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Oncologic Maxillary Reconstruction Outcomes: 22-year Experience Of 432 Cases
Z-Hye Lee, MD1, Kala Pham, BS
2, Christine Vu, PA
1, Rami Elmorsi, MD
1, John W. Shuck, MD
1, Edward I. Chang, MD
1, Patrick B. Garvey, MD
1, Peirong Yu, MD
1, Rene D. Largo, MD
1, Matthew M. Hanasono, MD
1.
1The University of Texas MD Anderson Cancer Center, Houston, TX, USA,
2Baylor College of Medicine, Houston, TX, USA.
PURPOSE:Oncologic defects resulting from maxillectomy present a formidable reconstructive challenge. We present our 22-year institutional experience including indications and outcomes.
METHODS:A review of 432 free flap reconstructions for oncologic maxillary defects performed at MD Anderson between January 2001 and April 2023 was performed.
RESULTS:The average age 59.0 years. 59.7% of patients received adjuvant radiation therapy and 32.2% received postoperative chemotherapy. Defects were classified as follows: superstructure maxillectomy (22%), posterior palatomaxillectomy (18%), hemi-palatomaxillectomy, (43%), bilateral palatomaxillectomy (8.8%) and anterior maxillectomy (8.3%). Bony free flaps were predominantly used for type bilateral palatomaxillectomy and anterior maxillectomy defects while soft tissue flaps were used for superstructure and posterior palatomaxillectomy defects (p<0.001). Hemi-maxillectomy defects reconstructed with bone flaps had higher rates of ultimate dental restoration than soft tissue flap (p=0.002). Postoperative complications included partial flap loss (0.7%), total flap loss (2.5%) and surgical site occurrences (15.3%). Most common late complications were fistula formation (15.9%) and ectropion (10.0%). Greater than 80 percent speech intelligibility was achieved by 83.6% of patients and 86.6% of patients tolerated an unrestricted or soft diet.
CONCLUSION:
Free flap reconstruction of the maxilla is safe and reliable. Bony reconstruction is critical for maximizing defects involving the anterior maxilla while soft tissue reconstruction is sufficient for superstructure maxillectomies and posterior defects. Dental rehabilitation outcomes are superior in bony reconstructions for hemi-palatomaxillectomy defects.
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