Purpose The maxillectomy defect is complex and the best means to achieve optimal reconstruction, and dental rehabilitation is a source of debate. The refinements in zygomatic implant techniques have altered the means and speed by which rehabilitation can be achieved and has also influenced the choice regarding ideal flap reconstruction. The aim of this study is to report on how the method of reconstruction and oral rehabilitation of the maxilla has changed since 1994 in our Institution, and to reflect on case mix and survival. Methods Consecutive head and neck oncology cases involving maxillary resections over a 27-year period between January 1994 and November 2020 were identified from hospital records and previous studies. Case note review focussed on clinical characteristics, reconstruction, prosthetic rehabilitation, and survival. Results There were 186 patients and the tumour sites were: alveolus for 56% (104), hard palate for 19% (35), maxillary sinus for 18% (34) and nasal for 7% (13). 52% (97) were Brown class 2 defects. Forty-five patients were managed by obturation and 78% (142/183) had free tissue transfer. The main flaps used were radial (52), anterolateral thigh (27), DCIA (22), scapula (13) and fibula (11). There were significant changes over time regarding reconstruction type, use of primary implants, type of dental restoration, and length of hospital stay. Overall survival after 24 months was 64% (SE 4%) and after 60 months was 42% (SE 4%). Conclusion These data reflect a shift in the reconstruction of the maxillary defect afforded by the utilisation of zygomatic implants.

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We report a case of papillary renal cell carcinoma in a 19-year-old patient that manifested as ipsilateral numbness of the lower lip and swelling in the region of masseter insertion. Despite there being widespread metastatic disease at presentation, the diagnosis was delayed with false reassurance from a normal brain scan and the assumption that the symptoms were due to infection related to the lower wisdom tooth. Once the primary tumour site was established, the patient responded to the relatively new immunotherapy treatments for advanced renal cell carcinoma as advocated in the 2019 NICE guidance. There are no other documented case reports that discuss papillary renal carcinoma with metastatic spread to the mandible in teenagers. CPD/Clinical Relevance: This case highlights the importance of malignancy being a differential diagnosis of lip paraesthesia irrespective of age.

Cost-includes all materials needed, a dental model and an icon resin kit.

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