Composite Resection of Tumors of the Rostral Maxilla and Dorsolateral Muzzle Utilizing an Upper Lip-Sparing, Combined Approach in Dogs

Abstract

Tumors of the rostral maxilla that involve both the oral mucosa and the dermis or subdermis of the dorsolateral muzzle provide unique challenges for the oromaxillofacial surgeon. Traditionally described approaches to such lesions may involve an intraoral incision that extends and involves the upper lip to envelope the involved dermis of the dorsolateral muzzle. However, such an approach unnecessarily resects upper lip tissue resulting in a large defect that likely requires advanced skin flaps or grafts for reconstruction. Such flaps are technically challenging and introduce potential for significance postoperative complications. In this article, we provide a detailed description a combined intra- and extraoral approach that allows for composite resection of tumors of the rostral maxilla that also involve the dorsolateral muzzle. The described technique allows for excellent intraoperative visualization and provides a superior cosmetic outcome that minimizes postoperative complications. In addition, we describe our experience utilizing the technique in three clinical cases.

A modified full‐thickness labial/buccal rotational flap reconstruction technique following bilateral rostral maxillectomy and nasal planectomy for resection of maxillary tumors: Technique and results in two dogs

“…Skin‐sparing techniques 21,37 and a combined dorsolateral‐intraoral surgical approach 20,37 have been reported to reduce surgical trauma and wound complications, and facilitate the surgical approach, maxillofacial reconstruction, and cosmesis. We spared the labial/buccal mucosa flaps (full thickness) bilaterally for the reconstruction of the nose and rostral oral cavity based on the preservation of the superior labial artery and vein, and terminal branches of the facial artery and vein, on each side 28 .…”

“…9,15 A distinct subtype known as "histologically low-grade, yet biologically high-grade fibrosarcoma," seen particularly in retrievers, has been recognized widely. 10,13,21 Radiologic evidence of bone involvement was found in 63-78% of the cases with Hi-Lo FSA, 11,15,34 and, based on CT characteristics, a periosteal origin was proposed in a recent study. 13 In line with the literature, both dogs in our case series were retriever breed-related and had a rostral maxillary mass with osteolytic changes on CT.…”

“…Oral FSA is most frequently found in the canine maxilla 9,12,34 with reported similar distribution across the hard palate, and rostral and caudal maxilla 9,15 . A distinct subtype known as “histologically low‐grade, yet biologically high‐grade fibrosarcoma,” seen particularly in retrievers, has been recognized widely 10,13,21 . Radiologic evidence of bone involvement was found in 63–78% of the cases with Hi‐Lo FSA, 11,15,34 and, based on CT characteristics, a periosteal origin was proposed in a recent study 13 .…”

“…Tumor‐free margins are associated with a more favorable prognosis 3,12,14–16 . As such, a combined resection of the nasal planum and rostral maxilla, offering wider surgical margins, 2 has been described 17–23 …”

“…3,12,[14][15][16] As such, a combined resection of the nasal planum and rostral maxilla, offering wider surgical margins, 2 has been described. [17][18][19][20][21][22][23] Wound dehiscence, stenosis of the reconstructed nares, and poor cosmetic outcome are among the main postoperative concerns. 3,4,20,24 Stenosis of the nares is a common complication when utilizing the purse-string technique for nasal reconstruction following the combined resection of the nasal planum and incisive bone, 2 or for radical bilateral rostral maxillectomy.…”