title: Multidisciplinary reconstruction of a palatomaxillary defect with nonvascularized fibula bone graft and distraction osteogenesis.
abstract: Reconstruction of extensive palatomaxillary defects with oronasal/antral communication represents a challenge to surgeons. Bone-containing microvascular flaps have been suggested as a promising option for rehabilitation of function and esthetics. These types of flaps, however, might be associated with high morbidity. A combination of less complicated treatments might also provide acceptable results while diminishing potential donor site complications. This clinical report presents a bilateral maxillary defect with oronasal communication due to resection of malignant melanoma of the palate. The lost alveolar bone was initially reconstructed with a nonvascularized fibula bone graft. After 6 months, the alveolar segment was subjected to vertical distraction osteogenesis to increase bone height. After a 3-month consolidation period, the patient received 10 dental implants and an implant-supported fixed prosthesis. To preclude graft harvesting morbidity for reconstructing the oronasal fistula, the frame of the prosthesis was designed to include 3 ball attachments on which a palatal obturator, merely covering the palate, could be stabilized. The removable implant-retained obturator restored function perfectly. During the 5-year follow-up, no complication regarding bone graft, the dental implants, and the obturator has been observed.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Dentofacial Deformity Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. h_behnia@hotmail.com
authors.forename: Hossein
authors.initials: H
authors.lastname: Behnia
authors.forename: Sasan
authors.initials: S
authors.lastname: Homayoun
authors.forename: Kamal
authors.initials: K
authors.lastname: Qaranizade
authors.forename: Golnaz
authors.initials: G
authors.lastname: Morad
authors.forename: Arash
authors.initials: A
authors.lastname: Khojasteh
mesh_terms: D003758:Dental Implantation, Endosseous; D019094:Dental Prosthesis, Implant-Supported; D005260:Female; D005360:Fibula / Q000637:transplantation*; D006801:Humans; D008441:Maxillary Neoplasms / Q000601:surgery*; D008545:Melanoma / Q000601:surgery*; D008875:Middle Aged; D019857:Osteogenesis, Distraction / Q000379:methods*; D010157:Palatal Neoplasms / Q000601:surgery*; D010158:Palatal Obturators; D019651:Plastic Surgery Procedures / Q000379:methods*