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.