• Korean Journal of Head & Neck Oncology
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• v.15 no.1
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• pp.40-45
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• 1999

Objectives: Maxillary cancer is notorious for its poor prognosis because it is usually detected lately and the majority of patients have advanced disease. Especially when the cancer extended to infratemporal fossa or pterygopalatine fossa it is very difficult to remove all the involved structure by conventional maxillectomy. In these cases we have used radical maxillectomy through lateral approach. We tried to figure out the clinical significance of this procedure. Material and Methods: This study retrospectively analyzed 23 patients with squamous cell carcinoma of the maxillary sinus who underwent surgical treatment for cure. Among them 17 patients(group A) were treated with initial surgery and 6 patients(group B) underwent salvage surgery after radiotherpy. Radical maxillectomy was performed in 12 patients and conventional total maxillectomy in 11 patients. Results: In group A, 3 out of 9 total maxillectomy case and none of 8 radical maxillectomy case were recurred. In group B one patient died of postoperative complication and among the other 5 patients only one out of 3 radical maxillectomy was salvaged and 2 total maxillectomy cases were died of intercurrent disease. Conclusion: Wide surgical dissection of pterygopalatine fossa and infratemporal fossa may improve the survival rate in patients with posterior wall invasion of maxillary sinus.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.2
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• pp.143-151
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• 2007

One of the treatment methods for maxillary cancers or infections in maxilla is maxillectomy. Palatal defect can be resulted from this operation and it may cause functional problems with swallowing and speech, and psychological problems of patients. After maxillectomy, as rehabilitation, there can be two options. One is a prosthodontic treatment using obturator and the other is surgical reconstruction of defect with graft. As both methods have advantages and disadvantages, in determining treatment method after maxillectomy, various factors have to be considered. The purpose of this study is to compare the prosthodontic group to surgical group after maxillectomy with elapsed days prior to commencement of postoperative oral feeding, and to analyze the results of prosthodontic treatment and surgical treatment. During the period from March of 2000 to June of 2006, 74 patients were treatment by prosthodontic methods for maxillary defect. Among these patients, patients who had only velopharyngeal deficiency after surgery, whose data were incomplete, whose causes of palatal defect were not the treatment of diseases in maxilla, and who already had palatal defect due to previous surgery were excluded in this study. The patients who underwent maxillectomy for the treatment of diseases in the maxilla and were treated immediately after operation using surgical reconstruction or prosthodontic rehabilitation were included in this study. The records of 43 patients were reviewed to compare and to analyze the prosthodontic treatment and surgical reconstruction after maxillectomy. The median of days elapsed prior to commencement of postoperative oral feeding in the prosthodontic group was compared with data of surgical group. The data was analyzed using the Mann-Whitney test (${\alpha}$=.05). Days elapsed prior to postoperative oral feeding commencement in the prosthodontic group were less than those in the surgical group.

• Korean Journal of Bronchoesophagology
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• v.6 no.1
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• pp.118-126
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• 2000

A radical maxillectomy causes a defect of the alveolar bone, gingiva, palate, and orbital floor and causes cosmetical problems and masticatory and phonatory functions. Defect after a radical maxillectomy was reconstructed with skin or dermis graft was introduced, but recently wide resection of the tumor and functional reconstruction with free flap was introduced by several methods. The defect due to radical maxillectomy was reconstructed with scapula, iliac crest, radius. But reconstruction with a fibular osteocutaneous free flap was rarely introduced to defect of radical maxillectomy. The fibular osteocutaneous free flap was firstly introduced by Taylor. The fibular osteocutaneous free flap has several advantages. We experienced the first case of radical maxillectomy and reconstruction with the fibular osteocutaneous free flap, so we reported that case with literatures. The patient has a right maxillary sinus squamous carcinoma (T2N0M0), and performed a radical maxillectomy with right supraomohyoid neck dissection, and reconstruction with fibular osteocutaneous free flap. Donor site morbidity was little, and phonatory and masticatory function were nearly normalized. And cosmetical result was very acceptable.

