Pterygoid Implants for Maxillofacial Rehabilitation of a Patient With a Bilateral Maxillectomy Defect

Abstract

Bilateral maxillectomy is known to have serious esthetic and functional consequences. The retention and support of a maxillary obturator prosthesis in these patients is particularly challenging. Surgical placement of implants is also challenging because of the lack of available bone. Therefore, implant placement into remote sites such as zygoma has been advocated. Very few articles in the literature have discussed the use of pterygoid/pterygomaxillary implants in patients undergoing maxillectomy. This case report describes the maxillofacial rehabilitation of an elderly man who underwent a bilateral subtotal maxillectomy due to basaloid squamous cell carcinoma of the hard palate. After initial healing, the patient had a pterygoid implant placed on each side of the oral cavity. Zygomatic implants were also attempted, but they failed to osseointegrate. Both pterygoid implants showed successful osseointegration. These 2 implants significantly helped to retain a hollow maxillary obturator prosthesis that aided in improved swallowing, speech, and esthetics. To the authors' knowledge, this is the first report in the literature that describes usage of pterygoid implants for rehabilitation of a patient undergoing bilateral maxillectomy.

Zygoma Implant-Supported Prosthetic Rehabilitation of a Patient After Bilateral Maxillectomy

“…5 Various methods have been described for retention and support of a bilateral obturator prosthesis, such as zygomatic implants. 6 Zygoma implants, however, may be associated with several problems, including deficiency of hard and soft tissue, and overloading of the zygoma and implant. 1,5 This article describes the prosthetic rehabilitation of a patient with a severe intraoral defect resulting from a maxillectomy resection, using 2 zygoma implants connected by computer-aided design/computer-aided manufacturing (CAD/CAM)-fabricated milled bar (infrastructure framework) and a maxillary obturator prosthesis.…”

Quality of life of head and neck cancer patients after tumor treatment and subsequent maxillofacial rehabilitation

“…The most suitable sites for implant placement are the remaining premaxillary segment and the maxillary tuberosity (Davis et al, 1995). In cases after bilateral maxillectomy, zygoma implants can be used, or more rarely pterygoid implants to bear the obturator without any hard and soft tissue retention and support (Bidra et al, 2011).…”

A modified technique to fabricate a complete hollow obturator for bilateral maxillectomy in a patient with mucormycosis—A technical case report

“…In an extensive defect reflecting a Class II maxillectomy, where only minimal hard tissue is spared, retaining the obturator intraorally is a tricky task, primarily due to lack of hard tissue support and secondly due to the weight of the prosthesis. These situations warrant the use of endosseous, zygoma, and pterygoid implants for enhanced retention, but lack of viable bone, implant failure in recurrent lesions, and patient's acceptance for one more surgery are critical factors that need to be validated . In patients where implant placement is questionable, remaining undercuts along the anterior nasal aperture, velum, lateral scar bands, maxillary sinus, floor of the orbit and lateral pterygoid plate can be utilized in retaining the obturator .…”