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Purpose: The aim of this study was to develop an exercise protocol to improve maximal mouth opening (MMO), tongue protrusion (Tprot), tongue strength (Tstren), and lip strength (Lstren), and to assess its effects on subjects with scleroderma. Methods: We performed four replicated single-system studies in a consecutive sample of subjects with scleroderma. An instrumented assessment measured MMO, Tprot, Tstren, and Lstren. Each day, subjects were assessed and performed orofacial exercises conducted by speech therapists. Treatments were first aimed at improving mouth physical characteristics by impairment-oriented exercises and then to improve skills with function-oriented exercises. Results: The mean phase differences between assessment and treatment phases across subjects were from 0.88 to 9.56 mm in MMO, from 2.03 to 12.3 mm in Tprot, from –0.12 to 5.35 N in Tstren, and from –0.84 to 5.19 N in Lstren. After treatment, 3 subjects crossed the 5th percentile discriminating normal from abnormal performances for both Tstren and Tprot, while this occurred in 2 subjects for MMO and Lstren. Conclusions: The results of this study suggest that rehabilitation appears to be useful in reducing tongue and lip impairments and in improving oral functions in subjects with scleroderma.

Introduction: The aim of this study was to evaluate the associations between malnutrition and the clinical features of the disease and depression in patients with systemic sclerosis (SSc). Method: Patients with SSc who were followed up in our clinic were enrolled in the study. Malnutrition risk was assessed using the Malnutrition Universal Screening Tool (MUST). Skin involvement was assessed using the modified Rodnan skin score (mRSS) and interincisal distance (ID) measurements were used to assess the maximal mouth opening capacity. The Beck Depression Inventory (BDI) was used for measuring the severity of depression. Results: Ninety-eight patients with SSc (84.7% women; mean age 52.67 ± 11.26 years) were included in the study. According to the MUST scores, 61.2%, 15.3%, and 23.5% of patients had low, medium, and high risk for malnutrition, respectively. The mRSS was significantly higher in the group with high malnutrition risk compared with low-risk group (p = 0.014). Malnutrition risk was associated with interstitial lung disease and bowel involvement (p = 0.044 and p = 0.021, respectively). Interincisal distance was lower in the group with high malnutrition risk compared with the low-risk group (p = 0.003). Malnutrition risk was higher in patients who had mild-to-severe depressive symptoms than in those without (p = 0.012). Interincisal distance and bowel involvement were the most relevant factors for malnutrition. Conclusions: The risk of malnutrition is increased in patients with SSc. In our study, microstomia and bowel involvement were the most relevantly associated factors with malnutrition. Key Points: • The risk of malnutrition is increased in patients with systemic sclerosis (SSc). • Microstomia and bowel involvement are found to be the most important factors associated with malnutrition. • Depressive symptoms are seen frequently among patients with SSc, and depression seems to be one of the etiologic factors or the result of malnourishment in SSc. • Assessment of nutritional status and the presence of depression should be a part of routine clinical visits of patients with SSc. © 2019, International League of Associations for Rheumatology (ILAR).

Introduction: Systemic Sclerosis (SSc) is a multi-system connective tissue disorder of unknown aetiology characterised by thickening and stiffening of skin. SSc is clinically classified as limited cutaneous systemic sclerosis (LCSSc) and diffuse cutaneous systemic sclerosis (DCSSc). Objective: To compare the cutaneous and systemic features of LCSSc with those of DCSSc. Materials and Methods: A cross-sectional, descriptive study was conducted over a period of eight years in a tertiary care centre. All the patients of SSc were classified as LCSSc and DCSSc. Cutaneous features, systemic features and laboratory parameters were evaluated and compared between these two groups. Results: 54 cases of SSc were recruited for the study; of which 18 belonged to LCSSc and 36 to DCSSc. Female to male ratio was 5:1 in LCSSc and 11:1 in DCSSc. Mean age were 26.10±10.68 years and 34.72±15.95 years in LCSSc and DCSSc respectively. Statistically significant difference was observed in parameters like mean age, duration of Raynaud’s phenomenon, digital pitted scars, microstomia, diffuse hyperpigmentation, salt and pepper pigmentation, dyspnea on exertion, arthralgia, raised ESR and abnormality in spirometry. Conclusion: The duration of Raynaud’s phenomenon and digital pitted scars were significantly higher in LCSSc than DCSSc whereas microstomia, diffuse hyperpigmentation, salt and pepper pigmentation, dyspnea on exertion, arthragia, raised ESR and restrictive ventilatory defect were significantly higher in DCSSc than LCSSc. Pulmonary, renal and cardiac involvement were relatively less in our study population compared to other studies. Keywords: Limited cutaneous systemic sclerosis, diffuse cutaneous systemic sclerosis, Raynaud’s phenomenon, icrostomia, digital pitted scars, salt and pepper pigmentation.

