Zygomatic implants are not without complications, but they can be contained with surgical techniques available in contemporary oral and maxillofacial surgery. Summary: A 52 year old Caucasian male received 2 zygomatic implants and 2 screw form implants in the upper jaw with a bridge construction. Both the implants and the prosthetic solution were stable and fully functional. However the patient developed a large oro-antral communication along the left zygomatic implant. Several reconstructions with local flaps failed, only enlarging the defect with deterioration of speech and loss of fluids through the nose. An anterolateral thigh free flap transfer was used to cover the implant and to close the hemimaxillary defect. Healing was uneventful and no secondary measures or additional procedures were needed to retain the integrated implants and the well-functioning bridge at the one year follow-up. Key learning points: Removal of a zygomatic implant can exceptionally be avoided with a free flap transfer to obliterate a soft and hard tissue defect around a well-integrated implant that is surrounded by an oro-antral communication and maxillary sinusitis. Infection of the transferred tissue is rare due to the perfect vascularization of a free flap. The anterolateral thigh flap is well suited for obliteration of large unilateral maxillary Brown-Shaw class II defects.
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