Zygomatic Implants in Oncology Patients



Zygomatic and modified zygomatic implants emerge as a key adjunct in the management of patients presenting with maxillary and mid-facial benign and malignant diseases requiring radical resection to effect cure. Their popularity has gained momentum, especially over the past 10 years and the evidence for their successful use continues to evolve and be presented by clinicians in high-volume cancer centres. The zygomatic implant was conceived initially by Professor Branemark to support treatment of the maxillectomy patient by means of remote anchorage that was available in the highly cortical zygomatic bone with a design incorporating angle correction and extension into the oral cavity in order to provide much-needed support and retention for a prosthesis. This concept was taken up slowly around the world, but now is becoming an area of significant interest among multi-disciplinary teams who grapple with these challenging cases. This chapter covers the application and evolution of the zygomatic implant and its associated techniques, both alone and in conjunction with microvascular free tissue transfer in the prosthetic and prosthodontic management of the oncology patient. It discusses the evidence behind the treatments presented, the relevance of modified implant designs and illustrates the cutting-edge new techniques such as the Zygomatic Implant Perforated (ZIP) Flap technique that combines soft tissue reconstruction of the maxillary defect and full fixed dental reconstruction within weeks of surgery, irrespective of the need for adjuvant radiotherapy.


Zygomatic implant Maxillectomy ZIP flap Maxillofacial prosthesis 


  1. 1.
    Brown JS, Bekiroglu F, Shaw RJ, Woolgar JA, Rogers SN. Management of the neck and regional recurrence in squamous cell carcinoma of the maxillary alveolus and hard palate compared with other sites in the oral cavity. Head Neck. 2013;35(2):265–9.CrossRefGoogle Scholar
  2. 2.
    Moreno MA, Skoracki RJ, Hanna EY, Hanasono MM. Microvascular free flap reconstruction versus palatal obturation for maxillectomy defects. Head Neck. 2010;32(7):860–8.PubMedGoogle Scholar
  3. 3.
    Barber AJ, Butterworth CJ, Rogers SN. Systematic review of primary osseointegrated dental implants in head and neck oncology. Br J Oral Maxillofac Surg. 2011;49(1):29–36.CrossRefGoogle Scholar
  4. 4.
    Boyes-Varley JG, Howes DG, Davidge-Pitts KD, Brånemark I, McAlpine JA. A protocol for maxillary reconstruction following oncology resection using zygomatic implants. Int J Prosthodont. 2007;20(5):521–31.PubMedGoogle Scholar
  5. 5.
    Chuka R, Abdullah W, Rieger J, Nayar S, Seikaly H, Osswald M, et al. Implant utilization and time to prosthetic rehabilitation in conventional and advanced fibular free flap reconstruction of the maxilla and mandible. Int J Prosthodont. 2017;30(3):289–94.CrossRefGoogle Scholar
  6. 6.
    Butterworth CJ, Rogers SN. The zygomatic implant perforated (ZIP) flap: a new technique for combined surgical reconstruction and rapid fixed dental rehabilitation following low-level maxillectomy. Int J Implant Dent. 2017;3(1):37.CrossRefGoogle Scholar
  7. 7.
    Dholam KP, Chouksey GC, Dugad J. Oral health-related quality of life after prosthetic rehabilitation in patients with oral cancer: a longitudinal study with the Liverpool Oral Rehabilitation Questionnaire version 3 and Oral Health Impact Profile-14 questionnaire. Indian J Cancer. 2016;53(2):256–60.CrossRefGoogle Scholar
  8. 8.
    Brown JS, Shaw RJ. Reconstruction of the maxilla and midface: introducing a new classification. Lancet Oncol. 2010;11(10):1001–8.CrossRefGoogle Scholar
  9. 9.
    Bowden JR, Flood TR, Downie IP. Zygomaticus implants for retention of nasal prostheses after rhinectomy. Br J Oral Maxillofac Surg. 2006;44(1):54–6.CrossRefGoogle Scholar
  10. 10.
    Scott N, Kittur MA, Evans PL, Dovgalski L, Hodder SC. The use of zygomatic implants for the retention of nasal prosthesis following rhinectomy: the Morriston experience. Int J Oral Maxillofac Surg. 2016;45(8):1044–8.CrossRefGoogle Scholar
  11. 11.
    Parel SM, Brånemark PI, Ohrnell LO, Svensson B. Remote implant anchorage for the rehabilitation of maxillary defects. J Prosthet Dent. 2001;86(4):377–81.CrossRefGoogle Scholar
  12. 12.
    Schmidt BL, Pogrel MA, Young CW, Sharma A. Reconstruction of extensive maxillary defects using zygomaticus implants. J Oral Maxillofac Surg. 2004;62(9 Suppl 2):82–9.CrossRefGoogle Scholar
  13. 13.
    Zwahlen RA, Gratz KW, Oechslin CK, Studer SP. Survival rate of zygomatic implants in atrophic or partially resected maxillae prior to functional loading: a retrospective clinical report. Int J Oral Maxillofac Implants. 2006;21(3):413–20.PubMedGoogle Scholar
  14. 14.
    Landes CA, Paffrath C, Koehler C, Thai VD, Stübinger S, Sader R, et al. Zygoma implants for midfacial prosthetic rehabilitation using telescopes: 9-year follow-up. Int J Prosthodont. 2009;22(1):20–32.PubMedGoogle Scholar
  15. 15.
    Huang W, Wu Y, Zou D, Zhang Z, Zhang C, Sun J, et al. Long-term results for maxillary rehabilitation with dental implants after tumor resection. Clin Implant Dent Relat Res. 2014;16(2):282–91.CrossRefGoogle Scholar
  16. 16.
    Pellegrino G, Tarsitano A, Basile F, Pizzigallo A, Marchetti C. Computer-aided rehabilitation of maxillary oncological defects using zygomatic implants: a defect-based classification. J Oral Maxillofac Surg. 2015;73(12):2446.e1–e11.CrossRefGoogle Scholar
  17. 17.
    Butterworth C. Primary vs secondary zygomatic implant placement in patients with head and neck cancer-A 10-year prospective study. Head Neck. 2019;41(6):1687–95.Google Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Liverpool Head & Neck CentreUniversity of LiverpoolLiverpoolUK

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