Limited oral opening is an acquired or congenital abnormal condition that compromises patient esthetics, nutrition, and quality of life. In addition, it may hinder conventional prosthetic procedures of edentulous patients, make it challenging, and present difficulties at all its stages. This clinical report presents different clinical treatment options suitable to be chosen by the prosthodontic carer in the case of reduced oral aperture.

This clinical report describes prosthetic rehabilitation applied to an edentulous patient with microstomia. Intraoral scanning was used for preliminary impressions, edentulous models were printed using a 3D printer, custom 2-piece impression trays for definitive impressions were made, and a 2-piece collapsible maxillary and a conventional mandibular denture were fabricated. Intraoral scanning is a useful alternative to conventional impression techniques and can be used safely in patients with microstomia for preliminary impressions.

Clinical description Freeman-Burian syndrome (FBS) is a rare congenital myopathic craniofacial syndrome. Considerable variability in severity is seen, but diagnosis requires the following: microstomia, whistling-face appearance (pursed lips), H or V-shaped chin defect, and prominent nasolabial folds. Some patients do not have limb malformations, but essentially all do, typically camptodactyly with ulnar deviation of the hand and talipes equinovarus. Neuro-cognitive function is not impaired. Epidemiology Population prevalence of FBS is unknown. Aetiology Environmental and parental factors are not implicated in pathogenesis. Allelic variations in embryonic myosin heavy chain gene are associated with FBS. White fibrous tissue within histologically normal muscle fibres and complete replacement of muscle by fibrous tissue, which behaves like tendinous tissue, are observed. Management Optimal care seems best achieved through a combination of early craniofacial reconstructive surgery and intensive physiotherapy for most other problems. Much of the therapeutic focus is on the areas of fibrous tissue replacement, which are either operatively released or gradually stretched with physiotherapy to reduce contractures. Operative procedures and techniques that do not account for the unique problems of the muscle and fibrous tissue replacement have poor clinical and functional outcomes. Important implications exist to facilitate patients’ legitimate opportunity to meaningfully overcome functional limitations and become well.

Statement of problem Prosthetic techniques commonly employed for the rehabilitation of edentulous patients might not be adequate in the treatment of patients with microstomia. Purpose The purpose of this paper is to systematically review all the prosthetic techniques that have been used in the oral rehabilitation of patients with microstomia. Materials and methods Data sources, including PubMed, Google Scholar, SCOPUS and Web of Science, were searched for case reports and case series published through September 2017. Three investigators reviewed and verified the extracted data. Only case reports and case series on prosthetic rehabilitation in microstomia patients published in the English language were considered eligible. Results A total of 212 records were identified from the database search. Forty duplicate records were removed. The remaining 172 articles were assessed for eligibility, and 139 articles were removed because they did not satisfy the inclusion criteria. A total of 34 cases (including 32 case reports and 1 case series) were finally included in the qualitative analysis. The review revealed the use of a modified impression technique with flexible and sectional trays to record impressions in patients with microstomia. Modified forms of oral prostheses ranging from sectional, flexible, collapsible and hinged dentures to implant-supported prosthesis were fabricated to overcome the limited mouth opening. The success of the prosthetic technique primarily depended on the extent of the microstomia and the nature of the cause of the microstomia. Conclusion Even though the patient acceptance of the prosthetic techniques summarized in the systematic review were high, long-term success rates for each option could not be assessed because of the short follow-up time in most of the included case reports and series.

Made available in DSpace on 2022-04-28T19:40:23Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Systemic scleroderma is a relatively rare, autoimmune, chronic, and debilitating disease, and its etiology is unknown.The disease is characterized by vasomotor disturbances causing skin and mucosa hardening, hand stiffness, excess production of collagen fibers, and impairment of the internal organs associated with the immune system. Extreme mouth-opening limitation is one of the symptoms in the oral cavity, and compromises dental intervention. One of the fundamental steps when performing a dental procedure is dental arch impression. In the presented clinical case, limited mouth opening hindered the impression accuracy. The objective was to present an alterna-tive impression technique for a patient affected by scleroderma, with limited mouth opening and the need for oral rehabilitation with a removable partial prosthesis in the maxillary arch. An individualized tray was developed with design characteristics that allowed access to the oral cavity and removal, after which it was possible to perform the oral impression, reproducing the areas of interest without causing injury to the oral tissues.The orientation plan was elaborated after obtaining the cast. The teeth were assembled, tested in the mouth, and sent to the laboratory for acrylization. The prosthesis was placed once ready. The alternative impression technique enabled oral rehabilitation of the patient despite the mouth-opening limitation, and provided an accurate impression and a good prosthetic result. 1244389). Department of Dental Materials and Prosthetics Institute of Science and Technology. Sao Jos£ Dos Campos Dental School Sao Paulo State University (UNE-SP) Department of Dental Materials and Prosthetics Institute of Science and Technology. Sao Jos£ Dos Campos Dental School Sao Paulo State University (UNE-SP)

