surgical treatment for neoplastic lesions of the oral cavity often requires resection involving the mandible , floor of the mouth , tongue and also the palate . loss of mandibular continuity in consequence of surgical treatment leads to mandibular deviation and altered muscle function . the extent of deviation depends on the location and extension of the resection , the amount of soft tissue and innervations involvement and the presence of remaining natural teeth . a corrective device known as  guide flange prosthesis it can be applied either immediate postoperatively as intermaxillary fixation or within 710 days after the resection as removable device , for restoring mandibular function . the earlier the guidance therapy is initiated in the course of treatment , the more successful is the patient 's definitive occlusal relationship . delays in the initiation due to extensive tissue loss , tight wound closure and other postsurgical morbidities , may result in an inability to achieve normal maxilla - mandibular relationships . it has been reported that fabrication of a provisional guide plane facilitates the fabrication of a definitive restoration . this mandibular deviation is mainly due to uncompensated influence of contralateral musculature particularly the internal pterygoid muscle and pull from the contraction of cicatricial tissue on resected side . uncoordinated masticatory movements due to deviated path of closure may result in eccentric occlusion , a disoriented masticatory cycle , facial disfigurement , distorted speech , dental or soft tissue trauma . several modalities to return the mandible to optimum maxilla - mandibular relationship have been described . these include intermaxillary fixation , vacuum formed pvc splints , mandibular guidance prostheses and a widened maxillary occlusal table using a double row of teeth . a mandibular guidance prosthesis can be defined as a maxillofacial prosthesis used to maintain a functional position for the jaws ( maxillae and mandible ) , improve speech and deglutition following trauma or / and surgery to the mandible or / and adjacent structures . a 29-year - old male patient shohaib aktar reported to the department of prosthetic dentistry , dr r ahmed dental college and hospital , kolkata , complaining of inability to grind food , dryness of the mouth and disfigured facial appearance following mandibular resection . extra oral examination revealed deviation of residual mandible towards right side and loss of functional occlusion on left side with predominant facial defect on right infraauricular region . intraoral examination reveals missing 25 , 26 , 27 , 28 , 35 , 36 , 37 , 38 . primary maxillary and mandibular impressions were made with alginate and poured with dental stone . both the cast are mounted using bite registration record . after mounting of the mandibular cast it was observed that the buccal surface of the mandibular teeth were almost 8 mm lingual to the palatal surface of the maxillary palatal cusps [ figure 1 ] . , additional wax was added on the left side of the prosthesis towards the palatal surface . the whole pattern was invested , dewaxing done and heat cure acrylic was packed and processed . the patient was recalled and the maxillary prosthesis was inserted and checked for retention and stability . the prosthesis is then modified to act as guidance prosthesis by the addition of self - cure acrylic resin to form a ramp or guide plane palatal to the maxillary teeth opposing the nonresected portion of the mandible [ figure 2 ] . the prosthesis was inserted and patient was given instruction regarding the maintenance of the prosthesis and was put on a regular follow - up . occlusal view of maxillary prosthesis with palatal ramp occlusion achieved with the prosthesis in place at maximum intercuspation ( lateral view ) rehabilitation is an essential phase of cancer care and should be considered from the time of diagnosis in a complete and comprehensive treatment plan . the most important objective is to re - educate the mandibular muscles to re - establish an acceptable occlusal relationship ( physiotherapeutic function ) for residual hemimandible , so that the patient could control adequately and repeatedly opening and closing mandibular movements . the guide flange provided a mechanical system which prevented the mandible from turning towards the resected side . for better results , prosthetic management can be combined with an exercise program , which can be started 2 weeks after surgery . the presence of teeth in both the arches is important for effective guidance and reprogramming of mandibular movements . the patient in this clinical report retained all his teeth , except those on the defect site . therefore , the patient had a better proprioceptive sense and was able to achieve the functional position after insertion of prosthesis . guidance prosthesis served as a training appliance till a cast partial denture can be fabricated for the patient . within 3 weeks this prosthesis helped the patient to get accustomed to close the mandible into the correct intercuspal position without the use of any external aid [ figure 3 ] . the success of mandibular guidance therapy varies and depends upon the nature of the surgical defect , early initiation of guidance therapy , patient co - operation , and other factors . this therapy is most successful in patients for whom the resection involves only bony structures , with minimal sacrifice of tongue , floor of the mouth , and adjacent soft tissues , the literature shows various types of cast metal guidance prostheses which are effective in managing the mandibular deviation . but such appliances are complex ; the technique is sensitive and costly and requires many patient visits . the acrylic guide flange prosthesis presented here is simple and cost effective method for managing the mandibular deviation . the number of patient visits is also less as compared to the cast metal guidance prosthesis .
mandibular resection following surgical treatment for neoplastic lesions of the oral cavity leads to numerous complications including altered mandibular movements , disfigurement , difficult in swallowing , impaired speech and articulation , and deviation of the mandible towards the resected site . 
 various prosthetic methods are employed to reduce or minimize mandibular deviation and improve and restore the lost functions and esthetic , like maxillomandibular fixation , implant supported prosthesis , removable mandibular guide flange prosthesis , and palatal based guidance restoration . 
 this clinical report describes the rehabilitation of a patient following segmental mandibulectomy using palatal ramp prosthesis .