Current Concepts in Maxillary Reconstruction

Abstract

The concepts in maxillary reconstruction are still evolving when compared to the reconstruction of the mandible. Maxillary defects affect the functions of the speech, swallowing, and mastication and also cause cosmetic disfigurement. Rehabilitation of the maxillary defects is either possible by using an obturator prosthesis or by a surgical reconstruction. A variety of reconstructive methods are available. The classification systems are also many, none universally accepted. The oncologic safety of these procedures is still debated and conclusive evidence in this regard has not emerged yet. Management of the defects of the orbit associated with maxillectomy is an area yet to be solved. Tissue engineering, though thought to be one of the possible solutions for this reconstructive problem, has not come out with reliable and reproducible results yet. This chapter discusses the rationale and oncological safety of reconstructing the maxillary defects, critically analyzes the classification systems, and discusses the different reconstructive methods and controversies in this scenario. The management of the retained and exenterated orbit associated with maxillectomy is reviewed. The surgical morbidity, complications, and the recent advances in this field are also looked into. An algorithm, based on our experience, is presented.