The difficulty of restoration with a maxillary obturator prosthesis depends on the extent of the surgical resection, with the acceptance that resections with an increasing horizontal component provide a much greater prosthodontic challenge. The number of remaining teeth is a key component in conventional obturator design [9] with the remaining dentition being used exclusively to retain the prosthesis by means of clasps which are often in the visual field and affect the resulting aesthetic outcome for the patient as well as placing significant forces onto them. In conventional maxillary defect preparation, the additional use of a split skin graft into the lateral aspect of the cheek is used to provide a scar band to aid with defect retention, and this brings added morbidity to the procedure especially for a paediatric patient. In conventional hemi-maxillectomy cases, gaining some form of retention from the defect is essential in providing the patient with confidence in the use of the prosthesis, and the discomfort associated with this can make paediatric patients anxious about placing and removing the obturator themselves. The advantages of providing “in-defect” support and retention by means of zygomatic implant placement addresses all of these potential difficulties and allows the construction of a simple highly polished acrylic prosthesis that does not require clasping of the teeth in the aesthetic zone, requires very little extension into the defect to affect a peripheral seal and most of all provides good support when the patient masticates on the defect side. No additional skin grafting is required, and the placement and retrieval of the prosthesis is comfortable and atraumatic. Maintenance of the prosthesis is simple with modifications to the peripheral seal as required at the chair side and replacement of the bar attachments from time to time.

In a paediatric patient, the development and subsequent growth of facial skeleton is an added concern, although by age 13/14, the major mid-face growth will be largely completed [10]. Certainly in this case, the bone volume of the zygomatic body was more than adequate for the placement of the implants. In terms of ongoing facial growth, Min Kim et al. report a case where an 11-year-old male underwent a hemi-maxillectomy and a modified functional obturator (MFO) prosthesis was successfully used to obturate the defect and restore aesthetics and function. After 18 months of wearing the MFO, the result was stable, and at 3 years post-operatively, the patient’s facial profile was reported as near normal. In the case reported here, it was felt that due to the removable nature of the obturator prosthesis, the implant technique employed would allow for the construction of a new maxillary obturator in the event of any significant continued mid-facial/maxillary growth, which so far has not been required.