The surgical management and prosthodontic rehabilitation of the maxillectomy patient is complex with a variety of options available to the head and neck cancer team ranging from simple prosthodontic obturation [1] to reconstruction using pre-fabricated or digitally planned composite flaps [2] with or without the placement of osseointegrated implants [3]. The primary aims of treatment include effective eradication of the primary tumour, closure of the resulting maxillary defect, preservation of facial form, and ideally, the restoration of the resected maxillary dentition. Whilst the techniques for surgical closure of the low-level maxillectomy defect are well established, it can be challenging to subsequently achieve effective dental rehabilitation. The use of an obturator is not without its difficulties in terms of fit, retention and comfort, as well as preventing the transgress of fluid from the mouth to the nose. Providing and maintaining an effective obturator is demanding on both the patient and prosthodontist. Although some patients are able to tolerate the use of a removable denture following treatment, depending on retention, many are unable due to the change in the oral anatomy, oral dryness and the fragility of the irradiated tissues. Sealing the defect and providing bone and soft tissue through the use of free tissue transfer has both advantages and disadvantages. Following free tissue transfer providing secondary rehabilitation might be delayed or not possible. The situation is made worse by the frequent requirement for post-operative radiotherapy, which ideally should start as soon as feasible following tumour ablation.

The development of highly specialised tools such as zygomatic, oncology and co-axis implants (Southern Implants Ltd., South Africa) have provided a platform for effective maxillary dental rehabilitation in a rapid manner following maxillary resective surgery. Boyes-Varley et al. (2007) [4] successfully demonstrated the use of early loading in this cancer setting utilising oncology zygomatic and dental implants together with prosthetic obturation. Whilst implant survival was not a problem, the amount of prosthodontic maintenance was significant and most likely related to the complex issues around establishing and maintaining an oro-nasal seal in a changing maxillectomy cavity. The technique presented here incorporates an early loading zygomatic and oncology implant protocol for maxillectomy patients together with microvascular free-flap closure of the resultant defect with a fascio-cutaneous flap and early delivery of a fixed dental prosthesis within a few weeks following surgery.