|Year : 2016 | Volume
| Issue : 1 | Page : 44-47
Thrifty way of managing hemifacial palsy patients using an innovative detachable cheek plumper prosthesis
Santosh S Doddamani, Priyanka T Somashekhar, Sunitha N Shamnur, Premaleela Doddamani, Khinnavar Poonam, Chethan Malladihalli Devendrappa
Department of Prosthodontics, Bapuji Dental College and Hospital, Davangere, Karnataka, India
|Date of Web Publication||21-Jul-2016|
Santosh S Doddamani
Department of Prosthodontics, Bapuji Dental College and Hospital, Davangere - 577 004, Karnataka
Source of Support: None, Conflict of Interest: None
Emphasis on facial esthetics has become an integral part of dental treatment. Facial paralysis of permanent nature affects the prosthetic outcome. Providing complete denture therapy to such patients is challenging. These patients frequently suffer from the ongoing diminution of denture foundation, the loss of support of facial musculature. In this clinical report, an attempt has been made to alter denture design and dimensions to improve esthetics, function, retention, and stability. Here, a completely edentulous hemiparalytic patient has been rehabilitated with an innovative, simple, cost-effective, and noninvasive treatment using detachable cheek plumper to support flaccid musculature.
Keywords: Cheek plumper, complete denture, hemiparalytic patient, press button
|How to cite this article:|
Doddamani SS, Somashekhar PT, Shamnur SN, Doddamani P, Poonam K, Devendrappa CM. Thrifty way of managing hemifacial palsy patients using an innovative detachable cheek plumper prosthesis. Int J Oral Health Sci 2016;6:44-7
|How to cite this URL:|
Doddamani SS, Somashekhar PT, Shamnur SN, Doddamani P, Poonam K, Devendrappa CM. Thrifty way of managing hemifacial palsy patients using an innovative detachable cheek plumper prosthesis. Int J Oral Health Sci [serial online] 2016 [cited 2019 Sep 17];6:44-7. Available from: http://www.ijohsjournal.org/text.asp?2016/6/1/44/186668
| Introduction|| |
Esthetics plays an important role in a person's professional and social life. Hemifacial palsy affects the unilateral facial muscles with typical features of an inability to blink, absence of wrinkles on the forehead, and asymmetry of the face.  Cheeks impart greatly to facial esthetics; in this situation, patients are treated using therapies that induce the regeneration of nerves, nerve grafting, adenosine triphosphate drugs, vitamins, and acupuncture.  Recent advances in treatment modalities such as reconstructive surgery improved collaborative rehabilitation efforts between surgical reconstruction and prosthetic rehabilitation. , The problems encountered during prosthodontic rehabilitation include uncontrolled flow of saliva, a mask-like expressionless appearance, and cheek biting.  An intraoral prosthesis specially designed for the correction of facial disfigurement and for supporting the sunken cheeks intraorally is known as the "cheek plumper." In this case, the patient was not willing for invasive reconstructive surgery and was not affordable for the attachment-retained cheek plumper due to financial constraints. Hence, a completely edentulous hemiparalytic patient has been rehabilitated with a noninvasive, cost-effective, detachable cheek plumper to support flaccid musculature.
| Case Report|| |
A 70-year-old male reported to the Department of Prosthodontics for the replacement of missing teeth. The patient had a history of unilateral left facial paralysis of unknown origin, which was associated with drooling of saliva and loss of muscle tone for 4 years. On extraoral examination, asymmetry of the face was noticed with loss of muscle bulk on the paralyzed side [Figure 1]. The face was drawn to the left side during function, there was a significant difficulty in pronouncing letters such as bilabial plosives (p, b) and fricatives (f, v), and restricted lip movement along with drooling of saliva was observed.
Intraoral examination revealed complete upper and lower edentulous ridges with adequate interarch distance. No hard and soft tissue abnormalities were detected. By considering the priorities and requirements, the available treatment options and their pros and cons were explained to the patient. He gave both verbal and written consent to undergo detachable cheek plumper prosthesis.
Maxillary and mandibular diagnostic impressions were made with alginate (Tropicalgin, Zhermack ® , China) impression material. Custom trays were fabricated, and sectional border molding was done using green stick compound (DPI ® , Dental Products of India, Mumbai, Maharashtra, India). Final impressions were made using zinc oxide eugenol impression paste (DPI Impression Paste ® , Dental Products of India, Mumbai, Maharashtra, India) to obtain a master cast. Jaw relation and try-in were carried out in conventional manner.
