Zygoma implants and hemimaxillectomy

Zygoma Implants after Hemimaxillectomy and mandibular implants in a fibula graft

Luc Vrielinck

• Gunshot war injury: this patient underwent multiple reconstructive procedures including a soft tissue flap in the right maxilla and a fibula osteomycutaneous flap in the lower mandible on the right side • Problems: – Poor retention of the removable prosthesis in the upper jaw – Impossibility to wear a prosthesis in the lower jaw

Treatment plan • Release of the fibrous tissue scar in the cheek • Thinning of the fibula flap and vestibuloplasty • Placement of zygoma and standard implants in the upper jaw • Placement of standard implants in the lower jaw • Immediate loading with a fixed bridge in the upper jaw and the lower jaw

fibula

Intake: situation after mandibular reconstruction with a fibula flap, the maxilla was already closed with soft tissue flap

Operative images & immediately postoperative 19/01/2017

19/01/2017: Operative & early postoperative images

Maxilla

Fibula flap

mandible mandible

19/01/2017: Operative & early postoperative images

Treatment of the mandible

Flap before thinning out

Fibula graft

19/01/2017: Operative & early postoperative images

Flap before thinning out

tongue

19/01/2017: Operative & early postoperative images

19/01/2017: Operative & early postoperative images

dougnuts Golden tip!

There was a need to push the softtissue down to avoid soft tissue overgrowing the abutments Prefabricated ‘dougnuts’ in acrylic were placed over the multiunit abutments On top of it a acrylic bar was fitted and fixed with perimandibular metallic wires.

This prevented that the fibula flap after swelling would cover the implants (see next slide) and at the same time keeps the softtissue down (= a modification of the old vestibuloplasty technique)

With many thanks to Dr Wolfgang Bolz who learned me the dougnut technique. He uses this in AO4 treatment

Perimandibular wires

19/01/2017: Operative & early postoperative images

Treatment of the Maxilla

19/01/2017: Operative & early postoperative images

Nobelactive Implants

Zygoma implants

In this situation the dougnuts were attached to the impression copings and are included in the impression

19/01/2017: Operative & early postoperative images

Perimandibular wires

19/01/2017: Operative & early postoperative images

19/01/2017: Operative & early postoperative images

19/01/2017: Operative & early postoperative images

19/01/2017: Operative & early postoperative images

19/01/2017: Operative & early postoperative images

19/01/2017: Operative & early postoperative images

19/01/2017: Prosthodontist Rohnny Morren in action!

• • • •

Surgery: Dr Luc Vrielinck (implants) Surgery: Dr Joeri Meyns (fibula graft) Prosthesis: prostodontist Rohnny Morren Dental lab: Luc & Patrick Rutten