Oncologic maxillary reconstruction: when, what, and how

Abstract

Background: Maxillary defects caused by oncologic treatment can lead to significant facial deformity and functional impairment. Although different techniques have been used in the maxillary reconstruction, there is no consensus on when, what and how to repair the maxillary defects. Objective: The objective of the present study was to compare different reconstructive techniques currently used for the oncologic maxillary defects. Methods: We retrospectively reviewed our experiences of maxillary reconstruction after tumour ablation. The indications and clinical outcomes of different reconstructive techniques were compared. Findings: In our case series, the pathology of maxillary tumours included squamous cell carcinoma, adenoid cystic carcinoma, ameloblastic carcinoma, malignant fibrous histiocytoma, myoepithelial carcinoma, ameloblastoma, cementifying fibroma, and odontogenic fibroma. The most commonly used methods for the reconstruction of maxillary defects were obturator prostheses, soft-tissue flaps, and bony flaps. Obturator prostheses were used for small or medium defects, especially in medically compromised patients. Soft tissue flaps were indicated in posterior infrastructure maxillectomy with palatal or buccal soft tissue defects. Bony flap could be used for the majority of the maxillary defects to restore the form and function of maxilla. For bony flap reconstruction, computer aided surgery planning and three-dimensional printed surgical templates can facilitate the operation process, reduce the surgical time, and increase the reconstruction accuracy. Conclusion: Maxillary reconstruction after tumour resection is still a challenging issue. There is no unique and omnipotent method. Personalised reconstructive planning is the key to achieve satisfactory aesthetic and functional outcome.