Journal of Oral Implantology February 2013 - (Page 91)

CASE REPORT Pterygoid Implants for Maxillofacial Rehabilitation of a Patient With a Bilateral Maxillectomy Defect Avinash S. Bidra, BDS, MS, FACP1* George W. May, DDS2 Greggory E. Tharp DMD2 Mark S. Chambers, DMD, MS3 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. Key Words: pterygoid, pterygomaxillary, implant, tuberosity, maxillectomy, hollow obturator INTRODUCTION M axillectomy or maxillary resection is defined as surgical removal of a part or all of the maxilla.1 This definition is broad and does not describe the resection in lateral, superior, or posterior extensions. For better description and for communication purposes, several classifications have been proposed with no unanimity of use.2–9 A classification system described by Spiro et al6 is simple and is popular among surgeons and maxillofacial prosthodontists. In this system, adjectives are used to describe the extent of maxillary resection as limited, subtotal, or total. 1 Department of Reconstructive Sciences, University of Connecticut, Farmington, Conn. 2 Private practice, Jackson, Miss. 3 Section of Dental Oncology, University of Texas, M.D Anderson Cancer Center, Houston, Tex. * Corresponding author, e-mail: avinashbidra@yahoo.com DOI: 10.1563/AAID-JOI-D-10-00181 Limited maxillectomy is defined as any maxillary resection that primarily removes 1 wall of the antrum, usually the floor or the medial wall. Subtotal maxillectomy is defined as any maxillectomy that removes at least 2 walls, including the floor of the antrum (hard palate) but not the posterior wall. Total maxillectomy is defined as complete removal of the maxilla, usually involving orbital exenteration. Additional details, such as unilateral or bilateral and the contiguous structures involved, are usually specified along with the classified resection.6 Obturation of bilateral subtotal or total maxillectomy defects presents a significant challenge to the maxillofacial prosthodontist.10–13 Often there is inadequate retention, stability, and support for the prosthesis because of the apparent loss of anatomic structures. Patients with such defects have significant difficulties in swallowing, speech, mastication, and esthetics.10,11 They often have poor lip support, scarring of the lip, midfacial collapse, lip incompetency, drooping commissures, and trismus due to Journal of Oral Implantology 91

Table of Contents for the Digital Edition of Journal of Oral Implantology February 2013

Could the Fountain of Youth Be All in Your Bones?
Vertical Bone Augmentation With Simultaneous Implant Placement Using Particulate
Evaluation of the Bone Healing Process Utilizing Platelet-Rich Plasma Activated by Thrombin
Effect of Model Parameters on Finite Element Analysis of Micromotions in Implant Dentistry
Peri-Implant Defect Augmentation With Autogenous Bone: A Study in Beagle Dogs
Would Nitric Oxide be an Effective Marker for Earlier Stages of Peri-Implant Disease? An
The Effect of Different Surface Treatments on Cement-Retained Implant-Supported
Effect of Rotating Osteotomes on Primary Implant Stability—An In Vitro Investigation
Horizontal Augmentation Through the Ridge-Split Procedure: A Predictable Surgical
The Bis-Acryl Stent
Clinical, Histological, and Histomorphometrical Analysis of Maxillary Sinus Augmentation
A Technique to Salvage a Single Implant-Supported Fixed Dental Prosthesis Having a
Ridge Expansion and Immediate Placement With Piezosurgery and Screw Expanders in
Pterygoid Implants for Maxillofacial Rehabilitation of a Patient With a Bilateral Maxillectomy
Technology in Maxillary Premolar Region: A New Strategy for Soft Tissue Management
Fracture of Anterior Iliac Crest Following Bone Graft Harvest in an Anorexic Patient: Case
A Technique for Constructing a New Maxillary Overdenture to a Nonretrievable Implant
Edentulous Maxillary Arch Fixed Implant Rehabilitation Using a Hybrid Prosthesis Made of

Journal of Oral Implantology February 2013