reconstruction post oncologic maxillectomy. ipras

RECONSTRUCTION POST

ONCOLOGIC MAXILLECTOMY

Ricardo Yáñez MD, Francisco J. Loyola MD, Diego Alcocer DDS and Jorge Cornejo M.D

Dr. Sotero del Río HospitalChile

IPRAS 2013

Background

•The midfacial defects

reconstructions for oncologic

resections are a surgical challenge

Mc Carthy C, Cordeiro P et al. Plast. Reconstr. Surg. 2010; 126:1947-59

IPRAS 2013

Background

•The maxillar provide the structural support between skull base and maxillary arches.

•To separate oral and nasal cavities.

•To participate in swallowing, phonation, mastication, vision and aesthetic appearance.

IPRAS 2013

Background•Generally we need to realize the

maxillectomy associated with soft tissue resection.

•This results in different functional impairments

•The maxillary reconstruction going from obturator prosthesis, local flaps to free flaps.Algorithm and Outcomes: 15-year Review of Midface Reconstruction. Plast. Reconstr.

Surg. 2011. In press

IPRAS 2013

Aim

•To present the different

reconstructives alternatives

used after a maxillectomy for

oncologic disease in our

hospital.

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Maxillectomy classification

Type I

Type II

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Maxillectomy classification

Type III A

Type IIIB

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Maxillectomy classification

Type IV

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Method

•Retrospective analysis of all patients that was submitted to a maxillectomy for oncologic disease between 2008 and 2011 in our center

•Medical record review.

•Clinical control

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Method

•Complications

•Perioperative < 30 days after

surgery

•Late > 30 days after surgery

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ResultsPatients

characteristics n=12

Age (median and

range)57 years range 25 - 84 years

Genderfemale : male

8:4

Smoking 8 75%

Alcoholism 5 41.6%

Consultation reason

Bulking/painDental

derivation

57 41.6%

58.4%

TNMStage IV

12 100%

Characteristics of the patients with a maxillectomy for oncologic disease

IPRAS 2013

ResultsPathologic diagnosis

n %

Squamous cell 6 50%

Melanoma 2 16.7%

Sarcoma 2 16.7%

Adenoid cystic carcinoma

1 8.3%

Basal - cell carcinoma

1 8.3%

Porcentual distribution by pathologic diagnosis

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ResultsMaxillectomy Total

Obturator prosthesis

Temporalis muscle flap*

Radial forearm flap**

Latissimus dorsi flap**

I 3 3 - - -

IIA 2 1 - 1 -

IIB 2 - - 2 -

IIIA 4 - 3 - 1

IIIB 1 - - - 1

IV - - - - -

Total 12 4 3 3 2* Local Flap / **Free

flapDistribution by Maxillectomy and realized reconstruction

IPRAS 2013

Maxillar, nasal and palate cancer – Maxillectomy IIA – Obturator prosthesis

Maxillar, nasal and palate cancer – Maxillectomy IIA – Obturator prosthesis

Palate cancer– Maxillectomy IIB – Radial flap

Left Maxillary sinus cancer – Maxillectomy IIB – Radial flap

Maxillary sinus cancer– Maxyllectomy IIIA – Latissimus dorsi flap

Maxillary sinus cancer – Maxillectomy IIIA – Latissimus dorsi flap

Adenid Cystic Cancer of Maxillary sinus - Maxillectomy IIIA - Temporalis flap

Adenid Cystic Cancer of Maxillary sinus - Maxillectomy IIIA - Temporalis flap

Maxillary cancer - Maxillectomy IIIA - Temporalis flap

Basal Cell skin cancer/maxillary compromise - Maxillectomy IIIB - Latissimus dorsi

Results•In all patients we achieve a

satisfactory functional outcome

•Complications

•Aspirative pneumonia in two patients.

•Partial necrosis of latissimus dorsi flap

•venous thrombosis

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Discussion•Is recommended to adjust the

reconstructive choice to

•Maxillectomy realized

•Age

•TNM

•Comorbidities

•Functional outcomes

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Discussion

•The obturator prosthesis can

be reserve for selected

patients with limited palatal

defects.

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Discussion

•The unilateral or bilateral

temporalis muscle flap is

recommended and presents

adequate functional outcome in

patients with advanced disease

and poor prognosis.

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Discussion•The microsurgical reconstruction

is the surgical alternative of

choice, with the best funcional

and aesthetics outcomes in

patients with type II - III - IV

maxillectomies

IPRAS 2013

RECONSTRUCTION POST

ONCOLOGIC MAXILLECTOMY

Ricardo Yáñez MD, Francisco J. Loyola MD, Diego Alcocer DDS and Jorge Cornejo M.D

Dr. Sotero del Río HospitalChile

IPRAS 2013