 2022 Jul;128(1):107-111.
 Aramany MA, Downs JA, Beery QC, Aslan Y. Prosthodontic
rehabilitation for glossectomy patients. J Prosthet Dent. 1982
Jul;48(1):78-81.