1. RECONSTRUCTION POST
ONCOLOGIC MAXILLECTOMY
Ricardo Yáñez MD, Francisco J. Loyola MD,
Diego Alcocer DDS and Jorge Cornejo M.D
Dr. Sotero del Río Hospital
Chile
IPRAS 2013

2. Background
• The midfacial defects reconstructions for
oncologic resections are a surgical
challenge
Mc Carthy C, Cordeiro P et al. Plast. Reconstr. Surg. 2010; 126:1947-59
IPRAS 2013

3. Background
• The maxillar provide the structural
support between skull base and maxillary
arches.
• To separate oral and nasal cavities.
• To participate in swallowing, phonation,
mastication, vision and aesthetic
appearance.
IPRAS 2013

4. Background
• Generally we need to realize the
maxillectomy associated with soft tissue
resection.
• This results in different functional
impairments
• The maxillary reconstruction going from
obturator prosthesis, local flaps to free
flaps. Algorithm and Outcomes: 15-year Review of Midface Reconstruction. Plast. Reconstr. Surg. 2011. In
press
IPRAS 2013

5. Aim
• To present the different
reconstructives alternatives used after
a maxillectomy for oncologic disease
in our hospital.
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6. Maxillectomy classification
Type I
Type II
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7. Maxillectomy classification
Type III A
Type IIIB
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8. Maxillectomy classification
Type IV
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9. Method
• Retrospective analysis of all patients
that was submitted to a maxillectomy
for oncologic disease between 2008
and 2011 in our center
• Medical record review.
• Clinical control
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10. Method
• Complications
• Perioperative < 30 days after
surgery
• Late > 30 days after surgery
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11. ResultsPatients
characteristics
n=12
Age
(median and
range)
57 years range 25 - 84 years
Gender
female : male
8:4
Smoking 8 75%
Alcoholism 5 41.6%
Consultation
reason
Bulking/pain
Dental derivation
5
7 41.6%
58.4%
TNM
Stage IV
12 100%
Characteristics of the patients with a maxillectomy for oncologic disease
IPRAS 2013

12. Results
Pathologic
diagnosis
n %
Squamous cell 6 50%
Melanoma 2 16.7%
Sarcoma 2 16.7%
Adenoid cystic
carcinoma
1 8.3%
Basal - cell
carcinoma
1 8.3%
Porcentual distribution by pathologic diagnosis
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13. Results
Maxillectomy Total
Obturator
prosthesis
Temporalis
muscle flap*
Radial
forearm
flap**
Latissimus
dorsi flap**
I 3 3 - - -
IIA 2 1 - 1 -
IIB 2 - - 2 -
IIIA 4 - 3 - 1
IIIB 1 - - - 1
IV - - - - -
Total 12 4 3 3 2
* Local Flap / **Free flap
Distribution by Maxillectomy and realized reconstruction
IPRAS 2013

14. Maxillar, nasal and palate cancer – Maxillectomy IIA – Obturator prosthesis

15. Maxillar, nasal and palate cancer – Maxillectomy IIA – Obturator prosthesis

16. Palate cancer– Maxillectomy IIB – Radial flap

17. Left Maxillary sinus cancer – Maxillectomy IIB – Radial flap

18. Maxillary sinus cancer– Maxyllectomy IIIA – Latissimus dorsi flap

19. Maxillary sinus cancer – Maxillectomy IIIA – Latissimus dorsi flap

20. Adenid Cystic Cancer of Maxillary sinus - Maxillectomy IIIA - Temporalis flap

21. Adenid Cystic Cancer of Maxillary sinus - Maxillectomy IIIA - Temporalis flap

22. Maxillary cancer - Maxillectomy IIIA - Temporalis flap

23. Basal Cell skin cancer/maxillary compromise - Maxillectomy IIIB - Latissimus dorsi

24. Results
• In all patients we achieve a
satisfactory functional outcome
• Complications
• Aspirative pneumonia in two
patients.
• Partial necrosis of latissimus dorsi
flap
• venous thrombosis
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25. Discussion
• Is recommended to adjust the
reconstructive choice to
• Maxillectomy realized
• Age
• TNM
• Comorbidities
• Functional outcomes
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26. Discussion
• The obturator prosthesis can be
reserve for selected patients with
limited palatal defects.
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27. Discussion
• The unilateral or bilateral temporalis
muscle flap is recommended and
presents adequate functional outcome
in patients with advanced disease and
poor prognosis.
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28. Discussion
• The microsurgical reconstruction is the
surgical alternative of choice, with the
best funcional and aesthetics outcomes in
patients with type II - III - IV
maxillectomies
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29. RECONSTRUCTION POST
ONCOLOGIC MAXILLECTOMY
Ricardo Yáñez MD, Francisco J. Loyola MD,
Diego Alcocer DDS and Jorge Cornejo M.D
Dr. Sotero del Río Hospital
Chile
IPRAS 2013