Immediately loaded zygomatic implants used for a functional and aesthetic rehabilitation following a combined maxillectomy and rhinectomy

Abstract

Malignancies of the nasal vestibule are rare, yet may result in massive destruction of the face if left untreated. The position and extent of the resulting defects is not only a rehabilitative challenge but also a major psychological burden for the patient. This paper describes a technique for designing and fabricating an immediate surgical obturator and nasal prosthesis to help minimize the post-surgical impact following a total rhinectomy and partial maxillectomy procedure in a patient diagnosed with a squamous cell carcinoma of the nasal septum. The restoration consisted of bilateral zygomatic implants attached to a resin framework housing a central magnet. The latter was used to retain the nasal prosthesis and help support an interim maxillary obturator. Conventional impressions of the dentition and a moulage of the nasal defect were taken. The master casts were poured and used for design and fabrication of the obturator and nasal wax pattern Colour matching of the nose and facial areas was performed with the aid of a digital spectrophotometer (Quickweigh; Spectromatch Ltd., UK), and a silicone nasal prosthesis was fabricated. This case demonstrated how both a functional rehabilitation and reduced psychological impact was achieved by delivering an immediate surgical obturator and facial prosthesis.