The patient, a male 46 years old at the time of our visit, underwent surgical resection of nasal pyramid and premaxilla including the whole upper jaw teeth sparing nasal bones. When the patient came to our clinic, apart from the defect resulting from the resection, he presented with a retraction scar crossing the upper lip from the floor of the nasal defect through the filtrum. The surgical resection was performed in another clinic the previous year, and since then, the patient experienced a severe decrease in the quality of social life including the loss of job and falling into reactive depression. The histological aspect of the neoplasia was characterized by high malignancy and contraindicated a microvascular flap reconstruction in order to allow the inspection of the nasal cavity and the facial skin nearby the nasal defect during follow-up appointments.

Furthermore, the conspicuous defect and the different kind of tissues needed would have required multiple donor sites, making the achievement of a good aesthetic and functional result quite challenging. Insofar, due to the entity of the defect, the uncertain outcome of the surgical reconstruction, time-costing evaluation and follow-up need, the patient was proposed to undergo zygoma-implant-supported prosthetic restorations.

Radiographic examination was carried out by means of CT scans of the maxillofacial complex. After the evaluation of the residual maxillary bone, insertion of four zygoma implants was planned.

The surgical intervention was performed under general anaesthesia. Our surgical treatment started with an incision extended from the palatal aspect of the second molar site to the crestal aspect of the canine site bilaterally, with two posterior release incisions. A full-thickness flap was then elevated, and the anterolateral wall of the maxilla was exposed. An oval-shaped window was first drawn and was then opened trough the upper aspect of the maxillary buttress using a large round diamond bur. These windows are used to check the right direction of the zygomatic fixtures during their insertion trough the zygomatic bone. Once the maxillary buttress has been prepared bilaterally, the zygoma implant insertion could start. The preoperative planning provided the insertion of four zygomatic fixtures (Branemark System Zygoma, Zygoma TiUnite® Implant, Nobel Biocare, Goteborg, Sweden), one through the first molar area and one through the lateral canine area on both sides (Fig. 1). The reflected mucoperiosteal flap was then sutured with resorbable suture (Polysorb 4.0, Covidien, Mansfield, MA, USA).