The prosthodontic management of the maxillectomy patient

Ablative defects of the maxilla caused by malignant tumours create a multitude of difficulties for patients and the clinical teams looking after them. Tumours of the maxilla, while relatively uncommon, require significant multi-disciplinary involvement due to their effects on the aesthetic, functional and psychological aspects of the patients involved. Patients with these tumours have worse survival than other head and neck sites, with a propensity to local and regional recurrence. As a result, prosthetic rehabilitation of this patient cohort must be timely to restore form and function before patients become adapted to their pathologically adapted state. This article will discuss classification of maxillary defects and surgical decision-making in this complex area, together with the role of the maxillofacial prosthodontist/restorative dentist in providing effective pre, peri and postoperative intervention and support to the surgical team and to the patient. While prosthetic obturation has been used historically to manage maxillectomy patients, the use of composite microvascular free flap reconstruction, with or without dental implants, is often required for high-level defects. More recently, the use of the zygomatic implant perforated flap reconstructive procedure for rapid prosthodontic rehabilitation and palatal reconstruction has been described and validated.