Resection of oral or mouth cancer can result in defects of the tongue, upper jawbone (maxilla), and lower jawbone (mandible). Defects of the tongue are best restored with a free tissue transfer of either the radial forearm, thigh, or scapula. A reconstructive surgeon performs this procedure. In some situations for tongue cancer patients, a palatal augmentation prosthesis is needed. It is a removable prosthesis that alters the hard and/or soft palate’s topographical form adjacent to the tongue (Figure 1).
Defects of the upper jawbone include both hard and soft tissue deficits. If the defect is limited to the hard palate, either surgical reconstruction by the head and neck reconstructive surgeon or prosthetic obturation (Figure 2) is available. Your doctor will review your options with you at the time of your visit. If prosthetic obturation is
used, the patient usually will have an surgical obturator placed at the time of surgical resection. The surgical obturator is a temporary prosthesis inserted during or immediately following surgical or traumatic loss of a portion of the upper jawbone including gums and teeth. During the healing process, the obturator will need to be relined periodically. After treatment for the cancer is completed, a definitive obturator can be fabricated which can include dental implants, if indicated (Figure 3).
If the defect involves the soft palate, then a speech bulb prosthesis or soft palate obturator may be necessary (Figure 4). The soft palate is dynamic or movable tissue which means that the prosthesis has to be molded to incorporate the movement of the back of the throat. This prosthesis improves speech by sealing off the soft palate defect to achieve velopharyngeal competency. Another prosthesis that may be used is a palatal lift prosthesis. This prosthesis is used when the soft palate is intact, but, it doesn’t move. This prosthesis elevates and assists in restoring soft palate function. In most situations, it is used as an interim measure to determine its usefulness in achieving palatopharyngeal competency or enhance swallowing reflexes.
For defects of the lower jaw, a resection appliance is needed. Most lower jawbone defects are reconstructed with a free tissue transfer consisting of bone and/or soft tissue depending upon the defect type (Figure 5). The resection prosthesis can be made without any teeth similar to a denture, with teeth similar to a removable partial denture, and with dental implants.