Rehabilitation of a complex midfacial defect by means of a zygoma-implant-supported prosthesis and nasal epithesis: a novel technique.

Trevisiol, Lorenzo; Procacci, Pasquale; D'Agostino, Antonio; Ferrari, Francesca; De Santis, Daniele; Nocini, Pier Francesco

PURPOSE Several authors have described zygoma implants as a reliable surgical option to rehabilitate severe maxillary defects in case of extreme atrophy or oncological resections. The aim of this study is to report a new technical approach to the rehabilitation of a complex oronasal defect by means of a zygoma-implant-supported full-arch dental prosthesis combined with a nasal epithesis. PATIENTS AND METHODS The patient presented with a subtotal bilateral maxillectomy and total rhinectomy defect because of a squamous cell carcinoma of the nose. No reconstructive surgery was performed because of the high risk of recurrence; moreover, the patient refused any secondary procedure. After surgery, the patient presented a wide palatal defect associated to the absence of the nasal pyramid. Zygoma-retained prostheses are well documented, and they offer good anchorage in rehabilitating wide defects after oncological surgery and a good chance for patients to improve their quality of life. We hereby describe two prosthetic devices rehabilitating two iatrogenic defects by means of a single intraoral implant-supported bar extending throughout the oronasal communication, thus offering nasal epithesis anchorage. RESULTS At 1-year follow-up after functional prosthetic loading, no implant failure has been reported. Clinical and radiological follow-up showed no sign of nasal infection or peri-implantitis. The patient reported a sensitive improvement of his quality of life. CONCLUSIONS Simultaneous oral and nasal rehabilitation of complex oronasal defects with zygoma-implant-supported dental prosthesis and nasal epithesis represents a reliable surgical technique. According to this clinical report, the above-mentioned technique seems to be a valuable treatment option as it is safe, reliable and easy to handle for both surgeon and patient.