Skleroderma, bir çok organ sistemini tutan sistemik kronik otoimmün bir hastalık olan ilerleyici sistemik sklerozun erken belirtilerindendir. Orofasiyal bulgular, genelde, mikrostomiye neden olan ağız ve çevre derideki sertleşme, gastroözefagial reflü, kserostomi ve kötü oral hijyen ile bağlantılıdır. Bu hastalarda uzmanlaşmış profesyonel diş hekimliği bakımı hemen her zaman gerekli olmaktadır. Bu olgu raporunda, sklerodermaya bağlı mikrostomisi olan orta yaşlı bir bayan hastanın tam dişsiz mandibulasının protetik rehabilitasyonu anlatılmaktadır. Hastaya, iki osseintegre dental implant üzerine yerleşen parçalı mandibular tam protez yapıldı. Orta lingual bölgede yerleşmiş sürtünen kızak tarzındaki hassas bağlantı sayesinde protez kolaylıkla takılıp çıkartılabildi, ayrıca implantlar da proteze yeterli bir retansiyon ve stabilite sağladı. Tedavinin sonunda, hem estetik hem de fonksiyonel bakımdan sonuçlar yeterliydi ve hasta tedaviden memnundu. Scleroderma is the initial manifestation of a process better described as progressive systemic sclerosis which is a chronic autoimmune systemic disease that affects many organ systems. İncluding the skin and the gastrointestinal tract. Orofacial findings are commonly associated with hardening of the skin around the mouth causing microstomia, also gastroasophageal reflux, xerostomia and poor oral hygiene, therefore advanced dental Professional care is nearly always needed for these patients. This case report presents the prosthodontic management of totally edentulous mandibula of a middle-aged female patient with microstomia induced by scleroderma. Sectional complete mandibular denture retained on two osseointegrated dental implants was fabricated. With the use of lingual midline friction-slide stud attachment, the sectional denture was easily inserted and removed by the patient and the implants provided sufficient retention and stability for the prosthesis. Acceptable function and esthetics were obtained at the end of the treatment and the patient was pleased with the results.

Made available in DSpace on 2021-06-25T10:58:42Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Scleroderma is a rare autoimmune disease characterized by excessive collagen production. The oral manifestations of the patient with scleroderma can include microstomia, xerostomia, and changes in the resorption teeth. We report the case of a 7-year-old female patient diagnosed with systemic scleroderma where photobiomodulation therapy was used to treat xerostomia associated with hyposalivation. She attended a pediatric clinic and presented with dry and rigid facial skin, trismus, xerostomia, malocclusion, and difficulty swallowing. Stimulated salivary flow was assessed before, during, and after treatment. Photobiomodulation therapy was conducted at four points at the sublingual glands with 660 nm, 100 mW, and 0.8 J/cm2 to each point; eight points at the parotid glands; and six points at the submandibular glands with 808 nm, 100 mW, and 0.8 J/cm2 for 8 seconds at each point. After this therapy, an increase in salivary flow, remission of the xerostomia, and an improvement in mastication and swallowing were observed. Photobiomodulation therapy was effective in controlling xerostomia in this pediatric patient, resulting in increased salivary flow and an improvement in her quality of life. Universidade Estadual de São Paulo (Unesp) Faculdade de Odontologia de Araraquara Departamento de Morfologia e Clínica Infantil Universidade Estadual de São Paulo (Unesp) Faculdade de Odontologia de Araraquara Departamento de Diagnóstico e Cirurgia Universidade Estadual de São Paulo (Unesp) Faculdade de Odontologia de Araraquara Departamento de Morfologia e Clínica Infantil Universidade Estadual de São Paulo (Unesp) Faculdade de Odontologia de Araraquara Departamento de Diagnóstico e Cirurgia

Restricted mouth opening (RMO) in patients with anatomical anomalies is a major challenge in dental and oral surgery. There are many causes of restricted mouth opening. The origin of the anatomic anomaly may be acquired, such as in burn victims and in patients with disorders of the temporomandibular joint, or developmental, such as in Marfan syndrome.

Systemic sclerosis is a complex autoimmune connective tissue disease of unknown cause that causes sclerosis and inflammation of the skin and subcutaneous tissue. Sclerosis involving the face can lead to microstomia, leading to difficulties with mastication, phonation, and oral hygiene. Although many agents have been used to treat internal organ involvement, they often have compromised efficacy on cutaneous manifestation including facial dermal sclerosis. In this case presentation, we will introduce a surgical technique to correct scleroderma-induced microstomia.

