PROSTHETIC REHABILITATION

FOLLOWING PARTIAL AND

TOTAL GLOSSECTOMY

Rohan Grover
JR II

Introduction
Approx 5% of all cancers occur in the oral cavity.
Carcinoma of the tongue is the second most
common oral cancer.
Posterior lateral borders of the tongue are the
most frequent sites of cancer of the tongue.

( British Postgraduate Medical Federation, 1988)

FUNCTIONS AFFECTED BY GLOSSECTOMY

Speech difficulties.
Deglutition difficulties.
Difficulties in mastication and food
bolus management.
Difficulties in saliva management.

Prosthodontic Treatment of
Total Glossectomy
Tongue defects due to tumor removal can result
in either total or partial glossectomy.
A total glossectomy will create a large oral cavity
and pooling of saliva and liquids. These liquids
can seep around the epiglotis, leading to
aspiration.

 With present knowledge, it is impossible to

recreate the original function of the mobile
tongue either surgically or prosthetically. It is,

however, possible to improve function and

esthetics for these patients.

The major goals in prosthodontic

rehabilitation of the total glossectomy
patient without surgical reconstruction
are to (Cantor et al, 1969):

1. Reduce the size of the oral cavity, which

improves resonance and minimizes the degree

of pooling of saliva.

2. Direct the food bolus into the oropharynx with

the aid of a trough carved into the dorsum of the
tongue prosthesis.

3. Protect the underlying fragile mucosa if skin

flaps were not used.

4. Develop surface contact with the

surrounding structures during speech and

swallowing.
5. Improve appearance and psychosocial
adjustment.

 The success of prosthodontic rehabilitation

depends primarily on
patient motivation,
anatomic factors (such as the presence or absence

of teeth),
associated morbidity of the surrounding
structures, including mandibulectomy,
palatectomy, and radiation therapy to these
areas.

 In total glossectomy, the mandibular tongue

prosthesis is the treatment of choice (Moore,
1972).
However, in a situation involving an edentulous
patient and an irradiated, resorbed mandibular
ridge or a patient with a very mutilated
dentition, a palatal augmentation prosthesis

should be considered.

Construction of a Mandibular
Total Tongue Prosthesis
For preliminary impressions, the patient

should be seated in an upright position.

It is critical for the safety of the patient to

ensure that impression material does not

flow into the hypopharynx.
For this reason, the dental assistant must

accompany with a high-speed suction.

 A stock maxillary tray of proper size should

be selected.
The maxillary tray is necessary to register the
entire floor of the mouth.

 Utility wax is added to the posterior edge and

the vault of the tray to confine the hydrocolloid
material and to prevent it from flowing toward
the patient's throat.

Modified stock tray is tried in the patients mouth

for fit and comfort

Preliminary impression of the mandibular arch

and the floor of the mouth following total
glossectomy

Master cast
after block-out

Refractory
cast

Completed wax pattern

Spruing of the total

glossectomy framework

Finished chrome-cobalt framework on the master

cast

 The framework is tried in the patient's mouth

using rouge and chloroform or similar

disclosing media to ensure complete and
passive seating on the teeth

 Care should be taken to ensure that the

retentive meshwork does not touch the floor
of the mouth during any functional

movement.

If it does, it should be cut and soldered in a

more Occlusal position or the framework

remade at a higher level.

Mouth temperature wax is placed on the retentive

meshwork

 The patient is asked to perform functional

movements with the floor of the mouth such
as attempting to pronounce various sounds

like ee, opening and closing, and attempting

to swallow

Iowa-wax impression of the floor of the

mouth

 The wax tracing is inspected and more wax is

added to ensure passive contact with the floor of

the mouth during functional movements.
A mushroom like projection is waxed to the oral
surface of the framework to retain the oral
portion of the tongue prosthesis.

Acrylic resin base with a

retentive mushroom extension
fitted on the cast

Maxillary & mandibular casts

showing that the framework
and the mushroom retentive
extension do not interfere with
the opposing arch

 It has been suggested that three prosthetic

tongues be made:
one for speech
one for swallowing
one for both speech and swallowing

(Moore, 1972; Myers and Sun, 1996)

 The prosthetic tongue for speech should have an

anterior elevation to facilitate articulation of the

anterior linguoalveolar sounds t and d.

