Trans-Nasal, Zygomatic, Pterygoid case on a severely atrophic maxilla in a long term denture wearer

clinical case
Performed by Dr. Simon Oh DDS, FICOI
This 60-year-old female presented with a chief complaint of not being able to tolerate her denture anymore.  She has been wearing a complete removable denture for 20 years.  Upon examination, severe atrophy of the maxilla was noted. Quad zygomatic versus Trans-nasal and zygomatic configurations were discussed with the patient.
During surgery, the patient was intubated.  Local anesthesia was administered of the entire maxilla, from here a crestal incision was made, full-thickness flaps were reflected including nasal mucosa from the nasal fossa.  From here, 4.2x25mm Noris Tuff implants were placed into the bone supporting the inferior turbinates bilaterally and extending down through the knife-edge alveolus into the lateral incisor position. Once these were secured, Augma (hydroxyapatite and biphasic calcium sulfate) was used to coat the exposed implant in the nasal fossa, hopefully, to regain periosteal attachment of nasal mucosa. From here, 45mm zygomatic implants were placed in an inferior position of the zygoma, along with 20mm Pteryfit implants into the pyramidal process of the palatine bone.  Composite torque exceeded 500 NCM.  Multiunit abutments were attached, buccal fat was dragged over the zygomatic implants, and the flap was closed via 3-0 chromic gut sutures.  From here the patient was immediately loaded with a temp prosthesis.
Postoperatively this patient has no paresthesia or signs of epiphora.

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