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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
Maxillectomy 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. 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...