上顎切除後の血管柄付き腓骨皮弁に骨移植を追加してガイデッドサージェリーにてインプラント治療を行った1例

抄録

A 60-year-old male patient presented with a chief complaint of difficulty in chewing. The patient had been diagnosed as intranasal chondrosarcoma and underwent maxillectomy. The defect had been simultaneously reconstructed by re-vascularized fibular flap in another hospital 5 years earlier. There had been no recurrence of the problem since the last oncologic surgery. The initial panoramic radiograph revealed the absence of nasomaxillary buttress, bone resorption around the fibula, and native bone stumps associated with the periodontal involvement of the adjacent teeth. A maxillary complete denture was fabricated following the extraction of hopeless teeth. However, the patient decided to pursue implant treatment because of denture instability. Although additional reconstructive surgery was considered for development of the implant site, bone grafting in localized defects was chosen to eliminate the risk of injury to the anastomosed vessels. Platform-switched implants were selected because implants placed in sites reconstructed with fibular flaps are more susceptible to peri-implantitis. Guided implant surgery was performed to place five implants in the maxilla, with minimal mucoperiosteal flap elevation for three anterior implants and extensive periosteal elevation for two posterior implants to augment the implant sites and areas of bone loss with autogenous bone harvested from the mandibular ramus. A provisional restoration was performed 6 months after the implant surgery, followed by a period of observation. The final restoration was performed 14 months postoperatively. The patient has been followed up every 3 months for 4 years and 4 months. His postoperative course remains uneventful, with no bone fracture or resorption at the grafted sites and no signs of peri-implantitis.