Journal of Oral Implantology February 2013 - (Page 91)
CASE REPORT
Pterygoid Implants for Maxillofacial Rehabilitation of a
Patient With a Bilateral Maxillectomy Defect
Avinash S. Bidra, BDS, MS, FACP1*
George W. May, DDS2
Greggory E. Tharp DMD2
Mark S. Chambers, DMD, MS3
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.
Key Words: pterygoid, pterygomaxillary, implant, tuberosity, maxillectomy, hollow obturator
INTRODUCTION
M
axillectomy or maxillary resection
is defined as surgical removal of a
part or all of the maxilla.1 This
definition is broad and does not
describe the resection in lateral,
superior, or posterior extensions. For better description and for communication purposes, several
classifications have been proposed with no unanimity of use.2–9 A classification system described
by Spiro et al6 is simple and is popular among
surgeons and maxillofacial prosthodontists. In this
system, adjectives are used to describe the extent of
maxillary resection as limited, subtotal, or total.
1
Department of Reconstructive Sciences, University of Connecticut, Farmington, Conn.
2
Private practice, Jackson, Miss.
3
Section of Dental Oncology, University of Texas, M.D Anderson
Cancer Center, Houston, Tex.
* Corresponding author, e-mail: avinashbidra@yahoo.com
DOI: 10.1563/AAID-JOI-D-10-00181
Limited maxillectomy is defined as any maxillary
resection that primarily removes 1 wall of the
antrum, usually the floor or the medial wall.
Subtotal maxillectomy is defined as any maxillectomy that removes at least 2 walls, including the floor
of the antrum (hard palate) but not the posterior
wall. Total maxillectomy is defined as complete
removal of the maxilla, usually involving orbital
exenteration. Additional details, such as unilateral or
bilateral and the contiguous structures involved, are
usually specified along with the classified resection.6
Obturation of bilateral subtotal or total maxillectomy defects presents a significant challenge to
the maxillofacial prosthodontist.10–13 Often there is
inadequate retention, stability, and support for the
prosthesis because of the apparent loss of anatomic
structures. Patients with such defects have significant difficulties in swallowing, speech, mastication,
and esthetics.10,11 They often have poor lip support,
scarring of the lip, midfacial collapse, lip incompetency, drooping commissures, and trismus due to
Journal of Oral Implantology
91
Table of Contents for the Digital Edition of Journal of Oral Implantology February 2013
Could the Fountain of Youth Be All in Your Bones?
Vertical Bone Augmentation With Simultaneous Implant Placement Using Particulate
Evaluation of the Bone Healing Process Utilizing Platelet-Rich Plasma Activated by Thrombin
Effect of Model Parameters on Finite Element Analysis of Micromotions in Implant Dentistry
Peri-Implant Defect Augmentation With Autogenous Bone: A Study in Beagle Dogs
Would Nitric Oxide be an Effective Marker for Earlier Stages of Peri-Implant Disease? An
The Effect of Different Surface Treatments on Cement-Retained Implant-Supported
Effect of Rotating Osteotomes on Primary Implant Stability—An In Vitro Investigation
Horizontal Augmentation Through the Ridge-Split Procedure: A Predictable Surgical
The Bis-Acryl Stent
Clinical, Histological, and Histomorphometrical Analysis of Maxillary Sinus Augmentation
A Technique to Salvage a Single Implant-Supported Fixed Dental Prosthesis Having a
Ridge Expansion and Immediate Placement With Piezosurgery and Screw Expanders in
Pterygoid Implants for Maxillofacial Rehabilitation of a Patient With a Bilateral Maxillectomy
Technology in Maxillary Premolar Region: A New Strategy for Soft Tissue Management
Fracture of Anterior Iliac Crest Following Bone Graft Harvest in an Anorexic Patient: Case
A Technique for Constructing a New Maxillary Overdenture to a Nonretrievable Implant
Edentulous Maxillary Arch Fixed Implant Rehabilitation Using a Hybrid Prosthesis Made of
Journal of Oral Implantology February 2013
http://www.brightcopy.net/allen/orim/Glossary
https://www.nxtbook.com/allen/orim/40-6
https://www.nxtbook.com/allen/orim/40-5
https://www.nxtbook.com/allen/orim/40-4
https://www.nxtbook.com/allen/orim/40-s1
https://www.nxtbook.com/allen/orim/40-3
https://www.nxtbook.com/allen/orim/40-2
https://www.nxtbook.com/allen/orim/40-1
https://www.nxtbook.com/allen/orim/39-6
https://www.nxtbook.com/allen/orim/39-5
https://www.nxtbook.com/allen/orim/39-4
https://www.nxtbook.com/allen/orim/39-3
https://www.nxtbook.com/allen/orim/39-s1
https://www.nxtbook.com/allen/orim/39-2
https://www.nxtbook.com/allen/orim/39-1
https://www.nxtbook.com/allen/orim/38-6
https://www.nxtbook.com/allen/orim/38-5
https://www.nxtbook.com/allen/orim/38-s1
https://www.nxtbook.com/allen/orim/38-4
https://www.nxtbook.com/allen/orim/38-3
https://www.nxtbook.com/allen/orim/38-2
https://www.nxtbook.com/allen/orim/38-1
https://www.nxtbookmedia.com