Management of the oral defect after maxillectomy for malignant disease
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Abstract1. Purpose of the study: A review the management of the oral defect after maxillectomy was undertaken to improve patient care and outcome as the reconstructive armamentarium evolves. 2. Materials and Methods Used: The records of patients who underwent a maxillectomy at a single institution between January 2005 and December 2106 were reviewed. Demographic data as well as the method of managing the oral defect was retrieved. 3. Results: Twenty seven males and 17 females with a mean age of 63.8 years (range 23 – 88 years) underwent either a subtotal (sparing the orbit floor) (n=36), total (n=4) or partial (n=1) maxillectomy. A bilateral maxillectomy and an orbital exenteration was necessary in one patient each. Access was via a Weber-Ferguson incision with (n=15) or without (n=18) a lower eyelid incision, a lip split (n=3), the transoral route (n=2), and mandibulectomy incision (n=1). Frozen section was negative in 37 patients and positive in four. Final histology included squamous cell carcinoma (n=27), sarcoma (n=4), mucoepidermoid carcinoma (n=4), ameloblastoma (n=2), and one case each of adenoid cystic carcinoma, adenocarcinoma, melanoma, myoepithelial carcinoma, sinonasal carcinoma, verrucous carcinoma and a pyogenic granuloma. The lesion was right sided in 23 patients, left sided in 19 and bilateral in two. The resulting defect was managed with a free anterolateral thigh flap in 23 patients, a split skin graft and obturator in 13, a radial forearm free flap in three, the buccal fat pad in two, a fibula free flap in two and a double free flap, both a fibula and anterolateral thigh flap, in one patient. At the time of analysis (January 2017) 20 patients were alive. 4. Conclusion:
Encouraging is the high rate of negative margins on frozen section which reflects its utility in reflecting the surgical plan and procedure, extensively aided by preoperative imaging. Management of the oral defect continues to evolve away from split skin and an obturator that was one of the main forms of management early in the series, to the almost universal use of the reliable anterolateral thigh free flap, which restores it’s anatomy, physiology and function far better than can be achieved with artificial material and which has set our standard for current patients.
All Author(s) ListAlexander C Vlantis, Eddy WY Wong, Jason YK Chan, Tor Wo Chiu, Kevin WL Mo.
Name of ConferenceIFOS ENT World Congress 2017
Start Date of Conference24/06/2017
End Date of Conference28/06/2017
Place of ConferenceParis
Country/Region of ConferenceFrance
Year2017
Month6
LanguagesEnglish-United Kingdom

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