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]
In contrast, the use of a soft tissue flap such as the RFFF or antero-lateral thigh flap can often be safely employed in elderly patients with peripheral vascular disease without unduly lengthening the operation too significantly with two-team operating. In addition, the predictability of these flaps with their excellent pedicle lengths is ideal for closure of the resulting oro-nasal surgical defect. The use of a slightly oversized graft is recommended to ensure that any tension on the wound peripheries is kept to a minimum during the healing phase. In addition, for those patients undergoing post-operative radiotherapy, a degree of shrinkage and tightening of the flap tissues is to be expected.
Immediate/early loading of zygomatic [8] and dental implants [9] have been well demonstrated already within the literature with very high implant survival rates. In the oncology setting, Boyes-Varley et al. [4] lost no zygomatic/oncology implants in their series of 20 patients restored with implant-retained obturators, 6 of whom received radiotherapy post-operatively. The case reported has been followed up for 18 months so far without evidence of zygomatic implant failure despite the use of radiotherapy. A recent review of conventional zygomatic implant surgery demonstrated that the incidence of failure after the 6-month stage was extremely low [8] although for zygomatic oncology implants, this data is not yet fully reported in the literature with the only data available on zygomatic oncology implants being limited to the work of Boyes-Valey [4], Pellegrino [10] and the authors themselves [6]. The removal of teeth at primary cancer surgery to facilitate placement of implants on the non-defect side requires careful consideration; where teeth are of poor prognosis with poor bone support, it is easier to extract, perform localised osteoplasty prior to the insertion of a conventional zygomatic implant with its inherent excellent stability and ability to be loaded early in the post-operative period. Where teeth have excellent bone support but additional implants are required to facilitate the construction of a fixed prosthesis, then careful extraction of selected teeth with the immediate installation of a root form implant can be utilised with good success as long as high primary stability is achieved at these sites.
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
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- 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