Cheek plumper was customized to improve the affected side musculature in modeling wax (Hindustan Dental Products, Hyderabad, Telangana, India). At the cervical aspects, between the second premolar and first molar region, the wax cheek plumper was superficially attached to the left maxillary buccal flange of trial denture. After satisfactory try in both the upper and lower dentures, the cheek plumper was fabricated separately with a heat cure acrylic resin. Later, male and female parts of press buttons (Jyoti, B.D.R. Products Private Ltd, New Delhi, India) were embedded in denture using self-cure acrylic resin [Figure 2] (Rapid Repair, Pink Standard Pack, 64020021, Dentsply India, Navi Mumbai, Maharashtra, India).
After finishing and polishing, the prosthesis was delivered following the evaluation for fit and esthetics [Figure 3]. The mode of fixation/detachment of cheek plumper was demonstrated, and maintenance of the prosthesis by using denture cleaning brush was elaborated to the patient [Figure 4]. During recall visit after 48 h, the patient did not reveal any problems with speech and mastication. Even drooling of saliva was reduced and the patient was satisfied with the esthetics [Figure 5]. The case was recalled for every 6 months and followed up for 2 years, during which press buttons were replaced once.
| Discussion|| |
The cheeks are less mobile than the lips and are embraced on three sides by foundations that are subjected to little change: the zygoma, the mandible, and the parotid gland overlying the masseter muscle in the posterior region. In addition, support is also provided by subcutaneous fat and buccal fat pads, which are responsible for the soft, rounded contours of the cheeks in the lower third of the face. Cheek contours are further altered by the loss of posterior teeth, facial muscle paralysis, and subsequent loss of vertical dimension of occlusion. With the loss of posterior teeth, the cheeks tend to collapse and move medially to meet the laterally expanding tongue. 
The prosthodontic management of such patients with facial palsy should satisfy both the esthetic and functional demands. Treatment of permanent facial palsy is usually palliative along with special modifications of the prosthesis. There are various treatment options available for the treatment of sunken cheeks or drooping lips. Metallic wire with acrylic button/customized attachments was incorporated during the fabrication of cheek plumpers to provide support for sunken cheeks. , Nowadays, quick short-term results can be enhanced by using nonsurgical injectable fillers such as botulinum toxin-A, but long-term results are awaited.  Surgical correction is also an available treatment modality, but it leaves behind a postsurgical scar.  Turnbull  advocated padding of the buccal flanges as a modification for facial support. Fickling  advocated spring-loaded acrylic flange extensions.
Fabrication of cheek plumper prosthesis for hemi facial palsy patients is very common. The procedure described here has definitive assured advantages compared to conventional cheek plumper. A conventional cheek plumper is a part of the complete maxillary denture prosthesis with extensions on either side in the region of the buccal surfaces of the denture and it is continuous with the rest of the denture. The conventional cheek plumper could add excessive weight to the upper denture, and gravitational forces cause dislodgement of prosthesis. The buccal extension could interfere with masseter muscle and the coronoid process of the mandible, which may destabilize the upper denture, especially during eating. The extensions could result in muscle fatigue. The excessive medio-lateral width of the denture could result in difficulty in inserting the denture, especially in microstomia patients. 
To overcome the disadvantages of conventional cheek plumper, detachable cheek plumpers are now in use that have advantages of reduction in weight, easy insertion and removal, prevent muscle fatigue and cleaning. It even gives the option for the patient to wear only denture without cheek plumper. The common attachments utilized are magnets, wires, and buccal tube. ,, Magnets are used due to their small compact size and strong attractive forces. Some of the advantages include simplicity of the clinical and laboratory procedures, automatic reseating, and constant retentive force, with the consecutive number of insertion-removal cycles along with easy maintenance. ,, This type of prosthesis can be used even in patients with pacemakers, as magnets are surrounded by insulating material (acrylic resin). ,, At the same time, it has got many disadvantages such as poor corrosion resistance, harmful effects of magnetic field on the health of the oral tissues, and loss of magnetic property over a period of time may require frequent replacement. ,
Till date, there is no literature found regarding the usage of press buttons in cheek plumpers. This innovative idea has many advantages such as low maintenance cost, ease of replacement, cleaning, and better patient compliance. As the patient had Grade III loss of muscle tone, we could achieve an acceptable esthetics and function to rehabilitate the facial asymmetry with the prosthesis alone. Since the press buttons are easily corrodable, in future, there is a scope for replacing steel with fiber-reinforced material or noncorrosive inert cobalt-chromium alloy such as Vitallium.
| Conclusion|| |
This article has described a simple, effective, and noninvasive treatment alternative to improve facial appearance in a hemiparalytic patient with sunken cheeks. This prosthesis provides acceptable esthetics and stability during various functional movements and boosts the self-esteem of the patient by improving his appearance. The clinical result indicates that along with other palliative treatments, modification in prosthodontic treatment improves patient's sense of well-being.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]