7q11.23 Microduplication (dup7q11.23) syndrome is a rare autosomal dominant disorder due to a recurring 1.5 to 1.8 Mb duplication of the Williams&ndash, Beuren Syndrome critical region. Dup7q11.23 has been associated with several neuro-behavioral characteristics such as low cognitive and adaptive functioning, expressive language impairment, anxiety problems and autistic features. In the present study, we analyze the clinical features of ten individuals in which array-CGH detected dup7q11.23, spanning from 1.4 to 2.1 Mb. The clinical characteristics associated with dup7q11.23 are discussed with respect to its reciprocal deletion. Consistent with previous studies, we confirm that individuals with dup7q11.23 syndrome do not have a homogeneous clinical profile, although some recurring dysmorphic features were found, including macrocephaly, prominent forehead, elongated palpebral fissures, thin lip vermilion and microstomia. Minor congenital malformations include patent ductus arteriosus, cryptorchidism and pes planus. A common finding is hypotonia and joint laxity, resulting in mild motor delay. Neuropsychological and psychodiagnostic assessment confirm that mild cognitive impairment, expressive language deficits and anxiety are recurring neurobehavioral features. New insights into adaptive, psychopathological and neurodevelopmental profiles are discussed.

A 37-year-old woman with Raynaud’s phenomenon in all fingers and toes for 7 years presented with painful redness of both eyes for 2 weeks. On examination, she had digital ulcers ([figure 1][1]), skin tightening with microstomia (modified Rodnan’s skin score was 15/51), bilateral vision was 6/6

Objectives To present early teeth extractions as a treatment option in severe dental crowding in patients with generalized recessive dystrophic epidermolysis bullosa (RDEB). Materials and methods Three patients with generalized RDEB were treated with early teeth extractions to prevent severe dental crowding. Results Two patients had bilateral upper first premolars extraction, and the third patient had permanent maxillary canine extraction. Crowding was avoided, and no further orthodontic treatment was necessary. Conclusion Considering the challenges of severe mucosal fragility and microstomia in patients with generalized RDEB, early teeth extractions are a reasonable option as an orthodontic management. This approach reduces the severity of dental crowding as the child gets older and reduces the need for orthodontic appliances. Individual factors such as access to dental care, general health, and oral health have an important impact on the decision‐making process. Orthodontic treatment planning should include a multidisciplinary team.

Highlights • Oro-facial fibrosis presents a significant disease burden in systemic sclerosis. • There is currently no treatment available for oro-facial fibrosis. • Autologous fat grafting is a novel therapeutic method for oro-facial fibrosis., Introduction Oro-facial fibrosis is a common and disabling manifestation of systemic sclerosis (SSc), causing a plethora of functional, aesthetic and social compromise, yet is without effective treatment. Autologous lipotransfer is an established minimally invasive surgical procedure that is postulated to exert anti-fibrotic effects by adipose-derived stem cells, and presents a novel method in the treatment of fibrotic conditions. This study aims to assess the safety and efficacy of autologous lipotransfer for facial involvement in SSc. Methods and analysis This is the first randomised controlled study with an open label design to assess autologous lipotransfer for oro-facial involvement in systemic sclerosis. The goals of this study are to assess the feasibility of using a range of quantitative and qualitative outcome measures to effectively measure disease severity and treatment outcome, and to assess patient acceptability for future multi-centre trials. A total of 50 participants will be randomised to a treatment or control group. The treatment group will receive autologous fat transfer to the peri-oral region by a single surgeon. Dermal fibroblasts and adipose-derived stem cells will be isolated from tissue samples. All outcome measures will be taken at baseline, then at 6 weeks, 3 months and 6 months from the time of intervention in the treatment arm, or from baseline in the control arm. Ethics and dissemination The study has ethical approval (REC reference 19/LO/0718). Results will be available to patients, patient user groups, clinicians and the public through presentations at national and international rheumatology conferences and published in peer reviewed journals. Trial registration Registered on ISRCTN registry (ISRCTN17793055).

