Abstract
PurposeThe 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.MethodsConsecutive 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.ResultsThere 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%).ConclusionThese data reflect a shift in the reconstruction of the maxillary defect afforded by the utilisation of zygomatic implants.
Highlights
Oncological resection of the maxilla results in a complex defect which can be a challenge to optimally reconstruct and provide dental rehabilitation and function in the context of personalised treatment planning and outcomes
Forty-five patients were managed by obturation and 78% (142/183) had free tissue transfer
Overall survival after 24 months was 64% (SE 4%) and after 60 months was 42% (SE 4%). These data reflect a shift in the reconstruction of the maxillary defect afforded by the utilisation of zygomatic implants
Summary
Oncological resection of the maxilla results in a complex defect which can be a challenge to optimally reconstruct and provide dental rehabilitation and function in the context of personalised treatment planning and outcomes. The reconstruction of the defect might be influenced to a degree, by the relatively poor survival prognosis in those having maxillary resection compared to other head and neck cancer sites, notably oral cavity [16, 17]. This leads to a concept of radical palliative surgery with curative intent, such that for those where cure is not possible there should ideally be a time of comparatively satisfactory function and quality of life associated with minimal treatment burden and necessity for further hospital procedures. Many patients do not complete full oral rehabilitation and cope and adapt to their outcome [19]
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