Orofacial Rehabilitation in Maxillary Aplasia

Abstract

Orofacial rehabilitation in maxillary aplasia but the premaxilla requires, beyond addressing the oronasal communication, facial functional-aesthetic and dental prosthetic reconstruction.The report of a now 42-year-old patient, born with maxillary aplasia, presenting for surgical rehabilitation in 2002 (at 33 years old), further elaborates this complex challenge.A staged approach that included velopharyngoplasty was performed on the patient in 2002; alternatively to a preformed fibula, 2 zygomatic fixtures were later inserted bilaterally to the malar bone, and premaxillary teeth were retained. Subapical mandibular alveolar osteotomy was performed to reposition the malaligned alveolar process and teeth. Augmentation from the iliac crest to the left congenitally hypoplastic mandible followed, its alveolar nerve running atypically lingual and outside the bone. The maxilla was rehabilitated by telescoped coverdenture on ceramic primary crowns, the mandible with all ceramic crowns on standard implants after orthodontic tooth-arch harmonization.A most satisfying result was obtained regarding chewing, speaking, and swallowing. The good phonation and pharyngeal control that was shown by the patient after velopharyngoplasty was retained. Visual analog scale showed enhanced patient satisfaction from 4 to 8, and oral health impact profile 14G decreased from 16 to 7 impairment scores. Zygomatic implants and ceramic galvano-telescoped coverdenture were shown to be reliable, eventually for similar cases, combined if necessary with orthodontics, orthognathic surgery, and standard implants.