Reconstruction of a palatomaxillary defect with vascularized iliac bone combined with a superficial inferior epigastric artery flap and zygomatic implants as anchorage

Here is described a modified technique of palatomaxillary reconstruction that combines the use of a free vascularized bone graft by osteotomy, soft-tissue flap, zygomatic implant as an anchorage and two standard implants simultaneously. The patient presented with deformity in the left face after subtotal maxillectomy (Brown 2b classification). Preoperative work up was performed by a rapid prototyping model using computer-aided manufacturing technology. The purpose of this model is to provide accurate measurements of the defect. The palatomaxillary three-dimensional buttress system can be managed by orienting the bone graft vertically and horizontally. Reconstruction of the palatomaxillary defect was successfully accomplished in a single surgical procedure. Dental implant restoration achieved good osseointegration without any significant resorption. This new modification represents a significant contribution to palatomaxillary reconstruction using zygomatic implants as anchorage.