English

Abstract

Maxilla can be considered a hexahedrium with close relationship to surrounding critical anatomic structures, and thereby invariably involved in the resection process of tumours that arise from maxillary sinus, palate, nasal cavity, orbital contents, or intro-oral mucosa.1 Maxillary defects created after tumour ablation can cause severe functional and aesthetic deficits. Orbital floor defects with displacement of the eyeball results in deformities with possible consequences of enophthalmos, diplopia and impaired visual acuity. The eyeball can become displaced either due to alteration in the position of the orbital walls caused by trauma, or due to loss of support of the orbital floor during resection of a lesion. The role of the suspensory ligament of Lockwood in maintaining the superio - inferior position of the visual apparatus is recognized. The preservation of this ligament, which acts like a hammock holding the eyeball in position, prevents any drastic downward displacement except for the small limit which the slack of the ligament allows. Surgical reconstruction of orbital floor defects is the primary treatment modality, but remains nonetheless a challenge for surgeons. Currently various types of materials such as titanium meshes, hydroxyapatite, silica gel, Teflon, Medpor and autogenous bones are used for orbital reconstruction.2,3 Prosthetic rehabilitation of maxillary surgical defects is so predictable and effective that reconstructive surgery is not indicated in most instances.4,5 Prosthetic management of defects with orbital floor resection is usually obturators with extensions to support the visual apparatus.6 In clinical situations involving the resection of the orbital floor and maxillary sinus, without the sacrifice of the floor of maxilla, no oro-antral communication is created. This eliminates the need for an obturator prosthesis. In this scenario the support for the visual apparatus will be solely dependent on surgical reconstruction. However, when dealing with invasive and progressive diseases of fungal and bacterial origin, immediate surgical reconstruction is not generally recommended till complete resolution of the disease is achieved. The potential for recurrence of tumours varies from 10 - 30 % with benign tumours and over 50 % with malignant tumours. This creates a need for long term follow up, to assess the resection margins for signs of recurrence.4