As far as prosthetic design is concerned, it is mandatory to avoid or, if not possible, limit as much as possible distal cantilever: given the absence of the premaxilla, an anterior cantilever is already present. Implant splintage is recommended [1, 8], and the bar design must respect technical data (implant-to-implant distance, cross-arch stabilization avoiding to cover oronasal communication and shape offering nasal epithesis connection) and clinical requirements (patient’s aftercare, visible inspection for follow-up). One of the most important technical issues is about oronasal communication: if the bar crosses, it is close to the upper lip, no obturator can be manufactured and the lack of vestibular seal may cause nasal flow during beverage swallowing (Fig. 5).

The combined zygoma-implant-supported prosthesis and nasal epithesis represents a new approach to rehabilitate wide complex midfacial defects. Nasal reconstruction, oroantral communication closure, labial competence correction and dental prosthetic rehabilitation are not commonly corrected by a unique surgical intervention or by a unique prosthetic rehabilitation. The prosthetic rehabilitation here presented allows to achieve all the above-mentioned goals by means of a single prosthesis.

Intraoral implants offer good anchorage for palatal obturator prosthesis, and extraoral implants’ use to support facial epithesis is well documented. Dawood describes a new implant design to support nasal epithesis and upper jaw prosthesis, but he reports just a single patient treatment [12]. Bowden reports zygoma implant placement horizontally below orbital floors and nasal prosthesis anchorage, but we managed with combined midfacial and palatal defects [2].

Prosthetic aftercare usually requires patient’s instruction about bar and implants’ daily hygienic procedures and silicone nasal epithesis cleaning [13, 14]. Despite careful home care, silicone facial prosthesis lifespan is 1.5/2 years on average because of discoloration, clip detachment from acrylic to silicone or acrylic carrier detachment to silicone, bad fit or silicone laceration [13, 14]. Unfavourable events for intraoral prosthesis are screw loosening and bar dislocation or screw fracture, obturator misfitting due to soft tissue remodelling, implant failure and prosthetic teeth fracture or excessive abrasion due to occlusal loss of balance [14].