• Journal of Dental Rehabilitation and Applied Science
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• v.26 no.1
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• pp.33-38
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• 2010

Maxillectomy is a treatment option for maxillary cancer, which leaves the patient with a palatal defect. It may cause problems with facial deformation, swallowing, mastication, and speech. These functional problems and changes in appearance may result in psychological problems. To control these deficits after maxillectomy, surgical reconstruction or prosthodontic treatment can be chosen as a treatment option. Obturator prosthesis has been used as a preferred method of rehabilitation for most maxillectomy patients. This case is a patient who was classified Aramany classification II hemi-maxillectomy patient with residual teeth from #11-25, whose teeth had substantial labioversion and clinically lengthened from alveolar bone involution, thus making it hard to select proper framework design and resist to the rotational dislodging force of the obturator. Therefore we selected swing-lock attachment design to remain pre-existing crown and bridges and obtain retention and stability of obturator. The swing-lock RPD is economical than the conventional RPD because we can remain pre-existing crown and bridges. And residual teeth which have mobility and poor prognosis can be successfully retained through properly designed swing-lock RPD as it is functioning as a removable splint on the teeth.

• Archives of Craniofacial Surgery
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• v.10 no.1
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• pp.40-43
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• 2009

Purpose: Extensive midface defect following total maxillectomy with orbital exenteration and cheek skin resection should be three dimensionally reconstructed with a large flap that have a sufficient volume of tissue and multiple skin islands. We describe our transverse rectus abdominis myocutaneous(TRAM) free flap with three skin islands which was successfully used in this situation. Methods: A 58-year-old man was performed enbloc total maxillectomy including orbital contents and wide cheek skin because of invasive maxillary squamous cell carcinoma. He was immediately reconstructed with TRAM flap that was designed not vertical but transverse fashion for providing sufficient skin area. Also, deepithelialization procedure making for multiple skin islands was done in flap insetting period when appropriate modification according to the intraoperative situation was possible. Dead space was completely obliterated by bulky muscular tissue, and three skin islands were used for lining of lateral nasal wall, palatal surface, and cheek skin restoration. Results: Postoperative course was satisfying. Maintaining of proper ipsilateral nasal airway, loss of rhinolalia and oronasal regurgitation of food particles, and restoration of cheek contour were successfully obtained. Conclusion: We report clinical experience of threedimensional reconstruction using free TRAM flap after total maxillectomy with orbital exenteration.

• The Journal of Advanced Prosthodontics
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• v.4 no.4
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• pp.248-253
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• 2012

Maxillary obturator prosthesis is the most frequent treatment option for management of partial or total maxillectomy. Heavy weight of the obturators is often a dislocating factor. Hollowing the prosthesis to reduce its weight is the well established fact. The alternate technique to hollow-out the prosthesis has been described in this article which is a variation of previously described processing techniques. A pre-shaped wax-bolus was incorporated inside the flasks during packing of the heat-polymerized acrylic resin to automatically create the hollow space. The processing technique described is a single step flasking procedure to construct a closed-hollow-obturator prosthesis as a single unit. To best understand the technique, this article describes management of a patient who had undergone partial maxillectomy secondary to squamous cell carcinoma rehabilitated with a hollow-obturator prosthesis.

• Korean Journal of Head & Neck Oncology
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• v.22 no.1
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• pp.23-28
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• 2006

Background and Objectives: Maxillectomy is the mainstay of treatment for malignant tumors of the maxillary sinus(MS). Nevertheless, few have been reported on the surgical outcomes of maxillectomy for malignant tumors of MS in Korean literature. Based on our clinical experience, the authors aimed to present the treatment outcomes of maxillectomy for squamous cell carcinomas(SCC) of MS. Subjects and Methods: We reviewed the medical records of 26 cases of maxillectomies with see of MS, who were treated from 1995 to 2004 at Samsung Medical Center. Most patients(73.1%) were locally advanced stage(T3 or T4a) at initial presentation. Total maxillectomy was performed in 18 cases, which is the most frequent procedure(69.2%). We analyzed the treatment outcomes of see of MS and several variables includeing tumor stage and resection margin to identify predictors for treatment failure after maxillectomy. Follow-up duration ranged from 7 to 89 months with a mean of 33 months. Results: Treatment failure occurred in 7 cases(26.9%), among which 3 were salvaged. Three of 26 maxillectomies(11.5%) showed the positive or close(less than 5mm) resection margin in their posterior resection sites; however it did not coincide with the site of recurrence after radiation therapy. Among patients who had been followed up for more than 6 months, disease-free 3 year survival rate was 100.0% in T1 and T2, 76.2% in T3, 60% in T4a, and 69.6% in total. Conclusion: Even though most of see of MS were detected at locally advanced stage, maxillectomy with or without postoperative radiation therapy for resectable MS see(T1-T4a) provided the acceptable treatment outcome(70%, 3Y disease-free survival rate).

