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Review
. 2011 Aug;137(8):806-12.
doi: 10.1001/archoto.2011.132.

Current strategies in reconstruction of maxillectomy defects

Patricio Andrades  1 , Oleg Militsakh, Matthew M Hanasono, Jana Rieger, Eben L Rosenthal
Affiliations
Review

Current strategies in reconstruction of maxillectomy defects

Patricio Andrades et al. Arch Otolaryngol Head Neck Surg. 2011 Aug.

Abstract

Objective: To outline a contemporary review of defect classification and reconstructive options.

Design: Review article.

Setting: Tertiary care referral centers.

Results: Although prosthetic rehabilitation remains the standard of care in many institutions, the discomfort of wearing, removing, and cleaning a prosthesis; the inability to retain a prosthesis in large defects; and the frequent need for readjustments often limit the value of this cost-effective and successful method of restoring speech and mastication. However, flap reconstruction offers an option for many, although there is no agreement as to which techniques should be used for optimal reconstruction. Flap reconstruction also involves a longer recovery time with increased risk of surgical complications, has higher costs associated with the procedure, and requires access to a highly experienced surgeon.

Conclusion: The surgeon and reconstructive team must make individualized decisions based on the extent of the maxillectomy defect (eg, the resection of the infraorbital rim, the extent of palate excision, skin compromise) and the need for radiation therapy.

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Figures

Figure 1
Figure 1
Scores obtained in a study that included 23 patients who underwent obturation and 16 who underwent maxillary reconstruction. Normal values for nasalance ranged from 11.9% to 13.7% (average standard deviation, 4.8%); normal values for word and sentence intelligibility were higher than 90%.
Figure 2
Figure 2
Temporalis musculofascial rotational flap. The flap is isolated after detachment from the temporal line superiorly (A), passed under the zygomatic arch (B), and into the oral cavity, where it eventually mucosalizes (C).
Figure 3
Figure 3
Photographs of a patient. A, A woman with a massive maxillary ameloblastoma. B, The resection includes a total left maxillectomy, including the orbital floor, and a partial right maxillectomy, sparing the right orbital floor and region of the malar eminence. C, A fibula osteocutaneous free flap was used to reconstruct this bilateral maxillectomy defect, along with a bone graft secured by titanium mesh, which was used to reconstruct the left orbital floor. D, Postoperative appearance, 1 year later.
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