Successful Secondary Reconstruction and Dental Rehabilitation for a Maxillary Bone Defect With Discontinuity After Partial Maxillectomy: A Case Report
Secondary reconstruction of the maxillary defect with discontinuity after partial maxillectomy is extremely challenging due to extensive, severe adhesions between the maxillary sinus membrane and oral mucosa, resulting in no space for the grafted bone and a lack of soft tissue to cover the graft. This case reports a 23-year-old female patient who underwent secondary reconstruction for a bone defect caused by a partial maxillectomy to remove an ameloblastoma that had invaded the maxillary sinus. We incised the existing soft tissue ridge at the bone defect and extensive adhesions below the maxillary sinus to create space for the grafted bone and to form an adequate buccal flap. To ensure the grafted bone’s stability and to support the surrounding soft tissues, a cortical bone from the iliac crest was placed beneath the sinus membrane, with cancellous bone grafted underneath, and a titanium mesh was applied at the alveolar region. This approach allowed robust bone regeneration at the graft site, demonstrating dense, well-integrated new bone formation that facilitated successful implant treatment with good primary stability for 2 implants. This surgical approach, when indicated, can be less invasive than vascularized bone grafts.
Panoramic radiograph (a) and computed tomography images (b, c) at the first visit for ameloblastoma (arrowheads). A multilocular lesion involving the left maxillary sinus and the maxilla from the left upper lateral incisor to the left upper first molar. The left upper canine and upper second premolar adjacent to the lesion are displaced, primarily expanding toward the buccal side.
Panoramic radiograph (a) and computed tomography images (b–d) 5 years after tumor removal. No recurrence is observed in the surgical area, but complete loss of the maxillary bone is noted, indicating a discontinuous defect. Dotted lines, boundary of remaining bone; arrowheads, complete bone defect including alveolar and basal bone.
Five years after tumor removal, a thin, soft tissue ridge was observed (a). An incision was made at the center of the soft tissue ridge, and adhesions between the scar tissue and the maxillary sinus membrane were separated using a blade to form an adequate buccal flap (b). A small perforation occurred during the dissection and was repaired with a resorbable collagen membrane (c). Cortical bone harvested from the iliac crest was trimmed and fitted into the bony defect directly beneath the sinus membrane, followed by grafting of the cancellous bone below. To ensure graft bone stability, titanium mesh was applied and covered with an absorbable collagen membrane (d, e). The surgical wound was closed without tension (f).
(a) Panoramic radiograph immediately after iliac bone grafting with titanium mesh. (b–e) Computed tomography images at 6 months after bone grafting. Bone continuity of the maxilla was restored beneath the sinus membrane, and the grafted bone healed effectively, accompanied by the formation of a cortical lining.
(a) Planning for implant placement on the reconstructed maxilla. (b–d) Clinical photographs during titanium mesh and implant placement. The graft site showed robust bone regeneration, demonstrating dense, well-integrated new bone formation, which facilitated the successful placement of implants with good primary stability. (e–f) Panoramic radiographs immediately after implant placement and re-entry (abutment connection).
Final prosthesis.
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