Microsurgical reconstruction of maxillary defects after limited resections for malignant tumors
Introduction. Partial maxillectomy involves resection of 1 or 2 walls of the upper jaw, usually medial and anterior ones. The main purposes of reconstruction include the formation of an adequate support for the eyeball; isolation of the orbit from the nasal cavity, nasopharynx, and anterior skull ba...
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2021-08-01
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| Series: | Опухоли головы и шеи |
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| author | M. V. Bolotin V. Yu. Sobolevskiy A. A. Akhundov I. M. Gelfand S. V. Sapromadze |
| author_facet | M. V. Bolotin V. Yu. Sobolevskiy A. A. Akhundov I. M. Gelfand S. V. Sapromadze |
| author_sort | M. V. Bolotin |
| collection | DOAJ |
| description | Introduction. Partial maxillectomy involves resection of 1 or 2 walls of the upper jaw, usually medial and anterior ones. The main purposes of reconstruction include the formation of an adequate support for the eyeball; isolation of the orbit from the nasal cavity, nasopharynx, and anterior skull base; normal symmetry; good aesthetic result.Materials and methods. Between 2014 and 2020, we followed up 13 patients. Nine of them (69 %) had combined defects involving the inferior orbital, anterior, and medial walls of the maxilla (class V according to according to the Brown–Shaw classification, 2010), as well as skin on the buccal and zygomatic areas; 1 patient also had lower eyelid affected. Four individuals (31 %) had isolated defects involving the inferior orbital, anterior, and medial walls of the maxilla (class V according to according to the Brown–Shaw classification, 2010). Twelve patients have undergone preoperative 3D-computer simulation. We divided patients into 2 groups according to the size of their defects and resection areas in the anterior wall of the maxillary sinus. Group 1 included 5 patients with partial maxillary defects (involving 25–40 % of the total area), whereas Group 2 comprised 7 patients with limited maxillary defects (involving 25–40 % of the total area).Five patients have undergone reconstructive surgeries with fasciocutaneous flaps, including anterolateral thigh flaps used in 4 individuals (31 %) and thoracodorsal flap used in 1 individual (8 %). Eight patients had their defects repaired using radial fasciocutaneous flaps. The inferior orbital wall was reconstructed using an individual titanium mesh implant.Results. All patients from Group 1 after defect repair with anterolateral thigh flaps and thoracodorsal flaps (4 individuals) had satisfactory aesthetic result. One patient had an unsatisfactory aesthetic result after reconstruction with a radial fasciocutaneous flap due to mesh implant protrusion and formation of an opening in the nasal cavity. The assessment of the eyeball position demonstrated that symmetry was achieved in 4 patients (80 %) after reconstruction using anterolateral thigh flaps (3 patients) and thoracodorsal flap (1 patient). Five patients from Group 2 (72 %) had excellent results, while 2 patients (28 %) had satisfactory results. The assessment of the eyeball position demonstrated that symmetry was achieved in 5 patients (70 %); two participants (28 %) had lower eyelid ectropion.Conclusion. Patients with large maxillary defects (involving 41–60 % of the total area of the anterior wall of the maxillary sinus and the alveolar process of the maxilla) should undergo reconstructive surgeries with fasciocutaneous anterolateral thigh flaps. In case of relatively small defects (involving 25–40 % of the total area of the anterior wall of the maxillary sinus and the alveolar process of the maxilla) the best option is defect repair with radial fasciocutaneous flaps. Such strategy ensures excellent aesthetic and functional results in 75 % of patients. |
| format | Article |
| id | doaj-art-d6807b04fb1546cc94bfbdc7db4c6c2c |
| institution | Kabale University |
| issn | 2222-1468 2411-4634 |
| language | Russian |
| publishDate | 2021-08-01 |
| publisher | ABV-press |
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| series | Опухоли головы и шеи |
