Clinical examination and diagnosis
Extraoral examination of the patient shows a 19 mm limitation of mouth
opening between the inferior edge of the upper lip and the upper edge of
the lower lip, combined with microstomia and subtotal loss of laxity on
the right side. Despite the absence of occlusal wedging, we observe a
persisting labial inocclusion at rest, and a concave subnasal profile,
combined with collapse of the philtrum. The asymmetrical smile is due to
a paralysis of the integuments on the right side. Temporo-mandibular
joint (TMJ) displacements are reduced in propulsion and diduction
Prior to his first visit, the patient had some remaining teeth (figure
8) that were extracted 5 years ago. Thus, the intraoral examination
reveals totally edentulous arches with two symphysis implants (Zimmer®
Length 3.7mm x 10mm). The patient wears conventional complete
maxillo-mandibular removable prostheses which are unstable when he chews
hard food. Despite the severe bone resorption in both the maxilla and
mandible, the vertical and horizontal prosthetic space is reduced due to
the mouth opening limitation and microstomia. Tongue mobility is reduced
bilaterally. Saliva quality and quantity are both normal.