Functional and aesthetic rehabilitation with maxillary prosthesis supported by two zygomatic implants for maxillary defect resulting from cancer ablative surgery: a case report/technique article.

We report herein a case of functional and aesthetic rehabilitation with maxillary prosthesis supported by only two zygomatic implants for a patient with severe maxillary defect resulting from subtotal 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 malignant melanoma of the upper gingiva (cT3N1M0 stage IVA, American Joint Committee on Cancer) was made. Subtotal maxillectomy utilizing Le Fort I osteotomy and functional neck dissection were performed. A conventional resection denture was made and employed postoperatively, but was unable to be suitably retained due to insufficient residual maxillary structures. Six months after tumor resection, two zygomatic implants were inserted into bilateral zygomatic bones. Magnetic attachments were applied as a mechanism for attaching the implants and resection denture. After application of these implants, retention and stability of the prosthesis was considerably improved. The patient became able to eat a normal diet. From an aesthetic perspective, the depressed upper lip was also properly restored, leading to an acceptable facial appearance.

Chronological flap volume and distribution changes after reconstruction of total maxillectomy defect using a rectus abdominis myocutaneous flap.

BACKGROUND/PURPOSE: After total or subtotal maxillectomy, reconstruction using a free rectus abdominis myocutaneous (RAMC) flap is a fundamental and useful option. The purpose of the present study was to clarify the degree of flap volume change and volume distribution change with time after total or subtotal maxillectomy and free RAMC flap reconstruction and to examine the factors affecting the results. METHODS: A total of 20 patients who underwent total or subtotal maxillectomy with free RAMC flap reconstruction were examined, and the flap volume change rate (volume at final evaluation [POD 181-360] / volume at initial evaluation [POD 5-30]) was investigated using the results of imaging tests. Moreover, the flap was divided into four blocks (A-D) in the cranio-caudal direction, and the volume change of each block was individually analyzed. RESULTS: The overall volume change rate of fat/muscle/total was 0.84 ± 0.21/0.36 ± 0.08/0.67 ± 0.15, at the mean follow-up period of 309±35 days after the operation. The multiple regression analysis revealed that weight loss (for fat), postoperative RT (for fat and muscle), and young age (for muscle) were independently associated with flap volume loss. The results also indicated that the fat volume was stable, whereas the muscle volume decreased to <40% over time, assuming there were no influencing factors. Regarding flap volume distribution change, the fat volume tended to gather toward the central-cranial direction, while the muscle volume gathered toward the cranial direction, and total flap volume gathered toward the central direction.