TITLE: Rehabilitation of a Maxillectomy Patient Following Rhino-Mucormycosis using Patient-specific Implant

ABSTRACT BODY:

Introduction: In cases where surgical reconstruction of the defect is not possible, the prosthetic rehabilitation

should start immediately post-surgery to aid the patient in deglutition, speech as well as to support and elevate

the soft tissues to maintain continuity of the midfacial contour. However, in cases of extensive surgical defects,

the conventional rehabilitation techniques are limited. In such cases, the patient-specific implant prosthesis can

be planned; with its extent, length, and design customized according to the presenting defect situation.

Method: A 42-year-old patient presented after undergoing surgical debridement for SARS-CoV-2 associated

mucormycosis. The defect was classified as Aramany’s class I, encompassing the right palatine shelf, parts of

the hard and soft palate and extending to the right zygoma. The existing bone support was inadequate for the

placement of intra-osseous or zygomatic implants, and surgical repair of the defect was not feasible.

Therefore, the patient underwent rehabilitation using a titanium, patient-specific implant-supported (PSI)

prosthesis designed to restore speech and facial symmetry.

Results: The post-operative outcomes were positive, and the recovery was uneventful. Following one week,

the speech evaluation was satisfactory, and there was no nasal fluid leakage during swallowing with the

temporary prosthesis in situ. Two weeks post-surgery, the sutures were removed and oral examination

revealed no indications of inflammation or dehiscent bone surrounding the PSI framework. The final implant-

supported over-denture prosthesis was fabricated and delivered to the patient after three weeks. One-year

follow-up indicated that the soft tissues, prosthesis, and framework were in a good condition. The patient

indicated a notable improvement in his social life and restoration of his confidence as a major milestone.

Conclusion: The results suggest that a PSI-retained prosthesis is a viable alternative for restoring speech and

oral function in patients with largely compromised maxillary bone anatomy, alongside impaired aesthetics and

functionality, where conventional reconstruction methods are not viable. The easily removable patient specific

implant-supported obturator prosthesis is a major benefit, allowing for tissue examination and enabling patients

to independently maintain both the prosthesis and the peri-implant tissue.