Rehabilitation of a bilateral maxillectomy patient with a free fibula osteocutaneous flap.
Rehabilitation of patients who have undergone bilateral maxillectomy is difficult because of extensive loss of bone and soft tissue. In this clinical report, prosthodontic rehabilitation of oral function in a bilateral maxillecitomy patient combined with a new fibular osteocutaneous flap, which was designed to have two oronasal slits for the retention of an obturator prosthesis, was described. A 58-year-old man with a maxillary alveolar carcinoma underwent bilateral maxillectomy. The defect was reconstructed using a vascularized fibular bone wrapped circumferentially with a peroneal flap, which was fixed with miniplates between the right malar prominence and cut edge of the left zygoma remaining two slits anterior and posterior to the graft. Two and half weeks after the surgery, a delayed surgical obturator was delivered and an obturator prosthesis was delivered 6 weeks after the surgery. This obturator prosthesis could be extended into the slits to engage the tissue undercuts, and was stable during use. Mastication, deglutition, articulation and the mid-facial profile of the patient were rehabilitated. After installation of the obturator prosthesis, relining of the prosthesis base was carried out alongside the healing process of the graft, and adjustment of occlusions and high-pressure spots was carried out. No clinical disorders were observed either in the grafted tissue or the obturator prosthesis with a 3-year prognosis. Newly designing a fibular osteocutaneous flap combined with tissue-borne obturator prosthesis is one successful approach to the restoration of oral function, and increases the patient's quality of life after bilateral maxillectomy.
Department of Maxillofacial Prosthetics, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan. h.mukohyama.mfp@tmd.ac.jp
H
H
Mukohyama
M
M
Haraguchi
Y I
YI
Sumita
H
H
Iida
Y
Y
Hata
S
S
Kishimoto
H
H
Taniguchi
D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D017266:Dental Prosthesis; D005360:Fibula / Q000637:transplantation*; D006801:Humans; D008297:Male; D008441:Maxillary Neoplasms / Q000601:surgery*; D008444:Maxillary Sinus Neoplasms / Q000601:surgery*; D019931:Maxillofacial Prosthesis Implantation; D008875:Middle Aged; D010158:Palatal Obturators; D019651:Plastic Surgery Procedures; D013524:Surgical Flaps