| spelling | doaj-art-d6807b04fb1546cc94bfbdc7db4c6c2c2025-08-20T03:37:43ZrusABV-pressОпухоли головы и шеи2222-14682411-46342021-08-01112182410.17650/2222-1468-2021-11-2-18-24441Microsurgical reconstruction of maxillary defects after limited resections for malignant tumorsM. V. Bolotin0V. Yu. Sobolevskiy1A. A. Akhundov2I. M. Gelfand3S. V. Sapromadze4N.N. Blokhin Russian Cancer Research Center, Ministry of Health of RussiaN.N. Blokhin Russian Cancer Research Center, Ministry of Health of RussiaN.N. Blokhin Russian Cancer Research Center, Ministry of Health of RussiaN.N. Blokhin Russian Cancer Research Center, Ministry of Health of RussiaN.N. Blokhin Russian Cancer Research Center, Ministry of Health of RussiaIntroduction. Partial maxillectomy involves resection of 1 or 2 walls of the upper jaw, usually medial and anterior ones. The main purposes of reconstruction include the formation of an adequate support for the eyeball; isolation of the orbit from the nasal cavity, nasopharynx, and anterior skull base; normal symmetry; good aesthetic result.Materials and methods. Between 2014 and 2020, we followed up 13 patients. Nine of them (69 %) had combined defects involving the inferior orbital, anterior, and medial walls of the maxilla (class V according to according to the Brown–Shaw classification, 2010), as well as skin on the buccal and zygomatic areas; 1 patient also had lower eyelid affected. Four individuals (31 %) had isolated defects involving the inferior orbital, anterior, and medial walls of the maxilla (class V according to according to the Brown–Shaw classification, 2010). Twelve patients have undergone preoperative 3D-computer simulation. We divided patients into 2 groups according to the size of their defects and resection areas in the anterior wall of the maxillary sinus. Group 1 included 5 patients with partial maxillary defects (involving 25–40 % of the total area), whereas Group 2 comprised 7 patients with limited maxillary defects (involving 25–40 % of the total area).Five patients have undergone reconstructive surgeries with fasciocutaneous flaps, including anterolateral thigh flaps used in 4 individuals (31 %) and thoracodorsal flap used in 1 individual (8 %). Eight patients had their defects repaired using radial fasciocutaneous flaps. The inferior orbital wall was reconstructed using an individual titanium mesh implant.Results. All patients from Group 1 after defect repair with anterolateral thigh flaps and thoracodorsal flaps (4 individuals) had satisfactory aesthetic result. One patient had an unsatisfactory aesthetic result after reconstruction with a radial fasciocutaneous flap due to mesh implant protrusion and formation of an opening in the nasal cavity. The assessment of the eyeball position demonstrated that symmetry was achieved in 4 patients (80 %) after reconstruction using anterolateral thigh flaps (3 patients) and thoracodorsal flap (1 patient). Five patients from Group 2 (72 %) had excellent results, while 2 patients (28 %) had satisfactory results. The assessment of the eyeball position demonstrated that symmetry was achieved in 5 patients (70 %); two participants (28 %) had lower eyelid ectropion.Conclusion. Patients with large maxillary defects (involving 41–60 % of the total area of the anterior wall of the maxillary sinus and the alveolar process of the maxilla) should undergo reconstructive surgeries with fasciocutaneous anterolateral thigh flaps. In case of relatively small defects (involving 25–40 % of the total area of the anterior wall of the maxillary sinus and the alveolar process of the maxilla) the best option is defect repair with radial fasciocutaneous flaps. Such strategy ensures excellent aesthetic and functional results in 75 % of patients.https://ogsh.abvpress.ru/jour/article/view/642microsurgeryanterolateral thigh flapradial fasciocutaneous flapmaxillary resectiononcologypreoperative computer simulation |
| spellingShingle | M. V. Bolotin V. Yu. Sobolevskiy A. A. Akhundov I. M. Gelfand S. V. Sapromadze Microsurgical reconstruction of maxillary defects after limited resections for malignant tumors Опухоли головы и шеи microsurgery anterolateral thigh flap radial fasciocutaneous flap maxillary resection oncology preoperative computer simulation |
| title | Microsurgical reconstruction of maxillary defects after limited resections for malignant tumors |
| title_full | Microsurgical reconstruction of maxillary defects after limited resections for malignant tumors |
| title_fullStr | Microsurgical reconstruction of maxillary defects after limited resections for malignant tumors |
| title_full_unstemmed | Microsurgical reconstruction of maxillary defects after limited resections for malignant tumors |
| title_short | Microsurgical reconstruction of maxillary defects after limited resections for malignant tumors |
| title_sort | microsurgical reconstruction of maxillary defects after limited resections for malignant tumors |
| topic | microsurgery anterolateral thigh flap radial fasciocutaneous flap maxillary resection oncology preoperative computer simulation |
| url | https://ogsh.abvpress.ru/jour/article/view/642 |
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