Abstract : The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy
This aim of this report is to describe the development and evolution of a new surgical technique for the immediate surgical reconstruction and rapid post-operative prosthodontic rehabilitation with a fixed dental prosthesis following low-level maxillectomy for malignant disease.
The technique involves the use of a zygomatic oncology implant perforated micro-vascular soft tissue flap (ZIP flap) for the primary management of maxillary malignancy with surgical closure of the resultant maxillary defect and the installation of osseointegrated support for a zygomatic implant-supported maxillary fixed dental prosthesis.
The use of this technique facilitates extremely rapid oral and dental rehabilitation within a few weeks of resective surgery, providing rapid return to function and restoring appearance following low-level maxillary resection, even in cases where radiotherapy is required as an adjuvant treatment post-operatively. The ZIP flap technique has been adopted as a standard procedure in the unit for the management of low-level maxillary malignancy, and this report provides a detailed step-by-step approach to treatment and discusses modifications developed over the treatment of an initial cohort of patients.
Serial posts:
- Abstract : The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy
- Background : The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy
- Case presentation : The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy [1]
- Case presentation : The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy [2]
- Case presentation : The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy [3]
- Case presentation : The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy [4]
- Case presentation : The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy [5]
- Case presentation : The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy [6]
- Conclusions : The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy
- References : The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy
- Author information : The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy
- Ethics declarations : The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy
- Rights and permissions : The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy
- About this article : The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy
- Table 1 Patient-reported quality of life outcomes following ZIP flap procedure : The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy
- Fig. 1. Clinical view of left-sided maxillary tumour at presentation : The zygomatic implant
- Fig. 2. Staging MRI scan showing destructive lesion left maxilla : The zygomatic implant
- Fig. 3. Staging CT scan confirming maxillary destruction but preservation of the orbital floor : The zygomatic implant
- Fig. 4. Panoramic dental radiograph showing dental status at presentation : The zygomatic implant
- Fig. 5. Left-sided maxillary resection (Brown class 2b) : The zygomatic implant
- Fig. 6. Zygomatic oncology implants sited in the residual zygomatic bone on the defect side of the maxilla : The zygomatic implant
- Fig. 7. Conventional zygomatic implant insertion on the non-defect side of the maxilla following extraction of the remaining teeth and an alveoloplasty : The zygomatic implant
- Fig. 8. Abutment level impression utilising light-cured acrylic tray material : The zygomatic implant
- Fig. 9. Inter-occlusal registration using the pre-fabricated maxillary denture prosthesis relined with silicone putty over the implant abutment protection caps : The zygomatic implant
- Fig. 10. Radial forearm flap inset and sutured into the maxillary defect and perforated by the zygomatic oncology implant abutments : The zygomatic implant
- Fig. 11. Intra-oral view of the soft tissue flap at 3 weeks post-operatively with overgrowth of flap over the zygomatic oncology implants : The zygomatic implant
- Fig. 12. Provisional acrylic fixed dental prosthesis fitted at 4 weeks post-surgery : The zygomatic implant
- Fig. 13. Panoramic dental radiograph showing the position of the zygomatic implants and the seating of the initial fixed prosthesis : The zygomatic implant
- Fig. 14. Intra-oral view of perforated flap 3 weeks following radiotherapy : The zygomatic implant
- Fig. 15. Facial appearance 18 months following treatment : The zygomatic implant
- Fig. 16. Another ZIP flap case demonstrating the use of a perforated polythene “washer” to keep the flap from overgrowing the implant abutments during the healing phase : The zygomatic implant
- Fig. 17. The appearance of the case shown in Fig. 16 with the polythene “washer” removed at 2 weeks post-surgery, providing access to the zygomatic oncology implants : The zygomatic implant