Maxillectomy and its ophthalmic implications: A comprehensive analysis over 20 years

Abstract

PurposeMaxillectomy, a critical surgical intervention for head and neck malignancies, often leads to a comprehensive spectrum of ophthalmic complications due to its impact on orbital structures. This study, conducted over 20 years at a single university hospital, aims to evaluate the extent and severity of these complications, encompassing the entire range of ophthalmological issues encountered in the field. DesignA retrospective, observational cohort study. MethodsAmong the 163 patients who underwent maxillectomy at a single university hospital between January 2003 and December 2022, we analyzed the medical records of 101 patients with over one year of postoperative ophthalmological follow-up. Data on demographics, clinical parameters, surgical details, and ophthalmic complications were collected. Complications were categorized into six groups, with statistical analysis identifying factors influencing these outcomes. ResultsOur findings reveal a predominant occurrence of ophthalmic complications among maxillectomy patients. Only 4.4 % had no complications, while 95.6 % experienced at least one, especially with cornea/conjunctiva (56 %), eyelid (48.4 %), and lacrimal system issues (38.5 %) being the most frequent. Notably, 64.8 % had complications in two or more categories, and 33 % in three or more. Multivariate analysis identified that orbital floor resection was a significant risk factor for complications involving the eyelid and the cornea/conjunctiva (P = 0.008 and P = 0.021, respectively), while radiotherapy specifically emerged as a significant risk factor for cornea/conjunctiva complications (P = 0.009). Surgical management of complications following maxillectomy often involved major tissue transplantation in plastic surgery, particularly for cases of significant tissue contraction or severe orbital dystopia. Common secondary ophthalmic surgeries included dacryocystorhinostomy (DCR) in 14 eyes, tarsorrhaphy in 12 eyes, and lateral tarsal strip procedures in 5 eyes. The study found a high incidence of multiple complications, highlighting the complex nature of postoperative challenges. ConclusionMaxillectomy patients are highly susceptible to a range of ophthalmological complications, primarily influenced by surgical extent and adjuvant therapies. A multidisciplinary approach is essential for comprehensive management and improved quality of life in these patients. The study underscores the need for thorough ophthalmological evaluation and integrated care in treating maxillectomy-related complications.