It should also have a posterior elevation to aid in
the articulation of the glottal stops or posterior
linguoalveolar sounds g and k.
Both elevations help to shape the oral cavity,

thus improving vowel production in general.

Mandibular tongue prosthesis for speech. It is

made of clear acrylic and has anterior and
posterior elevations

 To create these elevations, green stick

compound is luted to the anterior portion of the
framework and the patient is asked to occlude
the teeth.
Compound is then added to the posterior portion
of the framework and the patient is asked again

to occlude the teeth.

Contact with the palate should be evident in
both areas of compound. Both anterior and
posterior elevations are reduced 2 to 3 mm and a
layer of Iowa wax is flowed onto the surface.

 The patient is asked to repeat t, d, k, g and

attempt swallowing.
The wax surface is then examined. It should be
glossy, indicating that contact with the palatal
tissue has been made.
If compound is showing through, it should be
reduced with a sharp knife and a new layer of
Iowa wax added.

 The patient should repeat the mandibular

movements to pronounce t, d, k, g.

These tracings should be performed in the

presence of a speech pathologist when possible.

After satisfactory production of these sounds,

the tongue prosthesis for speech is processed in
clear heat-cured acrylic resin, highly polished,
then tried in the patient's mouth

Mandibular tongue prosthesis for speech

 The prosthetic tongue for swallowing is

waxed in the form of a sloping trough like
base in the posterior aspect to help guide the

food bolus into the oropharynx. It is then

processed in denture-base acrylic resin.

 In some instances, the mandibular tongueprosthesis can be constructed to include both

features of swallowing and speech in a highly
motivated patient.
The framework with the processed acrylic-resin
base that contains the oral "mushroom

projection" is used for this purpose.

 A heavy mix of tissue-conditioning material is

added to the base and the patient is asked to
move the mandible while pronouncing t, d, k,

g as the material sets.

Add or remove material during this procedure
until the desired sounds are attained.

Tissue conditioner material is being used during

tracing of the mandibular prosthesis

After final tracing, the artificial tongue is snapped

off its acrylic resin base before processing with
silicone material

 The tissue conditioner tracing is then

removed and duplicated in silicone with

appropriate intrinsic coloration and attached
mechanically on the mushroom like
projection of the acrylic resin base.

Silicone tongue prosthesis for both speech and

swallowing

Case Reports

Glenn Bregeldt. Tongue Prosthesis for Total Glossectomy Patient.

J Prosthod 1992;1:131-133.

Case Reports

Mandibular denture showing elliptical acrylic

retention button and posterior platforms for posterior
support of the tongue prosthesis.
Glenn Bregeldt. Tongue Prosthesis for Total Glossectomy Patient.
J Prosthod 1992;1:131-133.

Case Reports

Final tongue prosthesis with mandibular denture.

Glenn Bregeldt. Tongue Prosthesis for Total Glossectomy Patient.

J Prosthod 1992;1:131-133.

Case Reports

Tongue prosthesis attached to mandibular denture

Glenn Bregeldt. Tongue Prosthesis for Total Glossectomy Patient.

J Prosthod 1992;1:131-133.

Case Reports

Completed soft acrylic tongue prosthesis that is

attached to the mandibular denture but removable
for hygiene
Glenn Bregeldt. Tongue Prosthesis for Total Glossectomy Patient.
J Prosthod 1992;1:131-133.

Prosthetic Treatment of
Partial Glossectomy
It has been demonstrated that removal of less
than 50% of the tongue may result in only minor
functional impairment and, consequently,
prosthodontic intervention is not required
(Aramany et al., 1982).
However, in cases where a patient has had a
partial glossectomy and a partial

mandibulectomy, there is a greater need for a

glossectomy prosthesis.

 Prosthodontic treatment for partial glossectomy is

necessary when the patient experiences difficulty in

speaking and/or managing a food bolus.
When indicated, either the palatal augmentation

prosthesis or a mandibular augmentation prosthesis may

be fabricated.
The function of the augmentation prosthesis is to fill the

volume deficiency between the remaining tongue and

the mandible and the palate

 The choice between a mandibular and a

palatal augmentation prosthesis depends
upon the availability of abutment teeth, the

extent and site of the tongue deficiency, and

patient acceptance.