Background: Peri-oral and oral soft tissue defects can be caused by several conditions, as resection of malignant and benign tumors, congenital malformations, traumatic injury. They can cause alterations in function and appearance of the affected area. Primary closure is the most commonly used technique for small defects, whilst medium and large defects require reconstruction with local, regional or free flaps. Local flaps are a good choice for reconstruction of medium-size defects of the lip, because they provide the same type of tissue, they are situated in proximity to the resected area, and they can be performed also in patients with multiple co-morbidities.Aim: To evaluate the role of lip and perioral reconstruction in plastic surgery unit of General Surgery Department, Zagazig University Hospitals.Methods: This study was carried out in plastic surgery department, Zagazig University Hospitals, from August 2018 to January 2019. It included 18 patients with perioral defects undergoing surgical tumor ablation. These patients were operated upon and referred to our outpatient clinic for the follow-up visits.Results: Out of 18 cases included, Karapandzic flap was used in 6 cases while mucosal advancement, rhomboidal flap were used in 4 cases. Hypothesia in 27.8%. Sialorrhea was in 16.7%. Microstomia was in 33%, partially satisfied in 50% and satisfied 50% after 6 months of the study.Conclusion: Local flaps provide the most satisfactory results and should be considered as the first choice for reconstruction of perioral defects.Keywords: Perioral reconstruction, local flaps, perioral defects.

Mild- to moderate-sized lip defects that affect one- to two-thirds of the total lip length often require that utilization of local soft tissue rearrangement in order to re-establish lip anatomy, function and esthetics. The use of local flaps in lip reconstruction often follows oncologic resection of common skin malignancies including basal cell carcinoma and squamous cell carcinoma. When considering the types of flaps to use for lip defects of one- to two-third total length, a variety of flaps designs have been described, each with its benefits in drawbacks. In this article, we reintroduce the use and value of the bilateral mucomyocutaneous ‘bandoneon’ flaps for lower lip reconstruction in two of our patients. When compared with other flap designs, it can be used as a single-stage procedure with a very good esthetic outcome, minimal to no microstomia and preservation of lip competence and sensory function.

Children suffering from conductive or mixed hearing loss may benefit from a bone-anchored hearing aid system (BAHA Attract implantable prosthesis). After audiological rehabilitation, different aspects of development are improving. The objective of this case report is to propose a comprehensive framework for monitoring cortical auditory function after implantation of a bone-anchored hearing aid system by using electrophysiological and neuropsychological measurements. We present the case of a seven-year-old boy with a congenital hearing loss due to a plurimalformative syndrome, including outer and middle ear malformation. After the diagnosis of hearing loss and the audiological rehabilitation with a BAHA Attract implantable prosthesis, the cortical auditory evoked potentials were recorded. We performed a neuropsychological evaluation using the Wechsler Intelligence Scale for Children – Fourth Edition, which was applied according to a standard procedure. The P1 latency was delayed according to the age (an objective biomarker for quantifying cortical auditory function). The neuropsychological evaluation revealed that the child’s working memory and verbal reasoning abilities were in the borderline range comparing with his nonverbal reasoning abilities and processing abilities, which were in the average and below-average range, respectively. Cortical auditory evoked potentials, along with neuropsychological evaluation, could be an essential tool for monitoring cortical auditory function in children with hearing loss after a bone-anchored hearing aid implantation.

Thermal disease presents a major burden to individual patient morbidity, healthcare cost as well as to over all economy. Burns also also represent a significant per-patient utlilisation of finite healthcare resources. Secondary complications in these patients, such as multiple drug resistant organisms, may have a devastating effect. Laser surgery has recently come of age as an optimal tool in the secondary reconstruction of burn injury, that is able to simultaneously address significant sheet scar tightness, hypertrophic, atrophic, and keloid complications, pruritus, microstomia, ectropion, skin graft honeycombing, and improve range of movement whilst reducing the risk of infection to1%. Yet, cutaneous laser surgery is often underutilised due to the perceived concerns about the sustainability of a new service with relatively high startup cost. We present a dual methodology to explore this concern: an evidence-based background review of the last 5 years of current best evidence, and a 22-year cost-analysis comparison at an established, high volume UK Centre of reconstructive surgery. We report that fiscal viability for laser surgery services for secondary burn reconstruction is supported by: level 2 (one systematic review) level 4 evidence (2 studies) and level 5 evidence (expert reports). Evidence over 22 years from an established super-regional NHS laser centre shows that introduction of this service led to sustained and substantial cost saving, producing excellent surgical results at a fraction of the cost of traditional surgery. Analysis of the potential dollar-effect of these advantages to the general population supports state investment in expertise and capital equipment as a medium to long-term cost saving strategy, which may also aid re-integrating patients into the workforce making a meaningful contribution to the economy.

