Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical
  • Published:

The prosthodontic management of the maxillectomy patient

Abstract

Ablative defects of the maxilla caused by malignant tumours create a multitude of difficulties for patients and the clinical teams looking after them. Tumours of the maxilla, while relatively uncommon, require significant multi-disciplinary involvement due to their effects on the aesthetic, functional and psychological aspects of the patients involved. Patients with these tumours have worse survival than other head and neck sites, with a propensity to local and regional recurrence. As a result, prosthetic rehabilitation of this patient cohort must be timely to restore form and function before patients become adapted to their pathologically adapted state. This article will discuss classification of maxillary defects and surgical decision-making in this complex area, together with the role of the maxillofacial prosthodontist/restorative dentist in providing effective pre, peri and postoperative intervention and support to the surgical team and to the patient. While prosthetic obturation has been used historically to manage maxillectomy patients, the use of composite microvascular free flap reconstruction, with or without dental implants, is often required for high-level defects. More recently, the use of the zygomatic implant perforated flap reconstructive procedure for rapid prosthodontic rehabilitation and palatal reconstruction has been described and validated.

Key points

  • Patients with maxillary tumours should be managed in multi-disciplinary centres which are able to offer dental rehabilitation, as well as tumour resection.

  • The primary placement of zygomatic and dental implants at time of resection can facilitate early dental rehabilitation by providing support and retention for maxillary obturators.

  • New techniques, such as the zygomatic implant perforated flap procedure, can provide rapid fixed dental rehabilitation, together with palatal reconstruction by means of a soft tissue flap.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Rogers S N, Adatia A, Hackett S et al. Changing trends in the microvascular reconstruction and oral rehabilitation following maxillary cancer. Eur Arch Otorhinolaryngol 2022; 279: 4113-4126.

  2. Brown J S, Shaw R J. Reconstruction of the maxilla and midface: introducing a new classification. Lancet Oncol 2010; 11: 1001-1008.

  3. Butterworth C, McCaul L, Barclay C. Restorative dentistry and oral rehabilitation: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol 2016; DOI: 10.1017/S0022215116000414.

  4. Butterworth C J. Primary vs secondary zygomatic implant placement in patients with head and neck cancer-A 10-year prospective study. Head Neck 2019; 41: 1687-1695.

  5. Butterworth C J. Prosthetic Management of the Head & Neck Cancer Patient. In Watkinson J, Clarke R (eds) Scott-Brown's Otorhinolaryngology: Head and Neck Surgery. 8th ed. Florida: CRC Press, 2018.

  6. Butterworth C J, Rogers S N. The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy. Int J Implant Dent 2017; 3: 37.

  7. Butterworth C J, Lowe D, Rogers S N. The Zygomatic Implant Perforated (ZIP) flap reconstructive technique for the management of low-level maxillary malignancy - clinical & patient related outcomes on 35 consecutively treated patients. Head Neck 2022; 44: 345-358.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Chris Butterworth.

Ethics declarations

The author declares no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Butterworth, C. The prosthodontic management of the maxillectomy patient. Br Dent J 233, 744–748 (2022). https://doi.org/10.1038/s41415-022-5106-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41415-022-5106-9

Search

Quick links