Immediate rehabilitation after total glossectomy: A clinical

report
Paul Kaplan, DDS, MS*
University of Chicago, Chicago, 111.

T otal glossectomywith laryngectomy resultsin the At this time the patient had dentures that had beenfab-
inability to control fluid during swallowing and loss of ricated 8 months before surgery. He had originally sought
speechwith associatedemotional impairment. Prior plan- dental treatment becausehis 15-year-old set of dentures
ning and coordination with rehabilitation team members had started to be uncomfortable and no longer “seemedto
can decreasethe severity of the physical and emotional fit.” New dentureswere made.After multiple adjustments,
impact. However, this coordination may not always occur. another dentist referred the patient to an oral surgeonfor
examination. The patient was then referred to the oto-
CLINICAL REPORT laryngology department of the Loyola University Medical
The patient was a 72-year-old white man with an Center.
uncomplicated 3-week postoperative course from surgery
that included total glossectomyand laryngectomy. A free
skin graft had beenplaced in the floor of the mouth. Heal-
ing appeared to be proceeding within normal limits.
The patient wasreceiving a liquid diet, which he wasun-
able to swalloweffectively. He gave the clinical impression
of being frustrated and angry. He repeatedly made written
notes that expressedthe thought that he would have been
better dead than being left in this state. His wife of 53 years
was trying to cope with the “devastation” that had oc-
curred in their lives. No counseling had been available ei-
ther before or after surgery.

*Lecturer, Department of Surgery, University of Chicago, and

Clinical Associate Professor, Department of Fixed Prosthodon-
tics, Loyola University, Chicago.
J PROSTHET DENT 1993;69:462-3. Fig. 2. Depression in center raises posterior edge and
Copyright @ 1993 by The Editorial Council of THE JOURNAL OF funnel to left establishescontrol over ingested liquids.
PROSTHETIC DENTISTRY. Pooling, followed by posterior tilt of head to initiate spill-
0022-3913/93/$1.00 +.10 10/l/44589 age through funnel, gives control of liquids.

Fig. 3. Artificial tongue is established,which further aids

Fig. 1. Acrylic resin was cut to fit relined denture base. in control of fluid.

462 VOLUME69 NUMBER6

KAPLAN
Fig. 4. Dropped palate stimulates swallow reflex by pro-
viding artificial tongue with palate that can be reached on
mandibular closure.
The patient wasreferred for maxillofacial prosthodontic
care 3 weeks postoperatively. Examination indicated that
although the maxillary denture was relatively stable, the
mandibular denture could not be placed becauseof the al-
teration of the floor of the mouth and the complete removal
of normal lingual anatomic landmarks.
The maxillary denture wasrelined clinically. After com-
plete removal of the lingual flange, the mandibular denture
could be inserted. A clinical reline was then molded to
readapt this denture to the postsurgical foundation. A
sheet of pink light-cured acrylic resin (Triad, Dentsply,
York, Pa.) wascut to fit the lingual borders of the mandib-
ular denture (Fig. 1). This sheet was placed in the mouth
and the patient was asked to simulate swallowing and to
rotate and tilt the head. The light-cured resin sheet was
initially polymerized clinically to prevent distortion on re-
moval. The modified denture wasthen fully polymerized in
a light-curing oven (Triad, Dentsply, York, Pa.). It was
noted that a cup and funnel had been shapedin the floor
of the mouth (Fig. 2). The successof this procedure became
immediately apparent to the patient, who becamevisibly
excited. The patient immediately began liquid nourish-
ment in quantities exceeding what he had been previously
attempting. By allowing quantities to pool in the cup and
then tilting the head back and allowing liquids to flow
through the funnel, swallowingcontrol was reestablished.
To further aid fluid control, a “tongue” was provided
(Fig. 3). This addition controlled the splashingeffect and
limited the quantity of liquid spilling posteriorly. It also
provided emotional support to both the patient and his
wife to believe that the tongue was being replaced.
Another sheet of light-cured resin was cut to shapeand
MAY 1993
THE JOCRNAI. OF PROSTlIETI(’ DENTISTRY
Fig. 5. Revised dentures show dropped palate, artificial
tongue, and molded funnel.
adapted to the maxillary denture at the level of the palate
necks of the teeth. This addition establishedan artificial
palate without a significant increasein weight (Fig. 4). The
location of the dropped palate wasdetermined by placing
the dentures into occlusionand then placing the dropped
palate a millimeter above the simulated tongue (Fig. 5).
Placement wasuneventful. No adjustmentswere needed
at recall appointments. Patient appearanceand demeanor
have dramatically improved. With frequent smilesthe pa-
tient’s wife reported that progresshas been made from a
liquid to a soft diet and that more solid foods were being
tried.
SUMMARY
Rehabilitation has psychological and physical compo-
nents. Planning and discussion with the surgeon and
patient before surgery can often easethe impact of treat-
ment and help to establishreasonablepostoperative goals.
When prior planning is not possible,the physical and psy-
chological impact can be severe.
In addition, consideration must be given to the needsof
the primary postsurgicalprovider, in this casethe spouse
of 50 years. By allowing the wife to observethe procedures
and keepingher fully informed of the desiredoutcome and
goals,her psychological concernswere also addressed.
Use of light-cured resin material can aid in providing
definitive and rapid maxillofacial prosthetic treatment.
Reprint requests to
DR. PACL KAPLAh
SUITE 811, HYUE PARK BANK BUILDING
1525 E. 53RD ST.
CHI(‘AGO, IL 60637
463