Systemic sclerosis (SSc) is an autoimmune disease that can cause fibrosis in vital organs, often resulting in damage to the skin, blood vessels, gastrointestinal system, lungs, heart, and/or kidneys. Patients with SSc are also likely to develop microstomia, which can render dental treatment difficult and painful, thereby necessitating advanced anesthetic management. This is a case report of a 61-year-old woman with a history of SSc with microstomia, interstitial pneumonia, and gastroesophageal reflux disease in whom intravenous moderate sedation was performed using a combination of dexmedetomidine and ketamine for dental extractions. Both anesthetic agents are known to have analgesic effects while minimizing respiratory depression. Consequently, the increased discomfort caused by opening the patient's mouth and stretching the buccal mucosa was sufficiently managed, permitting an increase in maximum interincisal opening and completion of treatment without complications. Patients with SSc present with serious comorbidities that can negatively impact anesthetic management, so the implementation of an anesthetic plan that takes such risks into account is required. Furthermore, emergency airway management is likely to be difficult in patients with microstomia. For intravenous moderate sedation, combined use of dexmedetomidine and ketamine, which have analgesic effects while minimizing respiratory depression, may be particularly effective in patients with SSc and microstomia.

BackgroundOtocephaly is a rare lethal malformation of the first branchial arch. While the knowledge on the causes of otocephaly in animals is limited, different syndromic forms in man are associated with variants of thePRRX1andOTX2genes.Case presentationA stillborn male lamb of the Istrian Pramenka sheep breed showed several congenital craniofacial anomalies including microstomia, agnathia, aglossia, and synotia. In addition, the lamb had a cleft palate, a small opening in the ventral neck region, a cystic oesophagus and two hepatic cysts. The brain was normally developed despite the deformed shape of the head. Taken together the findings led to a diagnosis of otocephaly. Whole-genome sequencing was performed from DNA of the affected lamb and both parents revealing a heterozygous single nucleotide variant in theOTX2gene (Chr7: 71478714G > A). The variant was absent in both parents and therefore due to a de novo mutation event. It was a nonsense variant, XM_015097088.2:c.265C > T; which leads to an early premature stop codon and is predicted to truncate more than 70% of theOTX2open reading frame (p.Arg89*).ConclusionsThe genetic findings were consistent with the diagnosis of the otocephaly and provide strong evidence that the identified loss-of-function variant is pathogenic due toOTX2haploinsufficiency. The benefits of trio-based whole-genome sequencing as an emerging tool in veterinary pathology to confirm diagnosis are highlighted.

Journal of The Dental Association of Thailand, 70, 2, 117-123

It is difficult to make impression and fabricate conventional dentures for patients with microstomia and flat ridge. This is a case report of 53-year-old female with limited mouth opening (25 mm) who had been wearing denture for 7 years and which was recently broken. Close mouth with suction impression method was used. Proper diagnosis and appropriate set of procedures and methods were needed for this patient. The conventional complete denture fitted with closed mouth method for this condition resulted in retentive and stable denture which was inserted and removed easily.

Reconstruction of the oral commissure is necessary after trauma, pathological resection, or electrical, chemical, or thermal burns. Using dental appliances is strongly recommended to prevent microstomia in victims with oral commissure injury caused by burns. These appliances can be modified from dynamic to static for more patient comfort during the healing period and used in trauma patients to prevent rounding of the labial commissure. Preventing relapse of microstomia and forming acute angles at the corner of the mouth are 2 optimal goals when performing this surgery.

Background Systemic sclerosis is a systemic connective tissue disease characterized by endothelium damage, fibrosis, and subsequent atrophy of the skin. Perioral fibrosis produces a characteristic microstomia together with microcheilia, both of which cause severe difficulties and affects patients’ daily life, such as eating and oral hygiene. Since there are no effective and specific therapies, we have aimed at evaluating the response to filler injections of hyaluronic acid together with platelet-rich plasma. Methods Ten female patients aged between 18 and 70 were included in this study. Each patient was treated with three filler injections of hyaluronic acid and platelet-rich plasma at an interval of 15 to 20 days. Follow-up check-ups were recorded 1, 3, and 24 months after the end of the treatment. During the therapy and the subsequent follow-up, we evaluated the mouth’s opening, freedom of movement of the lips, and skin elasticity. Results After the treatment, patients had achieved good results already after the first injection and the improvement was maintained in the following months, up to 2 years. In particular, 8 (80%) patients showed a greater mouth’s opening and increased upper lip’s thickness during 1-month follow-up and maintained these results after 2 years (maximum mouth’s opening T0 47.61; T3 49.23; T4 48.60 p p p p p Conclusions Our study demonstrates that filler injections of hyaluronic acid and platelet-rich plasma represent an efficient local therapeutic alternative for patients affected by scleroderma. The treatment has significantly improved patients’ quality of living.

