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Keywords

maxillofacial prosthetics, implant bar, surgical complications, obturator

Abstract

Oral cancer resections cause tissue defects which result in functional complications such as masticatory dysfunction, dysphagia, articulation and phonation issues. When the defect involves the maxillary arch, obturation is needed whether it be surgical or prosthetic. In cases where surgical procedures become ineffective, prosthetic options could be challenging. This is a case of a 78-year-old male developed the diagnosis of squamous cell carcinoma of the right alveolar ridge. The patient underwent partial maxillectomy and right neck dissection with fibula free-flap reconstruction of the maxillary arch. Despite a positive doppler reading, the fibula free-flap became non-vital seven days post-operatively. At the time of removal of the non-vital flap, two osseointegrated dentoalveolar endosseous implants were placed in the remaining maxilla and a defect/adhesive-retained edentulous interim obturator was fabricated. Due to the size of the defect with only approximately 20% of remaining maxillary arch (Aramany Class IV, Okay Class III), prosthetic obturation was extremely difficult due to lack of retention and support from the defect side. The patient was brought back to the operating room for placement of two zygomatic implants on the defect side. To enhance the success of the zygomatic implants and patient’s function in the interim phase, a fixture level impression was made in the operating room to fabricate an interim bar, splinting all implants and providing retention for an immediate interim obturator prosthesis. Once the implants were healed and integrated, a definitive implant bar was fabricated to splint all implants and to ideally be placed within the confines of the prosthetic reconstruction. A locator-retained, implant bar-supported definitive obturator was fabricated. The patient was successfully prosthetically obturated with no evidence of nasal regurgitation or hypernasal speech. This case demonstrates the prosthetic possibilities when surgical obturation is contraindicated or unsuccessful.

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