• Archives of Plastic Surgery
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• v.32 no.3
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• pp.381-384
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• 2005

Rhabdomyosarcoma is a rare malignancy of head and neck region. When rhabdomyosarcoma occurs in maxillary area, total maxillectomy is necessary. Total maxillectomy causes defects of orbital floor, palate, gingiva, and alveolar bone, causing severe facial deformity and functional impairment. Immediate maxillary reconstruction has to cover both bone and soft tissue to minimize cosmetic and functional problems. The fibular osteocutaneous free flap can provide paranasal, gingiva, oral mucosal lining and foundation for dental prosthesis, thus ensuring good cosmetic results and mastication, phonation function. We have experienced a reconstruction case of a 19-year-old man with rhabdomyosarcoma of the left maxillary sinus. The patient underwent total maxillectomy and neck dissection. We designed a fibular free flap that had a vascularized bone segment and a double skin paddle. Surgical outcomes were excellent in cosmetic and functional aspects.

• Archives of Plastic Surgery
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• v.37 no.5
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• pp.607-612
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• 2010

Purpose: Maxillectomy for malignant tumor resection often leads to functional and aesthetic sequalae. Reconstruction following maxillectomy has been a challenging problem in the field of head and neck cancer surgery. In this article, we described three dimensional midface reconstructions using free flaps and their functional and aesthetic outcomes. Methods: We reconstructed 35 cases of maxillectomy defects using 9 radial forearm free flaps, 7 lattisimus dorsi musculocutaneous free flaps, 6 rectus abdominis musculocutaneous free flaps, 4 fibular osteocutaneous free flaps, and 9 anterolateral thigh free flaps, respectively. We classified post-maxillectomy defects by Brown's classification. 1 Articulation clarity was measured with picture consonant articulation test. Swallowing function was evaluated with the University of Washington quality-of-life Head and Neck questionnaire by 4 steps.2 Aesthetic outcomes were checked to compare preoperative with postoperative full face photographs by 5 medical doctors who did not involve in our operation. Results: The average articulation clarity was 92.4% (100-41.9%). 27 (81.9%) patients were able to eat an unrestricted diet. Aesthetic results were considered excellent in 18 patients (51.4%). Functional results were best in the group reconstructed with fibular osteocutaneous free flap. Considering the range of wide excision, aesthetic results is best in the group reconstructed with anterolateral thigh free flap. Conclusion: The free flap is a useful technique for the reconstruction of the midface leading to good results, both functionally and aesthetically. Especially, because osteocutaneous flap such as fibular osteocutaneous free flap offered bone source for osteointegrated implant, It produces the best functional results. And perforator flap like as anterolateral thigh free flap reliably provides the best aesthetic results, because it provides sufficient volume and has no postoperative volume diminution.

• Korean Journal of Head & Neck Oncology
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• v.13 no.1
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• pp.40-44
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• 1997

Background: Lateral rhinotomy and medial maxillectomy, an en bloc resection of the medial maxillary sinus, ethmoid sinus with the lamina papyracea, medial orbital floor, and lacrimal fossa-duct, have been advocated for lateral nasal wall neoplasms as a standard approach method. Objective: This report was conducted to investigate the clinical efficacy of lateral rhinotomy and medial maxillectomy for lateral nasal wall neoplasms. Materials and Methods: We retrospectively analyzed clinical data of 31 patients who were treated at department of otolaryngology-head and neck surgery, Catholic university of Korea, school of medicine between 1990 and 1996. Results: Twenty five patients had benign lesions(80.6%). By far, the largest percentage was inverted papillomas(80%, 20/25). Of the six malignant lesions(19.4%), 33.3%(2/6) was squamous cell carcinoma and other lesions were metastatic renal cell carcinoma, adecarcinoma, transitional cell cacinoma, and hemangiopericytoma. There were a 4% recurrence for benign tumors(1/25), 5% especially for inverted papilloma(1/20), and 50% for malignant neoplasms(3/6). The overall complication rate was 9.7%. Conclusion: Despite the various approach for treatment of lateral nasal wall neoplasms including inverted papilloma, we continue to advocate a lateral rhinotomy and medial maxillectomy as the treatment of choice.