Objectives The aim of this study was to investigate the role of the extended Abbe flap in the reconstruction of complex midfacial defects (upper lip, nasal base and medial cheek). We describe our personal experience with this method and present some interesting aspects from the relevant literature. Materials and methods Between 2003 and 2017 we retrospectively evaluated the records of all patients with defects of the upper lip and nasal base after the resection of malignant tumors or traumata and reconstruction by means of the extended Abbe flap. We looked for information on the origin of the defect, the functional result, the aesthetic outcome and postoperative complications. The functional result of the reconstruction of the oral commissure was assessed with regard to postoperative subjective speech integrity, preservation of competence of the oral sphincter and lip sensation. The aesthetic outcome was evaluated with regard to limitations in facial expression and scar formation. Results The study included 8 patients. Follow–up in the oncological cases was 85 months (range: 20–150 months). No tumor recurrences were detected. All patients achieved normal oral competence and mouth opening. No cases of blunting or microstomia were detected. Conclusion Reconstruction of the upper lip and nasal base with the extended Abbe flap is associated with an outstanding functional outcome that is cosmetically very acceptable.

This clinical report describes a digital workflow using extraoral digital photographs and volumetric datasets from cone beam computed tomography (CBCT) imaging to create a 3-dimensional (3D), virtual patient with photorealistic appearance. In a patient with microstomia, hinge axis approximation, diagnostic casts simulating postextraction alveolar ridge profile, and facial simulation of prosthetic treatment outcome were completed in a 3D, virtual environment. The approach facilitated the diagnosis, communication, and patient acceptance of the treatment of maxillary and mandibular computer-aided design and computer-aided manufacturing (CAD-CAM) of immediate dentures at increased occlusal vertical dimension.

Purpose Virtual surgical planning (VSP) is an indispensable aid in craniomaxillofacial reconstruction, yet no protocol is established in facial gunshot wounds. We review our experience with computer-aided reconstruction of self-inflicted facial gunshot wounds (SIGSW'S) and propose a protocol for the staged repair. Methods A retrospective case series enrolling patients with SIGSW's managed with the Functional Anatomic Computer Engineered Surgical protocol (FACES) was implemented. Subjects were evaluated at least one month postoperatively. Outcome variables were jaw position, facial projection, oro-nasal communication, lip competence, feeding tube and tracheostomy dependence, descriptive statistics were computed. The FACES protocol implemented during the initial hospitalization is as follows 1) damage control; 2) selective debridement; 3) VSP reconstruction back converted into navigation software 4) navigation assisted midfacial skeletal reconstruction; 5) computer aided oro-mandibular reconstruction with or without microvascular free flaps using custom cutting guides/hardware; 6) navigation assisted, computer aided palatomaxillary reconstruction with or without microvascular free flaps using cutting guides/hardware; 7) navigation assisted reconstruction of the internal orbit; 8) and confirmation of accurate reconstruction using intraoperative CT. Results The sample was composed of 10 patients, mean age of 43 years (range, 28 - 62 years, 70% M), 100% with SIGSW's to the submental/submandibular region. All had satisfactory facial projection (n=10), nine had satisfactory jaw position, were decannulated by one month's follow up and were feeding tube independent (90%). All traumatic oro-antral communications were closed (n=8, 7 surgical, 1 obturator), seven had adequate lip competence (70%). Complications included fibula malunion (n=1), plate exposure (n=2) infection (n=2), intracranial abscess (n=1) and microstomia (n=2). Conclusion Computer-aided surgery is an indispensable tool in the reconstruction of SIGSW's. Successfully implemented, it proved to be a useful adjunct for: the restoration of orbital volume, facial projection and symmetry; the inset of composite tissue, and the facilitation of dental implant supported prosthetic rehabilitation.

Background The repair of extensive lower lip defects is difficult due to the presence of both functional and esthetic requirements. This report describes functional lip repair using the partial latissimus dorsi free flap without nerve coaptation. Methods Reconstruction of the lower lip due to subtotal and total tissue defects was performed using latissimus dorsi free flap on twelve patients, between 2013 and 2017. The etiology was squamous cell carcinoma in six patients, malignant melanoma in one, firearm injury in three and microstomia in two. Following exposure of the lip defect, the partial latissumus dorsi muscle flap was harvested and transfered into the lower lip defect. The microvascular anastomoses was done and no nerve coaptation was performed. The muscle was covered with a skin graft taken from the thigh for mucosal and skin lining. Functional outcomes were assessed using physical examination, electromyography (EMG), electroneuromyography, cold/warm and pain sensation, two point discrimination (TPD), and Semmes Weinstein (SMW) tests. Results Postoperative course was uneventful for all of the flaps. Patients were followed for between fifteen months and four years (mean 28.2 months).Color match between the flap and the face and functional outcome was satisfactory. Reinnervation was detected at EMG in eleven patients undergoing surgery six months postoperatively.After 1 year, the patients demonstrated quite normal results of the test with SMW and TDP results. None of patients perceived both hot and cold sensation. Conclusion The technique is an alternative option in lower lip reconstruction since it provides satisfactory functional and esthetic results despite absence of any neural coaptation.

