Maxillary defects of acquired [1] or congenital origin produce a communication between the oral and nasal cavities sometimes via an opening into the maxillary antrum and by direct communication into the nose. This in turn can result in masticatory compromise, swallowing and speech impairment, nasal fluid regurgitation and aesthetic concerns. The management of the maxillectomy patient is a complex area where there is still much debate [2], but in the paediatric patient, there is virtually no literature detailing the most appropriate approach. The use of microvascular free-tissue transfer has gained in popularity over time in adults in order to effect a biological closure of the resulting oro-nasal communication, but in the paediatric patient with maxillary malignancy, the use of a prosthetic obturator is more commonly reported [3]. The use of free-tissue transfer in children in the maxillofacial region seems to be mainly restricted to reconstruction of the mandible from the reviewed available literature [4] presumably because prosthetic obturation can offer good results in the maxilla and defer additional complex surgeries to a later date.

An obturator is a custom-made denture prosthesis that is used to close the communication with the antrum/nose in order to allow satisfactory mastication and speech. In the dentate patient, maxillary obturator prostheses may be retained by the natural dentition together with the engagement of undercuts within the maxillary defect itself. The use of osseointegrated implants to assist with the retention of a maxillary obturator has been reported [5]; utilising both dental implants into the residual alveolus and, more recently, the use of zygomatic implants in large maxillectomy defects has also been described [6]. Osseointegrated zygomatic implants provide rigid support and retention for the overlying implant-retained obturator with two, three [7] or four zygomatic implants being used for rehabilitation of a bilateral maxillectomy resection. There is no real information available on the use of zygomatic implants in the support and retention of obturator prostheses for unilateral maxillary defects in the dentate patient, but this situation mandates the use of two implants to allow splinting and bar construction to provide the best available support. Whilst the use of conventional zygomatic implants is possible in this clinical approach, the use of zygomatic implants manufactured specifically for use in maxillectomy situations possess some advantages. The zygomatic oncology implant (Southern Implants Ltd, South Africa) (Fig. 1) has a 20-mm threaded apical portion for engagement in the zygoma bone with the rest of the implant having a polished surface where it extends into the maxillectomy cavity. This improves the patient’s ability to clean the implant and the defect and reduces the adherence of nasal secretions and food debris. The 55° angulated implant platform head also facilitates screwdriver access and brings it directly into the line of the prosthodontic arch.