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OBJECTIVE: To test the effectiveness of an educational intervention including "face to face" training, compared to a standard information program, to reduce microstomia in women with systemic sclerosis. DESIGN: Single-blind, two-arm, randomized controlled study with a 12-month follow-up period. SETTING: Hospital wards of a large Italian dermatological reference center. SUBJECTS: Female inpatients with diagnosis of systemic sclerosis. INTERVENTIONS: For both groups an information brochure and an audio-visual DVD were developed specifically for the study. The control group was assigned to educational materials alone (i.e. brochures and DVD), while the experimental group, in addition to the same educational materials, received specific "face-to-face" interventions, repeated at each follow-up visit. MAIN MEASURES: Primary outcome was measurement of the opening of the mouth. Secondary outcomes was the self-reported mouth disability. RESULTS: The intention-to-treat analysis included 63 patients. Compared to the baseline measurement, we observed an increase of the mouth opening of 0.31 cm (95% confidence interval: 0.13-0.49), P = 0.003; in the control group, the increase was 0.13 cm (95% confidence interval: 0.01-0.25), P = 0.06. The difference in improvement between the two groups was not statistically significant (P = 0.10); however, it reached statistical significance in the per-protocol analysis (39 patients, P = 0.02). CONCLUSION: Face-to-face nursing rehabilitation training seems to improve microstomia to a greater extent, when compared to a standard intervention based only on written and audio-visual materials.

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Dental management of scleroderma patients is difficult and complicated because of compromised intraoral access. Physiotherapy may play an adjunctive and effective treatment role as described in a follow-up report on a previously documented case history.

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Microstomia is a common occurrence in clinical practice that may hinder the conventional prosthetic treatment of edentulous patients. Oral augmentation exercises to increase the vertical opening and sectional or collapsible dentures have been described in the past, which have their own drawbacks and limitations. The present article highlights a new approach for rehabilitation of a patient with microstomia with cast lock and key attachments leading to greater ease for both the patient and the clinician. The chief advantage of this technique is the simple fabrication procedure and the reduction in the denture base thickness, providing a larger intraoral space and thus better comfort to the patient, overcoming the shortcomings of previously described sectional denture bases.

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OBJECTIVES: The present paper aims to review the literature on various approaches in the tray designs and different techniques used to overcome difficulties in making impressions of patients with severely limited mouth opening published from 1984 to 2009. STUDY DESIGN: A search in the National Library of Medicine's Pub Med database, Google search and Science Direct was performed to include all case reports and reviews on prosthodontic rehabilitation of patients with microstomia. A total of 17 articles were included for discussion in the review out of the 22 articles found to be giving new tray designs. CONCLUSIONS: Different tray designs and impression techniques which can be useful in management of difficult cases causing little discomfort to the patient and help in getting back such patients to a comfortable social living.

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Congenital microstomia in the newborn can result in poor functional and aesthetic outcomes. In the past, treatment options have included surgical methods such as commissurotomies and z-plasties as well as nonsurgical treatments using oral splints. In severe microstomia, a surgical release may be required to permit splint placement. Because of the small diameter of the stoma, such surgical releases are not optimal and frequently must be repeated. We devised a nonoperative technique for the initial treatment of congenital microstomia that will slowly enlarge the stomal diameter without the need for surgical release. The patient is a newborn male born with multiple congenital anomalies including severe mandibular hypoplasia and retrusion, microstomia, and microglossia. The size of his oral cavity was less than 1 cm at birth with no clinical signs of a tongue. After initial dilation in the operating room with Hagar dilators, the oral stoma was serially dilated using Boston Scientific esophageal balloons. Once full dilation was achieved, we fabricated oral splints to continue the dilation process while maintaining oral competence with no surgical intervention.

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PURPOSE: To examine the effect of a home orofacial exercise program on increasing oral aperture among adults with systemic sclerosis (SSc). METHOD: Forty-eight adults with SSc were assigned randomly to the multifaceted oral-health intervention or usual dental care control group. Participants with an oral aperture of <40 mm in the intervention group received an orofacial exercise program, which included daily manual mouth-stretching and oral-augmentation exercises twice a day with a total of 6 minutes for 6 months. The outcome measure was oral aperture which was measured at baseline, 3-months, and 6-months intervals. RESULTS: A significantly larger increase in oral aperture for participants received the orofacial exercise program was found when compared to those in the usual care at 3 months (P = 0.01), but not at 6-months evaluation. Participants' adherence rate to the exercise program was low (48.9%). CONCLUSIONS: The orofacial exercise program intervention for adults with SSc and microstomia did not show significant improvement at 6 months. In addition to the low exercise adherence rate, insufficient frequencies, repetitions, and durations of the orofacial exercises may contribute to these results.