Purpose: This review was intended to discuss the various possible modifications suggested in the literature for prosthetic steps and surgical corrective procedures in nonresponding or complicated cases during rehabilitation of patients with restricted mouth opening. Material and Methods: Medline, PubMed, and Google were searched electronically for articles using keywords: microstomia and treatment options for restricted mouth opening. The various articles on prosthodontic rehabilitation in microstomia were segregated. From these, various modifications in the prosthetic steps were reviewed. Results: Oral hygiene maintenance is difficult for patient either due to limited access or due to associated lack of manual dexterity, so dental decay and periodontal problems are more extensive in such patients; hence, tooth loss is a common finding. All prosthetic procedures require wide mouth opening to carry out various steps, starting from tray placement during impression making to the final prosthesis insertion, especially removable prosthesis. Various prosthetic modifications given by authors are included in this review for each step in prosthodontic management. A total of eight stock tray designs, 12 custom tray designs, and 17 removable prosthesis designs are discussed along with fixed (either tooth-supported or implant-supported) and maxillofacial prosthesis. However, some patients require surgical intervention also for the correction of microstomia either for function or for esthetic purpose before prosthetic rehabilitation and are also enumerated here. Conclusion: Among all prosthetic restorative options, removable prosthesis is most difficult for dentist to fabricate as conventional methods are either very difficult or impossible to apply. To get a more accurate final prosthesis, we need to modify these steps according to the existing case. Several modifications available are discussed here which can help while managing these patients.

Microstomia is a condition with abnormally small oral aperture which is associated with compromised aesthetics and function of stomatognathic system. In young children, the leading cause of microstomia is oral electrical or chemical burns. Management of microstomia requires multidisciplinary approach including surgery, physiotherapy and appliance therapy. Appliance therapy in form of microstomia prevention appliance plays a pivotal role in prevention of contraction of tissue during healing. Numerous appliances have been described in literature to prevent microstomia. However, decision to use a particular appliance require meticulous planning considering the efficacy and effectiveness of the appliances and various patient factors like age, dentition status and compliance. This paper presents an unusual clinical condition where a unique customized microstomia prevention appliance therapy was instituted to prevent microstomia in 2 year old female patient following lip surgery. This appliance was constructed easily and inexpensively, could be adjusted so that it was almost painlessly inserted, and was progressively adapted. It was convenient for use in young child with minimal compliance offering improved mouth opening and consequently functional outcomes.

Reduced oral aperture(Microstomia) and mandibular hypo mobility/trismus are relatively common conditions that can be encountered in patients attending general dental practice, community dental practice and district general or dental teaching hospitals. All dental specialties may see patients with these conditions, and regardless of which environment or specialty, both patient and clinician may experience significant problems. The purpose of this case study is to review the development of problems encountered for patients and clinicians, and to identify options to treat or manage the conditions. Keywords:Mandibular hypomobility, Microstomia, Non Odontogenic, Odontogenic,Trismus.

A síndrome de Moebius ou sequencia de Moebius (SM), desordem congênita rara, não progressiva, de severidade variada, tem como principal manifestação paralisia uni ou bilateral do nervo facial, que confere inatividade dos músculos da expressão facial por ele inervados. As manifestações orofaciais que acompanham a SM são fissura palatina, língua fissurada, tônus dos músculos faciais e da língua deficiente, hipoplasia dentária, sialorreia por ausência de selamento labial, cárie, doença periodontal, micrognatia, microstomia, mordida aberta, úvula bífida, dificuldade da realização de movimentos excursivos mandibulares, pequenas fissuras palpebrais, ptose palpebral, epicanto bilateral, hipertelorismo ocular, deformidade da orelha externa com perda ocasional da audição. Portadores de SM com paralisia facial bilateral apresentam incapacidade para sorrir, devido à ausência de movimentos de elevação dos lábios e da comissura labial, além de dificuldades na fala, mastigação e deglutição. O objetivo deste estudo é relatar a abordagem terapêutica em paciente de 08 anos de idade portador de fissura pós forame associada à Síndrome de Moebius atendido no Serviço de Cirurgia Bucomaxilofacial do centro de fissurados das Obras Sociais Irmã Dulce (Salvador, Bahia), que apresentou ausência de expressão facial, déficit motor ocular, ausência de selamento labial com sialorreia, microstomia, hiperplasia gengival generalizada e dentes decíduos cariados. A paralisia facial e as malformações orofaciais e musculoesqueléticas apresentadas por portadores da síndrome de Moebius tem uma série de implicações sobre a saúde geral e bucal. A abordagem precoce do cirurgião-dentista é fundamental para o estabelecimento de uma condição bucal que garanta melhor qualidade de vida ao paciente.