Maxillectomy Procedures Research Articles

Incidence of secretory otitis media following maxillectomy

Objective. The purpose of this investigation was to determine the incidence and characteristics of secretory otitis media after maxillectomy procedures. Study design. Retrospective chart analysis was performed with the cases of 49 patients who underwent maxillectomy for tumor in the Departments of Otolaryngology-Head and Neck Surgery and Oral and Maxillofacial Surgery between the years 1990 and 1996. Results. In 10 patients (20%), secretory otitis media manifested itself from 1 week to 6 months after surgery; 1 patient developed a central perforation with chronic otitis media. Nearly one third of patients who underwent total maxillectomy had secretory otitis media. Six patients (8 ears) required insertion of ventilation tubes. Conclusions. Patients undergoing total and partial maxillectomies are prone to occurrences of secretory otitis media. Insertion of ventilation tubes easily resolves the problem. Preoperative and routine postoperative patient follow-up should always include otoscopy and audiometry, and tympanometry should be performed when warranted.

Maxillectomy and its classification.

Many adjectives are used to describe maxillectomy procedures, such as radical, total, extended, subtotal, medial, partial, and limited. The variety of nomenclature in our own Service database testifies that much confusion exists. We have reviewed a 10-year experience with 403 maxillectomies performed between 1984 and 1993. Based on our retrospective reassessment, the operations were grouped into one of three categories. The term "limited" (LM) was applied to any maxillectomy which primarily removed one wall of the antrum. Designated "subtotal" (SM) was any procedure which removed at least two walls, including the palate. We listed as "total" (TM) only those who had a complete resection of the maxilla. Hospital charts were selectively reviewed, and each of the three types of maxillectomy was analyzed to determine the histology and site of the index cancers and the incidence of complex reconstruction. We determined that the maxillectomy performed in 230 patients (57%) was a LM. Tumor site and extent defined five different approaches in this cohort: peroral, 73; medial maxillectomy, 53; anterior craniofacial, 43; upper cheek flap, 42; and transfacial, 19. Subtotal maxillectomy or TM was performed in 135 and 38 (34% and 9%, respectively), almost 90% of whom had a cheek flap approach. Only 51 patients had an orbital exenteration, including 27 of the 38 (71%) of those who had a TM. Complex repair was employed in a total of 63 patients (16%), most often in those having TM (14 of 38, 37%). Classification of maxillectomy either as LM, SM, or TM is useful and feasible. To define a LM, the portion of the maxilla removed (ie, palate, anterior wall, medial wall) must be specified. For any maxillectomy, the access used should be listed, and the surgeon should indicate whether the maxillectomy has been extended to include adjacent structures.

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Temporary obturator' is necessary for maxillectomy procedures to minimise functional disabilities of speech and the swallowing of food and fluid following surgery. It also provides a base to hold surgical packing and/ or tissue conditioners in place. This packing helps to restore function and counter act contraction during healing of the ,tissues at the operated site. Dental clinicians are often faced with the problem of surgical staffs requesting an obturator for their patients at short notice. This article describes a fast technique of constructing an immediate surgical obturator.

Surgical considerations in malignant neoplasia of nose and paranasal sinuses

Most recurrences of cancers of the nose and paranasal sinuses are attributed to inadequate local control of disease. Since such tumours are usually advanced a standard maxillectomy procedure is inadequate Nevertheless batter local control is obtainable by modifying palatal zygomatic or superior bone cuts (cranifacial resection) or including an appropriate part of the septum in the specimen. This paper describes 78 such cases undergoing surgicad ablation. Uses of CT and modifications of standard surgical techniques adapted for various tumour extensions are described.

Presurgical maxillary prosthesis: an analysis of speech intelligibility

Abstract Studies on speech intelligibility were conducted on six patients undergoing maxillectomy procedures for cancer. Each patient recorded a different word list from the Fairbanks' Test of Phonemic Differentiations for a presurgical and post-surgical speech analysis. Speech improvement as a result of wearing a maxillary prosthesis was measured by the paired comparison technique, and the percentage of improvement in intelligibility was reported.

Presurgical maxillary prosthesis: An analysis of speech intelligibility

Studies on speech intelligibility were conducted on six patients undergoing maxillectomy procedures for cancer. Each patient recorded a different word list from the Fairbanks' Test of Phonemic Differentiations for a presurgical and post-surgical speech analysis. Speech improvement as a result of wearing a maxillary prosthesis was measured by the paired comparison technique, and the percentage of improvement in intelligibility was reported.

Presurgical maxillectomy prosthesis

The use of the presurgical maxillary prosthesis in patients undergoing maxillectomy procedures for cancer greatly decreases the general morbidity connected with the procedure and aids the patient to adjust both physiologically and psychologically following the operation. Excellent speech quality and oral function can be attained almost universally. The historical, surgical, and prosthetic considerations concerning the presurgical maxillary prosthesis have been discussed, and the treatment of a patient is described to demonstrate the surgical and prosthetic principles involved in the management of cancer of the maxilla.