Functional and Esthetic Rehabilitation With Maxillary Prosthesis Supported by Zygomatic Implants for a Patient With Maxillary Defect Resulting From Cancer Ablative Surgery

For patients with a maxillary defect resulting from resection of a malignant tumor, occlusal rehabilitation is very important for optimizing quality of life. Retention and stability of the prosthesis is common challenging problem for such patients.[1] Although a prosthesis supported by dental implants is a quite effective option, insertion of dental implants is often difficult in patients with subtotal maxillectomy.[2] We report herein a case of functional and esthetic rehabilitation with maxillary prosthesis supported by zygomatic implants for a patient with maxillary defect resulting from maxillectomy for malignant melanoma of the upper gingiva. A 76-year-old woman was referred to our facility with non-painful discoloration of the upper gingiva. After several examinations, a clinical diagnosis of a malignant melanoma of the upper gingiva (cT3N1M0 stage IVA) was made. Under general anesthesia, subtotal maxillectomy utilizing Le Fort I osteotomy and functional neck dissection of the right side were performed. Initially, a conventional resection denture was made and employed postoperatively, but was unable to be retained due to insufficient residual maxillary structures. Fabrication of a maxillary prosthesis supported by bilateral zygomatic implants was therefore planned. Six months after tumor resection, two zygomatic implants (Brånemark system^® zygoma TiUnite; Nobel Biocare, Sweden) were inserted into bilateral zygomatic bones. After another 6 months, the implants were uncovered, and multi-unit abutments were installed. Magnetic attachments were applied as a mechanism for attaching the implants and resection denture. After application, retention and stability of the prosthesis was considerably improved, and the patient was able to eat a normal diet. From an esthetic perspective, the depressed upper lip was properly restored, leading to an acceptable facial appearance. The patient was quite satisfied with the esthetic and functional outcomes achieved with the prosthesis. After 15 months of functional loading, the zygomatic implants remain stable and the maxillary prosthesis is functional. However, because this prosthesis is retained by only two implants, further careful observation is indispensable.

References

1. Beumer J, III, Curtis TA, Marunick MT. St. Louis: Ishiyaku Euro America, Inc; 1996. Maxillofacial Rehabilitation: prosthodontic and Surgical Considerations; p. 251.

2. Soni R, Jindal S, Sinqh BP, Mittal N, Chaturvedi TP, Prithvirai DR: Oral rehabilitation of a patient with sub-total maxillectomy: Contemp Clin Dent 2011 Jan;2(1):63-65