A novel report on the use of an oncology zygomatic implant-retained maxillary obturator in a paediatric patient

David Richardson,Amit Dattani,Chris J Butterworth

doi:10.1186/s40729-017-0073-7

Abstract

This report details the use of zygomatic oncology osseointegrated implants to support and retain a maxillary obturator in a 13-year-old male patient who underwent a right-sided hemi-maxillectomy (Brown Class 2b) (Brown and Shaw, Lancet Oncol 11:1001–8, 2010) for a myxoid spindle cell carcinoma. At the time of maxillary resection, two zygomatic oncology implants were inserted into the right zygomatic body and subsequently utilised to provide in-defect support and retention for a bar-retained maxillary acrylic obturator prosthesis, which restored the patient’s aesthetics and function to a very high level. Close follow-up over 2 years demonstrated ongoing excellent function and disease control with no deleterious effects on facial or dento-alveolar growth clinically. This is the first clinical report of its kind in the published literature detailing the use of a zygomatic implant-retained obturator in a paediatric patient.

Highlights

Maxillary defects of acquired [1] or congenital origin produce a communication between the oral and nasal cavities sometimes via an opening into the maxillary antrum and by direct communication into the nose
The use of microvascular free-tissue transfer has gained in popularity over time in adults in order to effect a biological closure of the resulting oro-nasal communication, but in the paediatric patient with maxillary malignancy, the use of a prosthetic obturator is more commonly reported [3]
The zygomatic oncology implant (Southern Implants Ltd, South Africa) (Fig. 1) has a 20-mm threaded apical portion for engagement in the zygoma bone with the rest of the implant having a polished surface where it extends into the maxillectomy cavity

Summary

Background

Maxillary defects of acquired [1] or congenital origin produce a communication between the oral and nasal cavities sometimes via an opening into the maxillary antrum and by direct communication into the nose. The zygomatic oncology implant (Southern Implants Ltd, South Africa) (Fig. 1) has a 20-mm threaded apical portion for engagement in the zygoma bone with the rest of the implant having a polished surface where it extends into the maxillectomy cavity This improves the patient’s ability to clean the implant and the defect and reduces the adherence of nasal secretions and food debris. All mucosal polyposis resolved very quickly following the patient’s improved hygiene measures He continued under review with no evidence of recurrence or problems with the implants or prosthesis in the 22 months since the surgery. A recent radiographic review (Fig. 11) demonstrated no significant peri-implant bone resorption, and clinically, there had been no alteration in facial growth or appearance (Fig. 12) of this young patient who was 16 years of age at the time of his final review (February 2017)

Discussion

Conclusions