Mandibular Augmentation
Procedure
After constructing a conventional or interim mandibular

removable complete or partial denture, a thick mix of

tissue-conditioning material is added to the lingual
flange in the area of the tongue deficiency.
The prosthesis with the tissue conditioner is inserted

into the patient's mouth, and the patient is instructed to

swallow, open and close, and pronounce certain
phonemes depending on the site of the resection.

Mandibular lingual augmentation tracing in tissueconditioning material is added to the mandibular

temporary RPD

Completed mandibular lingual augmentation

prosthesis

Mandibular lingual augmentation prosthesis in

mouth

 Anterior resection situations require

the use of consonant sounds such as

t and d.
Posterior defects require glottal stop

execution such as k and g sounds.

 After the tissue-conditioning material has set, a

plaster matrix is made of the tissue-conditioner
impression and the soft liner material is
eliminated.

The augmented part of the prosthesis is

processed with autopolymerized acrylic resin.

 For an edentulous patient, the mandibular

final impression is made utilizing the neutral
zone technique and the denture is processed

accordingly .

Mandibular neutral zone impression to generate

the lingual augmentation prosthesis

Finished complete denture with the lingual flange

augmented towards the tongue defect

Palatal Augmentation
Prosthesis

A, Schematic illustration of functional contacts occurring between tongue and palate in

non-glossectomy subject.
B, Illustrates lowering of palatal vault in glossectomy patient with palatal augmentation
prosthesis allowing for functional contact between residual or reconstructed tongue
and prosthesis.

Palatal Augmentation Prosthesis

In dentate or partially dentate patients, a
maxillary framework is designed following

conventional prosthodontic techniques with an

added mid-palatal meshwork to retain the
augmentation portion of the prosthesis.

Functional molding of the augmentation portion

of the prosthesis is done in a similar manner to
the partially edentulous mandibular total
glossectomy prosthesis however, anterior
tongue position consonants are emphasized.

Tissue conditioning
palatal
augmentation
prosthesis after
tracing &
immediately before
duplication into
silicone

Final & disassembled palatal augmentation

prosthesis

 In the edentulous patient, conventional

maxillary and mandibular complete dentures
are fabricated and used for a brief time

(usually 2 weeks) before the maxillary

denture is augmented to compensate for
the tongue deficiency.

 A thick mix of tissue-conditioning material is

added to the palatal portion of the maxillary
denture.
While the material is still moldable, the patient is
instructed to swallow and to pronounce certain

phonemes, depending upon the location of the

deficiency.

Tracing of the palatal augmentation in maxillary

complete denture for a patient with partial
glossectomy

Finished palatal augmentation added to complete

denture for a partial glossectomy patient

Conclusion
Glossectomy prosthesis fabrication is an extremely

challenging facet of maxillofacial prosthodontics.

The expectations of the patient and the speech

therapist or pathologist are rarely met, and the

frustration level of the prosthodontist can be very
high indeed.

Realistic expectations only come with experience,

and with experience, the fabrication of glossectomy

prostheses can be very gratifying .

References
Clinical Maxillofacial Prosthetics Thomas D.
Taylor
Maxillofacial Prosthetics - WR Laney.
Maxillofacial Prosthetics : Multidisciplinary

Practice Chalian, Drane & Standish..

References
The efficacy of palatal augmentation prostheses for speech

and swallowing in patients undergoing glossectomy: A review

of the literature. J Prosthet Dent 2004;91:67-74.

Prosthetic management of a total glossectomy defect

after free flap reconstruction in an edentulous patient: A

clinical report. J Prosthet Dent 2003; 89:119-22.
Neutral zone approach for denture fabrication for a partial

glossectomy patient: A clinical report. J Prosthet Dent

2000;84:390-3.

References

Immediate rehabilitation after total glossectomy: A

clinical report. JPD 1993;462-63.

Armany M, Downs J, Beery Q et al. Prosthodontic
rehablitation for glossectomy patinet. J Prosthet Dent
1982;48:78.
Cantor R, Curtis T, Shipp T et al. Maxillary prosthesis for
mandibular surgical defects. J Prosthet Dnet
1969;22:253.
Moore D. Glossectomy rehabilitation by mandibular
tongue prosthesis. J Prosthet Dent 1972;28:429.
Luciello F, Vergo T, Schaff N. Prosthodontic and speech
rehabilitation after partial and complete glossectomy. J
Prosthet Dent 1980;43:204.