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BACKGROUND: Rhabdomyosarcoma is the most common malignant tumor in the nasal and paranasal sinus area at childhood. Multimodal treatment for this disorder has severe side effects due to normal tissue damage. As a result of this treatment, facial growth retardation and oral abnormalities such as malformation of teeth and microstomia can cause esthetic and functional problems. CASE REPORTS: Two cases are presented of patients with severe midfacial hypoplasia and reduced oral function as a result of treatment of rhabdomyosarcoma of the nasopharyngeal and nasal-tonsil region. With a combined surgical (osteotomy, distraction osteogenesis, implants) and prosthetic (implant-based overdenture) treatment, esthetics and function were improved.

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Rhabdomyosarcoma is a malignant tumor that is most often seen in children younger than 15 years of age. This pathology is found mainly in the head and neck region. Treatment of rhabdomyosarcoma at early stages of life usually affects the dental and osseous development of children. Because of impaired development, microstomia can arise, making dental treatment more difficult. This article presents a patient with microstomia caused by resection of an embryonal rhabdomyosarcoma in the nasolabial region. The patient was treated with 5 dental implants and fixed hybrid prosthesis in the maxilla and 2 implants supporting an overdenture in the mandible.

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The unusual treatment of a microstomia patient who was edentulous in the mandible is described. Impressions and registrations were taken with the help of sectional trays, and the treatment of choice for the final prosthesis was a two-piece, four-implant (BioHorizons)-supported bar overdenture with a connecting middle segment.

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Few published reports have addressed the issues related to upper lip reconstruction. The present clinical report describes the maxillofacial rehabilitation of an edentulous patient who had been diagnosed with squamous cell carcinoma of the nasal septum and contiguous structures. The patient underwent total rhinectomy, anterior maxillectomy, and maxillary lip resection. Her maxillary lip was reconstructed with a bilateral cheek advancement flap, which allowed primary closure of the lip and aided in maintaining function of the orbicularis oris muscle. Microstomia was anticipated and was a consequence of this procedure. During primary resection, and before chemoradiotherapy, dental implants were successfully placed in the maxilla. These implants helped to retain a maxillary obturator prosthesis, which, in turn, helped to retain a silicone nasal prosthesis that restored the nasal defect. An intranasal acrylic resin framework with magnets aided in connecting the extraoral prosthesis with the intraoral prosthesis. The surgical and prosthodontic advantages of a cheek advancement flap and the treatment challenges in a microstomic patient are discussed.

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One of the complications of thermal injury is the development of scars and contractures during the healing process. This scarring can be devastating, especially when it involves the mouth. The purpose of this report is to describe the construction of an alternative vertical mouth stretching orthosis for vertical microstomia. By using thermoplastic splinting material and a long thread screw, a vertical mouth-stretching orthosis can be custom-fit to any patient's mouth. The device can be fabricated for a pediatric or adult patient for the rehabilitation of a circumferential mouth burn, especially targeting the vertical diameter. When using this device, patients gave positive feedback for comfort and ease of use, with increased mouth mobility and range of motion. This vertical orthotic device provides an economical and comfortable alternative for vertical mouth diameter enlargement to the current five devices available in the literature.

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This clinical report describes the fabrication of a sectioned mandibular complete denture for a patient with severe microstomia. Dovetails were created in the denture base to orient and secure the prosthesis.

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Scleroderma poses many difficulties and challenges for the treating dentist. Until now, dental implant treatment for patients with scleroderma was limited to either complete overdentures or short-span fixed partial dentures. This clinical report describes the use of modified techniques to fabricate a long-span fixed prosthesis delivered after serial extractions and implant placement.

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A simplified technique was used to treat a patient who had limited mouth opening as a result of scleroderma. Treatment included the construction of a three-piece, sectional maxillary partial denture and a one-piece mandibular complete denture.

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Regardless of cause, the treatment of an edentulous patient with microstomia is difficult and often ingenious. Prosthodontic treatment modalities previously described are reviewed. A new type of prosthesis, the collapsible mandibular swing-lock complete denture, is introduced. The prosthesis incorporates a cast cobalt-chromium framework with a lingual hinge and a conventional labial swing-lock. This combination allows the prosthesis to be collapsible while maintaining structural durability. Advantages include ease of insertion and removal while providing maximum coverage for support, retention, and stability. A stepwise technique for the clinical and laboratory phases is described.

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Rehabilitation of the glossectomy patient is one of the most difficult and challenging problems for the prosthodontist and speech pathologist. The tongue plays an important role in articulation, control of secretions, formation of a bolus, propulsion of the bolus toward the pharynx, clearing the palate, and initiation of the swallow reflex. This paper presents speech and prosthodontic considerations for a patient who underwent a glossectomy and had the additional problem of reduced oral opening.

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Microstomia is a complication of facial burns, traumatic injuries, scleroderma, or surgical reconstructions involving the oral aperture. A variety of orthoses for the correction or prevention of microstomia are offered by dentists, occupational therapists, physical therapists, and other specialists. This paper provides an overview of the structural and clinical features of 12 common tissue-borne or tooth-borne microstomia appliances. The review is intended to facilitate the selection of suitable orthoses, and to indicate the need for interdisciplinary management of microstomia patients.

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