A 56-year-old male with a history of smoking (20 cigarettes/ day) due to an ulcerative lesion located in the posterior region of the upper jaw presented with a well-differentiated epidermoid carcinoma biopsy.
Preoperative study was normal and surgery was scheduled.
Under general anesthesia, a consistent procedure is performed to perform ipsilateral functional cervical lesion with posterior maxillectomy including the resection piece 2.5, 2.6 and 2.7.
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Soft tissue reconstruction was performed with Bichat's fat ball flap. An osteotomy of the alveolar process was planned distally to the 2.2 tooth, including in the segment the 2.3 and 2.4 pieces of the palatal fragment to ensure success.
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A modular distractor MODUS® (Medartis AG, Basel, Switzerland) and a 15 mm rod in open position to perform the transport by closing the distractor are placed.
To maintain the distraction vector, an intermaxillary block screw and an orthodontic elastic of 4 1/2 ounces were placed, which prevented the tendency of the maxillary distraction in the anterior sectors of the vector.
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Pathological anatomy: epidermoid carcinoma of well differentiated diameter of 3 cm maximum.
Osteonecrosis is not observed.
Tumor-free margins.
1/24 isolated adenopathies with metastases of squamous cell carcinoma of one centimeter in diameter, without breakage.
The patient did not receive radiotherapy.
The postoperative course is uneventful and after a latency period of five days, the fragment is distracted at a rate of 0.75 mm a day (three cycles of 0.25 mm) for 20 days until reaching the expected increase of 15 mm.
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After a 10-week consolidation phase, two implants of 4.1 X 12 mm premolar esthetic plus ITI® system (Strauman AG, Waldenburg, Syncel® pulpar prosthesis 2.3 mm continue in Switzerland piece vital root canal 2.4 weeks later).
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Subsequently, a connective tissue graft was obtained from the region of the right maxillary tuberosity for aesthetic improvement, since the implant neck in mesial position was visible after restoration while the distractor device was removed.
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The result is stable both in the mucosa and bone, with implants and those placed in native bone with bone loss less than 0.1 mm at 12 months.
