Pterygoid Implants for Maxillofacial Rehabilitation of a Patient With a Bilateral Maxillectomy Defect
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.
Figure 1. Preoperative panoramic radiograph of the patient at the time of initial presentation. Figure 2. Lateral radiographic image showing the placement of 2 pterygoid implants and 1 regular implant in the right zygoma, after bilateral maxillectomy. Figure 3. (a) Frontal view of the patient after bilateral maxillectomy, before the start of the prosthetic procedures. Note the drooping commissures and collapsed nose. (b) Profile view of the patient after bilateral maxillectomy and before the start of the prosthetic procedures. Note the collapse of the midfacial profile.
Figure 4 . Panoramic radiograph showing the ptergygoid implants with locator abutments and an implant in the right zygoma. Note the missing anatomic structures in comparison to Figure 1. Both locator abutments were confirmed as completely seated before prosthodontic treatment. Figure 5. Intraoral view of the patient's surgical defect showing implant abutments on pterygoid implants. Figure 6. Definitive cast of the surgical defect. Compare with Figure 5. Figure 7. Obturator that was trimmed hollow from the palatal surface. Note the lid ready to be placed.
Figure 8 . Frontal view of the hollow obturator (31.9 g) to demonstrate the volume of tissues restored. Figure 9. Intraoral view of the obturator prosthesis in maximum intercuspation. Figure 10. (a) Posttreatment frontal view of the patient with obturator in place. (b) Posttreatment profile view of the patient with obturator in place. Compare with Figure 3b to note restoration of the midfacial profile.
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